h 


UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 


SCHOOL  OF  LAW 
LIBRARY 


A   MANUAL 


MEDICAL   JURISPRUDENCE 


BY 

ALFRED  SWAINE  TAYLOR,  M.D.,  F.R.S. 

FELLOW    OF    THE    ROYAL    COLLEGE    OF    PHYSICIANS,    AND    PROFESSOR    OF    MEDICAL 
JURISPRUDENCE   AND  CHEMISTRY  IN    GUY's   HOSPITAL. 


Qui  nescit  ignorare  ignorat  scire. 


SIXTH  AMERICAN  FROM  THE  EIGHTH  AND  REVISED  LONDON  EDITION 

WITH 

NOTES  AND  REFERENCES  TO  AMERICAN  DECISIONS. 
BY 

CLEMENT  B.  PENROSE, 

OF  THE  PHILADELPHIA  BAR. 


PHILADELPHIA: 

n  E  N  E  Y     C.     LEA. 
1866. 


T^\XA- 


Entered  according  to  the  Act  of  Congress,  in  the  year  1866,  by 

HENRY   C.    LEA, 

In  the  Office  of  the  Clerk  of  the  District  Court  of  the  United  States  in  and  for  the 


Eastern  District  of  Pennsylvania. 


PHILADELPHIA : 
COLLINS,  PRINTER,  Too  JiY.N'E  sti:::lt 


3 


AMERICAN  PUBLISHER'S  NOTICE. 


In  preparing  for  the  press  the  present  edition,  it  has  been  thought 
advisable  to  restore  some  portions  of  the  matter  omitted  by  the 
author,  and  also  to  introduce  some  material  from  his  "  Principles 
and  Practice  of  Medical  Jurisprudence,"  thus  rendering  the  volume 
more  complete  for  those  to  whom  his  larger  work  is  not  accessible. 
These  additions  will  be  found  in  the  articles  on  noxious  animal  food, 
trichiniasis,  sexual  malformation,  insanity  as  affecting  civil  responsi- 
bility, suicidal  mania  and  suicide,  and  life  insurance. 

The  notes  of  the  former  American  editor,  Dr.  Hartshorne,  have 
been  retained,  and  will  be  found  inclosed  in  brackets,  distinguished 
by  the  letter  [H.].  Numerous  references  to  American  practice  and 
decisions  have  also  been  introduced  by  the  present  editor,  whose 
notes  are  signed  [P.]. 

Philadelphia,  October,  1866. 


PREFACE 


T.HE  EIGHTH   EDITION 


In  preparing  for  the  press  the  eighth  edition  of  the  Manual  of 
Medical  Jurisprudence,  it  has  been  considered  advisable  to  make 
a  few  changes  in  the  volume.  The  subjects  have  been  reduced  in 
extent  by  the  omission  of  the  details  of  cases,  which  now  find  a 
more  appropriate  place  in  the  large  work  lately  published  under 
the  title  of  The  Principles  and  Practice  of  Medical  Juris- 
prudence. Those  facts  only  are  retained  which  are  likely  to  be  of 
practical  utility  to  students  of  medicine  and  law,  as  well  as  to  junior 
medical  practitioners.  For  the  information  and  guidance  of  medi- 
cal men,  two  chapters  on  evidence  and  the  duties  and  responsibilities 
of  medical  witnesses  have  been  placed  at  the  commencement  of  the 
volume,  and  some  medico-legal  subjects,  not  hitherto  treated  in  the 
previous  editions,  have  been  introduced.  Among  other  changes 
may  be  noticed  the  introduction  of  numerous  engravings  represent- 
ing the  crystalline  forms  of  poisons  and  the  apparatus  used  for 
their  detection.  From  the  additions  thus  made,  it  is  hoped  that  this 
edition  of  the  Manual  will  be  found  a  convenient  guide  to  medico- 
legal practice. 

15  St.  James's  Terrace,  Regent's  Park: 
May,  18(36. 


CONTEXTS. 


MEDICAL  EVIDENCE. 
CHAPTER    I. 


ta<;£ 


The  practice  of  medical  jurisprudence — Medical  and  medico-legal  duties — Dying 
declarations — Inspection  of  bodies  in  death,  from  wounds  or  poisoning — Uses  of 
notes — Medico-legal  reports  .  •  .  .  .  .  .17 

CHAPTER    II. 

Coroners'  inquests — Trial  at  the  assizes — Subpoenas — Examination  in  court — 
Duties  of  medical  witnesses — Rules  for  the  delivery  of  evidence  .  .     36 

CHAPTER    III. 

Causes  of  death — Sudden  death — Syncope,  asphyxia,  coma — Signs  or  indications 
of  death — Cessation  of  circulation  and  respiration — Cooling  of  the  body — 
Cadaveric  rigidity — Putrefaction  .  .  .  .  .  .54 


POISONING. 

CHAPTER    IV. 

Definition  of  the  term  poison — Deadly  poisons — Mechanical  irritants — Influence 
of  habit  and  idiosyncrasy — Classification — Special  characters  of  irritant,  cor- 
rosive, and  neurotic  poisons  .  .  .  .  .  .  .61 

CPIAPTER   V. 

Evidence  of  poisoning  in  the  living  body — Action  of  poisons  increased  or  dimi- 
nished by  disease — Symptoms  connected  with  food  or  medicine — several  per- 
sons attacked  simultaneously — Evidence  from  the  detection  of  poison  in  the 
food  ..........     70 

CHAPTER  VI. 

On  the  evidence  of  poisoning  in  the  dead  body — Period  at  which  poisons  prove 
fatal — Chronic  poisoning — Appearances  produced  by  the  different  classes  of 
poisons — Redness  of  the  mucous  membrane  mistaken  for  inflammation — Ulcera- 
tion and  corrosion — Softening — Perforation  of  the  stomach  from  poison  and  dis- 
ease ..........     78 

CHAPTER  VII. 
Irritant  Poisons. — Sulphuric  acid  or  oil  of  vitriol— Nitric  acid  or  aquafortis — 
Hydrochloric  acid — Symptoms — Appearances  and  analysis         .  .  .90 


Vlll  CONTEXTS. 

CHAPTER  VIII. 

PAGE 

Poisoning  by  vegetable  acids — Oxalic  acid — Symptoms  and  appearances — Chemi- 
cal analysis — Acid  oxalate  of  potash  or  salt  of  sorrel — Tartaric  and  acetic  acids     98 

CHAPTER    IX. 

Poisoning  by  alkalies  and  alkaline  salts — Potash,  soda,  and  ammonia — Nitrate 
and  sulphate  of  potash — Chloride  of  barium    .  ....  104 

CHAPTER   X. 

Phosphorus — Symptoms  and  appearances — Chronic  poisoning — Chemical  analysis  109 

CHAPTER    XI. 

Metallic  Irritants. — Arsenic — Arsenious  acid — Symptoms — Chronic  poisoning — 
Appearances  after  death — Fatal  dose — Chemical  analysis — Arsenites — Arsenic 
acid — Orpimeut  and  other  compounds      .  .  .  .  .  .112 

CHAPTER    XII. 

Poisoning  by  mercury — Corrosive  sublimate — Symptoms — Chronic  poisoning — 
Appearances  after  death — Chemical  analysis— Process  for  mercury  in  organic 
liquids — White  and  red  precipitates — Mercuric  methide  and  other  compounds  128 

CHAPTER   XIII. 

On  poisoning  with  lead — Sugar  of  lead — Symptoms — Appearances  after  death — 
Chemical  analysis — Lead  in  organic  mixtures — Carbonate  or  white  lead — 
Chronic  poisoning — Poisoning  with  copper — Blue  vitriol — Symptoms — Appear- 
ances— Chemical  analysis — Copper  in  organic  liquids     ....   135 

CHAPTER   XIV. 

Tartar  emetic — Symptoms — Appearances — Chronic  poisoning — Chemical  analysis 
— Chloride  or  butter  of  antimony — Poisoning  with  salts  of  zinc  and  iron  .  141 

CHAPTER    XV. 

Vegetable  and  Animal  Irritants. — Vegetable  irritants — Aloes — Savin — Croton 
oil — Colchicum — Hellebore — Animal  irritants — Cantharides — Noxious  animal 
food  ..........  147 

CHAPTER    XVI. 

Necrotic  Poisons. — Opium — Symptoms — Appearances — Its  action  on  infants — 
Poisoning  with  opiate  compounds — Morphia  and  its  salts — Process  for  detect- 
ing opium  in  organic  mixtures      .  ,  .  .  •  •     • 

CHAPTER    XVII. 

Prussic  acid — Symptoms  and  appearances — Tests  for  the  acid — Process  for  organic 
mixtures — Cyanide  of  potassium — Essential  oil  of  bitter  almonds — Nitrobenzole  1 7< ' 

CHAPTER    XVIII. 

Alcohol — Ether  —  Chloroform  —  Camphor — Tobacco — Nicotina — Cocculus  indicus 
— Picrotoxine — Fun^i — Henbane  .  .  .  .  •  .178 


CONTENTS.  IX 

CHAPTER   XIX. 

PAGE 

Nux  vomica — Strychnia — Symptoms  and  appearances — Chemical  and  microscopi- 
cal analysis  of  nux  vomica  aud  strychnia — Process  for  organic  mixtures — 
Brucia        ..........  1S5 

CHAPTER   XX. 

Conium  maculatum — Hemlock — Conia — (Enanthe  crocata — iEthusa  cynapium  — 
Aconite  or  monkshood — Aconitina  ......  193 

CHAPTER   XXI. 

Atropa  belladonna  or  deadly  nightshade — Poisoning  by  atropia — Lobelia — Fox- 
glove— Digitaline — Datura  stramonium  or  thornapple — Daturia  .  .  201 


WOUNDS  AND  PERSONAL  INJURIES. 

CHAPTER    XXII. 

Definition  of  a  wound — Danger  to  life — Grievous  bodily  harm — Examination  of 
wounds — Description  of  wounds — Characters  of  wounds  inflicted  on  the  living 
and  dead  body — Ecchymosis  on  the  living  and  dead — Effects  of  violence  on  the 
dead  body — Ecchymosis  not  always  a  result  of  violence     .  .  .   209 

CHAPTER    XXIII. 

Evidence  of  the  use  of  a  weapon — Characters  of  wounds  caused  by  weapons — In- 
cised, punctured,  lacerated,  and  contused  wounds — Stabs  and  cuts — What  are 
weapons? — Examination  of  the  dress — Imputed  or  self-inflicted  wounds  .  216 

CHAPTER   XXIY. 

Wounds  indicative  of  homicide,  suicide,  or  accident — Evidence  from  the  situation    \ 
of  a  wound — Evidence  from  nature  and  extent — Evidence  from  the  direction  of 
a  wound — Wounds  inflicted  by  the  right  or  left  baud — Several  wounds — Use  of 
several  weapons     .........  225 

CHAPTER   XXV. 

Evidence  from  circumstances — The  position  of  the  body  and  of  the  weapon — Evi- 
dence from  blood,  hair,  and  other  substances  on  weapons — Marks  of  blood  on 
clothing  and  furniture,  on  the  deceased,  and  on  the  assailant     .  .  .  231 

CHAPTER   XXVI. 

Chemical  examination  of  blood-stains — Stains  of  blood  on  linen  and  other  stuffs 
— Age  or  date  of  the  stain — Other  stains  resembling  blood — Blood  on  weapons 
— Arterial  and  venous  blood — Varieties  of  blood — Blood  of  man  and  animals  — 
Microscopical  evidence      ........  238 

CHAPTER    XXVII. 

The  cause  of  death  from  wounds — Wounds  directly  or  indirectly  fatal — Death 
from  hemorrhage — Internal  bleeding — Death  from  mechanical  injury  and  sbock 
— Death  from  numerous  personal  injuries  irrespective  of  any  mortal  wound      .  251 


X  CONTEXTS 

CHAPTER   XXVIII. 

PARE 

Death  of  wounded  persons  from  natural  causes — Distinction  between  real  and 
apparent  cause — Death  from  wounds  or  latent  disease — Accelerating  cause — 
Death  from  wounds  after  long  periods — Avoidable  causes  of  death — Neglect — 
Imprudence — Unskilful  treatment — Unhealthy  state  of  body     .  .  .  258 

CHAPTER    XXIX. 

Wounds  indirectly  fatal — Tetanus  following  wounds — Erysipelas — Delirium  tre- 
mens— Gangrene — Death  from  surgical  operations — Primary  and  secondary 
causes  of  death — Unskilfulness  in  operations — Pyaemia — Medical  responsibility 
in  reference  to  operations — Actions  for  malapraxis  ....  268 

CHAPTER   XXX. 

Wounds  of  the  head — Concussion — How  distinguished  from  intoxication — Effu- 
sion of  blood  as  a  result  of  violence,  disease  or  mental  excitement — Wounds  of 
the  face — Deformity  as  a  consequence  of  wounds  of  the  face — Injuries  to  the 
spine  and  spinal  marrow — Fractures  of  the  vertebra       ....   276 

CHAPTER    XXXI. 

Wounds  of  the  chest — Wounds  and  ruptures  of  the  lungs  and  heart — Wounds  of 
large  bloodvessels — Wounds  and  ruptures  of  the  diaphragm — Direction  of 
wounds  of  the  chest — Wounds  of  the  abdomen — Death  from  blows  on  the 
cavity — Ruptures  of  the  liver,  gall-bladder,  spleen,  kidneys,  intestine-, 
stomach,  and  urinary  bladder — Wounds  of  the  genital  organs   .  .  .  287 

CHAPTER   XXXII. 

Fractures — Produced  by  a  blow  with  a  weapon  or  by  a  fall — Brittleness  of  the 
bones — Fractures  caused  by  slight  muscular  exertion — In  the  living  and  dead 
body — Has  a  bone  ever  been  fractured  ? — Locomotion — Dislocations  from  vio- 
lence or  natural  causes — Medical  opinions — Action  for  malapraxis         .  .  300 

CHAPTER   XXXIII. 

Gunshot  wounds — In  the  living  and  dead  bodv — Was  the  piece  fired  near  or  from 
a  distance? — Accidental,  suicidal,  or  homicidal  wounds — Position  of  the 
wounded  person  when  shot — Wounds  from  small  shot — Wounds  from  wadding 
and  gunpowder      .........  305 

CHAPTER    XXXIV. 

Death  from  burns  and  scalds — Symptoms — Stupor — Cause  of  death — Post-mor- 
tem appearances — Burns  on  the  dead  body — Accident,  homicide,  or  suicide — 
Wounds  caused  by  fire — Scalding — Burns  by  corrosive  liquids  .  .  .  311 


ASPHYXIA. 

CHAPTER   XXXV. 
Disowning. — Cause    of   death — Secondary   causes  —  Post-mortem    appearances — 
Medical  proofs  of  death  from  drowning — Specific  gravity  of  the  body — Coinci- 
dental causes  of  death— Marks  of  violence— Accidental  fractures— Homicidal 
and  suicidal  drowning       ........   319 


CONTEXTS.  XI 

CHAPTER    XXXVI. 

r.Ai;B 
Hanging. — Cause  of  death — Death  from  the  secondary  effects — Post-mortem 
appearances— Mark  of  the  cord  or  ligature—  Was  death  caused  by  hanging  ?— 
Hanging  after  death — Summary  of  medical  evidence — Marks  of  violence  on  the 
hanged — Was  the  hanging  the  result  of  accident,  suicide,  or  homicide  ? — The 
position  of  the  body  .........  337 

CHAPTER   XXXVII. 

Strangulation. — Cause  of  death — Appearance  after  death — Was  death  caused  by 
strangulation,  or  was  the  constriction  applied  to  the  neck  after  death  ? — Marks 
of  violence — Accidental,  homicidal,  and  suicidal  strangulation  .  .  .  354 

CHAPTER   XXXVIII. 

Suffocation. — Suffocation  from  mechanical  causes — Cause  of  death — Appearances 
after  death — Evidence  of  death  from  suffocation — Accidental,  suicidal,  and 
homicidal  suffocation — Smothering  ......  3G9 

CHAPTER    XXXIX. 

Gaseous  poisons — Carbonic  acid — Symptoms — Appearances — Analysis — Effects  of 
charcoal-vapor — Carbonic  oxide — Coal  and  coke  vapor — Sulphurous  acid — 
Vapors  of  lime,  cement,  and  brick-kilns — Confined  air — Coal  gas — Carburetted 
hydrogen — Sulphuretted  hydrogen — Effluvia  of  drains  and  sewers  .  .  380 

CHAPTER   XL. 

Lightning,  Cold,  Heat,  Starvation. — Effects  of  the  electric  fluid — Post-mortem 
appearances — Cold  an  occasional  cause  of  death — Symptoms — Circumstances 
which  accelerate  death — Post-mortem  appearances — Effect  of  heat — Starvation 
a  rare  cause  of  death — Symptoms — Appearances  after  death — Legal  relations  .  402 


PREGNANCY. 

CHAPTER    XLI. 

Signs  of  pregnancy — Suppression  of  the  menses — Quickening — Sounds  of  the 
foetal  heart — Feigned  pregnancy — Concealed  pregnancy — Pregnancy  in  the  dead 
— Impregnation  in  a  state  of  unconsciousness — Legal  relations  .  .  .  418 

CHAPTER    XLII. 

Delivery. — Delivery  in  the  living — Concealed  delivery — Signs  of  abortion  in  the 
early  stages  of  pregnancy — Signs  of  recent  and  remote  delivery — Feigned 
delivery — Delivery  in  a  state  of  unconsciousness — Signs  of  delivery  in  the  dead 
— True  and  false  corpora  lutea — Characters  of  the  ovum  or  embryo — Moles — 
Concealment  of  birth  ........  430 

CHAPTER    XLIII. 

Criminal  Abortion. — Abortion  from  natural  causes — Criminal  causes — Mechanical 
means — Medicinal   substances — Signs    of  abortion — Specific    abortives  —  Local 
applications — Feigned  abortion — Meaning  of  the  word  noxious  as  applied    to 
i — On  inducing  premature  labor — Proof  of  pregnancy  not  necessary — Abor- 
tion of  monsters — Moles  and  hydatids      ......  444 


xii  CONTEXTS. 

INFANTICIDE. 
CHAPTER  -XLIY. 

PAGE 

Nature  of  tlie  crime — Medical  evidence  at  inquests — Uterine  age  or  maturity  of 
the  child — characters  of  the  child  from  the  sixth  to  the  ninth  month — Signs  of 
maturity — Rules  for  inspecting  the  body  .....  466 

CHAPTER    XLY. 

Evidence  of  life  before  respiration — Putrefaction  in  utero — Evidence  of  life  after 
respiration — Color,  volume,  consistency,  and  absolute  weight  of  the  luugs — 
Static  test — Weight  increased  by  respiration       .  .  .  .  .471 

CHAPTER    XLYI. 

The  hydrostatic  test — Sinking  of  the  lungs  from  disease  or  atelectasis — Life  with 
perfect  atelectasis  or  entire  absence  of  air  from  the  lungs — Erroneous  medical 
inference  from  sinking  of  the  lungs — Floating  of  the  lungs  from  putrefaction — 
Effects  of  putrefaction  on  the  lungs  ......  479 

CHAPTER    XLVII. 

Floating  of  the  lungs  from  artificial  inflation — lunation  not  distinguishable  from 
imperfect  respiration — Results  of  compression — Improper  objections  to  the 
hydrostatic  test — Respiration  before  birth — Respiration  a  sign  of  life,  not  of  live 
birth — General  conclusions  .......  485 

CHAPTER    XLYIII. 

On  the  proofs  of  a  child  having  been  born  alive — Evidence  from  respiration — 
Marks  of  violence  and  natural  changes  iu  the  foetal  vessels — The  discovery  of 
food  in  the  stomach — General  conclusions  .....  492 

CHAPTER    XLIX. 

Causes  of  death  in  new-born  children — Proportion  of  children  born  dead — Natural 
causes  of  death — A  protracted  delivery — Debility — Bleeding  from  laceration 
of  the  navel-string — Compression  of  the  navel-string — Malformation — Destruc- 
tion of  monstrous  births — Death  from  congenital  diseases 

CHAPTER  L. 

Violent  causes  of  death — Suffocation — Drowning — Death  of  the  child  from  cold 
and  exposure — Starvation — Death  from  immaturity — Wounds  in  new-born 
children — Fractures  of  the  skull,  accidental  and  criminal — Twisting  of  the  neck 
— Violence  in  self-delivery — Power  of  locomotion  and  exertion  in  females  after 
delivery     .  .  .  .  .  .  .  .  •  .510 

CHAPTER    LI. 

Death  of  the  child  from  strangulation — Strangulation  by  the  navel-string — Acci- 
dental marks  resembling  those  of  strangulation — Constriction  before  and  after 
death — Before  and  after  breathing — Before  and  after  the  severance  of  the  navel- 
string — Examination  of  the  mother  ......    el!2 


CONTEXTS.  Xlll 


LEGITIMACY  OF  OFFSPRING. 
CHAPTER    LII. 

PAGE 

Birth,  Inheritance. — Live  birth  in  civil  cases — Date  of  birth — Signs  of  live  birth 
independently  of  respiration  or  crying — Vagitus  uterinus — Tenancy  by  courtesy 
— Legal  birth — Post-mortem  births — Minority  and  majority — Plural  and  mon- 
strous births  ......  ...  531 

CHAPTER    LIII. 

Legitimacy. — Presumption  of  legitimacy — Natural  period  of  gestation — Duration 
of  pregnancy  from  one  intercourse — Premature  births — Short  periods  of  gesta- 
tion— Viability — Earliest  period  at  which  a  child  may  be  born  living — Evidence 
from  the  state  of  the  child — Protracted  births — A  period  of  gestation  not  fixed 
by  law       ..........  543 

CHAPTER    LIV. 

Paternity. — Disputed  paternity — Parental  likeness — Affiliation  —  Posthumous 
children — Superfcetation  in  relation  to  legitimacy — Supposititious  children — 
Sexual  malformations       ........  560 

CHAPTER    LV. 

Impotenct,  Sterility. — Impotency — Causes — Procreative  power  in  the  male — 
Puberity — Age  for  virility — Virility  of  crypson  bides  and  monorchides — 
Sterility — Procreative  power  in  the  female — Earliest  and  latest  periods  for 
child-bearing — Legal  relations      .......  57S 


RAPE. 
CHAPTER   LVI. 

Sources  of  medical  evidence — Rape  on  infants  and  children — Marks  of  violence 

Purulent  discharges  from  the  vagina — Evidence  from  gonorrhoea  and  syphilis 

— Rape  on  girls  after  puberity — Defloration — Signs  of  virginity  .  .  59(J 

CHAPTER   LVII. 

Rape  on  married  and  adult  women — Circumstances  under  which  it  may  be  per- 
petrated on  adult  women — Loss  of  physical  evidence — Pregnancy  following  rape 
— Microscopical  evidence  •••....   612 


INSANITY. 


CHAPTER   LVIII. 


What  is  insanity  ? — Medical  definitions — Distinctions  of  sane  from  insane  persons 
— Moral  insanity — Legal  definitions — "  Non  compos  mentis" — Symptoms  of  in- 
cipient insanity — Hallucinations  and  illusions — Lucid  intervals  .  .   629 


CONTENTS. 


CHAPTER   LIX, 


Varieties  of  insanity— Mania— Abstinence  from  food— Delusions  regarding  poison 
— Delirium  distinguished  from  mania — Monomania — Dementia — Idiocy.— Imbe- 
cility—Hereditary  transmission— Feigned  insanity — Appearance  after  death — 
Eccentricity  .  .  .  •  •  •  •  •  .  ooj 

CHAPTER   LX. 

Medico-legal  questions  in  relation  to  the  insane— Imposition  of  restraint — Illegal 
imposition  of  restraint — Violence  of  temper — Certificates  of  insanity — Rules  for 
the  discharge  of  lunatics  ........   647 

CHAPTER   LXI. 


658 


Interdiction— Commissions  of  lunacy — Examination  of  alleged  lunatics — Medical 
and  legal  tests  of  competency — Conflict  of  evidence  and  opinion 

CHAPTER   LXII. 

Civil  responsibility — Testamentary  capacity — Wills  made  by  the  insane— Test  of 
capacity — Evidence  of  delusion — Eccentricity     ...... 

CHAPTER   LXIII. 

The  plea  or  defence  of  insanity— Circumstances  under  which  it  is  admissible- 
Homicidal  insanity — Moral  insanity — Symptoms — Legal  tests — Medical  tests — 
Delusion — Tests  of  irresponsibility — Medical  evidence    . 

CHAPTER   LXIV. 

Suicidal  mania — Suicide  not  necessarily  an  indication  of  insanity — Suicide  a 
felony — In  relation  to  life  insurance  —  Hereditary  taint — Puerperal  mania  — 
Pyromania  —  Kleptomania  —  Dipsomania  —  Responsibility  of  drunkards — De- 
lirium tremens — Somnambulism  ...... 


LIFE  INSURANCE. 

CHAPTER  LXV. 

Principles  of  life  insurance — Questions  to  persons  who  insure  their  lives — Medical 
questions — What  diseases  have  and  what  have  not  a  tendency  to  shorten  life  f 
—  Legal  decisions  respecting  the  meaning  of  these  words — Concealment  of  dis- 
eases— What  is  material  concealment  ? — Coucealment  of  habits — What  is  in- 
temperance ? — Proximate  and  remote  effects — Delirium  tremens — Epilepsy — 
Phthisis — Abstinence — Vegetarianism — Opium-eating — Inveterate  smoking — 
Insanity — Voidance  of  policies  by  suicide — Secret  poisoning  of  persons  whose 
lives  are  insured    ......... 


ILLUSTRATIONS 


PIT. 

1  Crystals  of  oxalic  acid 

2  Crystals  of  arsenic  from  sublimation 

3  Metallic  sublimates  of  arsenic 

4  Crystals  of  arsenic  from  solution 

5  Deposits  from  Marsh's  process 

b'  Apparatus  used  for  detecting  arsenic  in  the  tissues 

7  Apparatus  for  Marsh's  process 

8  Deposit  of  metallic  arsenic  by  heat 

9  Flask  used  for  Reinsch's  process 

10  Crystals  of  corrosive  sublimate  by  sublimation 

11  Crystals  of  corrosive  sublimate  by  solution 

12  Sublimate  of  metallic  mercury  in  globules 

13  Sugar  of  lead  crystals  from  a  solution 

14  Crystals  of  tartar  emetic 

15  Tips  of  the  leaves  of  savin    . 
lb'  Trichina  spiralis  in  its  capsule 

17  Trichina  spiralis  in  abdominal  muscles  of  man 

18  Crystals  of  morphia  from  the  hydrochlorate 

19  Crystals  of  cyanide  of  silver 

20  Berry  of  cocculus  indicus 

21  Seeds  of  henbane 

22  Silky  hairs  of  nux  vomica    . 

23  Crystals  of  strychnia 

24  Crystals  of  strychnia  from  sulphate 

25  Crystals  of  chromate  of  strychnia 

26  Crystals  of  sulphate  of  brucia 

27  Seeds  of  hemlock 

28  Seeds  of  (Enanthe  crocata 

29  Seeds  of  iEthusa  cynapium 

30  Root  of  aconite 

31  Root  of  horseradish   . 

32  Seeds  of  aconite 


PAUF. 

100 

115 
115 
117 
118 
120 
122 
122 
123 
131 
131 
132 
136 
143 
148 
157 
157 
168 
172 
182 
1S4 
1S8 
168 
188 
189 
192 
194 
195 
196 
199 
199 
200 


XVI 


LIST    OF    ILLUSTRATIONS. 


na. 

33  Seeds  of  belladonna  . 

34  Seeds  of  lobelia 

35  Seeds  of  foxglove 

36  Seeds  of  stramonium 

37  Crystals  of  daturia    . 
36  Blood-corpuscles  magnified 

39  Corpuscles  of  blood  in  linen  fibre 

40  Human  blood-corpuscles  with  fibrin 

41  Human  blood-corpuscles  dried 

42  Section  of  the  ergot  of  rye    . 

43  Granules  of  wheat-starch  and  of  arrowroot 

44  Oil-globules  of  human  and  cow's  milk 

45  Oil-globules  of  human  milk  and  colostrum 

46  Epithelial  scales         . 

47  Microscopical  appearances  of  meconium 


f.v;e 
203 

a  5 

206 
207 
208 
244 
246 
246 
246 
452 
498 
499 
499 
500 
503 


MEDICAL    JURISPRUDENCE. 


MEDICAL  EVIDENCE. 


CHAPTER  I. 

THE  PRACTICE  OF  MEDICAL  JURISPRUDENCE. — MEDICAL  AND  MEDICO- 
LEGAL DUTIES. — DYING  DECLARATIONS. — INSPECTION  OF  BODIES  IN 
DEATH  FROM  WOUNDS  OR  POISONING.  —  USE  OF  NOTES.  —  MEDICO- 
LEGAL REPORTS. 

Medical  Jurisprudence — or,  as  it  is  sometimes  called,  Forensic, 
Legal,  or  State  Medicine — may  be  defined  to  be  that  science  which 
teaches  the  application  of  every  branch  of  medical  knowledge  to  the 
purposes  of  the  law ;  hence  its  limits  are,  on  the  one  hand,  the  re- 
quirements of  the  law,  and  on  the  other,  the  whole  range  of  medicine. 
Anatomy,  physiology,  medicine,  surgery,  chemistry,  physics,  and 
botany,  lend  their  aid  as  necessity  arises ;  and  in  some  cases  all  these 
branches  of  science  are  required  to  enable  a  court  of  law  to  arrive 
at  a  proper  conclusion  on  a  contested  question  affecting  life  or  pro- 
perty. 

The  purpose  of  this  work  is  to  bring  as  far  as  possible  within  a 
small  compass  those  subjects  which  especially  demand  inquiry,  and 
which  more  particularly  concern  the  duties  of  the  educated  physician 
and  surgeon.  The  definition  above  given  necessarily  implies  that  a 
medical  jurist  should  have  a  theoretical  and  practical  knowledge  of 
all  branches  of  the  profession,  a  large  range  of  experience,  and  the 
rare  power  of  adapting  his  knowledge  and  experience  to  emergen- 
cies. He  should  be  able  to  elucidate  any  difficult  medico-legal  ques- 
tion which  may  arise,  and  be  prepared  at  all  times  to  make  a  cautious 
selection  of  such  medical  facts,  and  a  proper  application  of  such  medi- 
cal principles,  as  may  be  necessary  to  enable  a  judge  to  place  the 
subject  in  an  intelligible  light  before  a  jury,  and  to  enable  a  jury  to 
arrive  at  a  just  conclusion. 

The  variety  of  subjects  of  which  a  medical  jurist  is  required  to  have 
knowledge  may  well  alarm  a  student,  and  lead  him  to  suppose  that, 
as  he  cannot  make  himself  perfectly  acquainted  with  all,  he  may  well 
forego  the  labor  of  preparing  himself  in  any.  But  this  would  be 
taking  an  erroneous  view  of  his  position.  This  description  of  the 
2 


18  DUTIES    OF    PHYSICIANS    AND 

qualifications  necessary  to  constitute  a  normal  witness  in  a  court  of 
law  must  not  deter  him  from  entering  on  the  study.  It  is  assuredly 
beyond  the  mental  power  of  any  individual  that  he  should  be  at  the 
same  time  profoundly  versed  in  all  the  principles  of  medicine  and 
jurisprudence,  and  that  he  should  be  able  to  answer  all  possible  ques- 
tions, and  encounter  and  remove  all  medical  difficulties  that  may 
occur  during  the  trial  of  a  civil  or  criminal  case.  All  that  the  law 
expects  from  a  medical  man  is  a  fair  average  knowledge  not  merely 
of  his  profession,  but  of  that  which  falls  more  peculiarly  under  the 
province  of  a  medical  witness.  There  can  be  no  doubt  that  the  more 
perfectly  a  man  has  made  himself  master  of  his  profession,  the  better 
will  he  be  fitted  to  follow  the  principles  and  apply  himself  to  the 
practice  of  medical  jurisprudence;  but  he  must  divest  himself  of  the 
notion  that  these  principles  can  be  spontaneously  acquired,  or  that 
they  are  necessarily  derived  from  the  study  of  those  isolated  branches 
of  medicine  upon  which  medical  jurisprudence  is  based.  The  mate- 
rials for  the  medical  jurist  undoubtedly  exist  in  these  collateral  sci- 
ences; but  they  require  to  be  assorted,  selected,  and  moulded  into 
shape,  before  they  can  be  applied  to  any  useful  or  practical  purpose. 

The  duties  of  a  medical  jurist  are  distinct  from  those  of  a  physician 
or  surgeon ;  the  latter  looks  only  to  the  treatment  of  disease  or  acci- 
dent and  the  saving  of  life;  but  the  object  of  the  former,  in  a  large 
proportion  of  cases,  is,  whether  in  reference  to  the  living  or  dead,  to 
aid  the  law  in  fixing  on  the  perpetrator  of  a  crime,  or  to  rescue  an 
innocent  person  from  a  falsely  imputed  crime.  Thus  he  may  be 
required  to  determine  whether,  in  a  particular  case,  the  cause  of  death 
is  natural  or  violent;  and  for  this  purpose  it  will  be  necessary  for 
him  to  make  an  entirely  new  application  of  his  professional  know- 
ledge. He  has  now  the  difficult  task  of  making  a  selection  from 
those  parts  of  the  medical  sciences  which  bear  upon  the  legal  proof 
and  development  of  crime. 

Some  members  of  the  profession  have  been  inclined  to  look  upon 
medico-legal  practice  as  an  unnecessary  addition  to  their  ordinary 
duties;  but  there  are  few  who  have  been  long  engaged  in  practice, 
who  have  not  found  themselves  occasionally  placed  in  situations  of 
difficulty  from  the  accidental  occurrence  of  cases  demanding  medico- 
legal investigation.  A  medical  man  is  summoned  to  attend  a  person 
laboring  under  the  effects  of  poison  criminally  administered,  but  at 
the  time  he  may  have  no  knowledge  or  even  suspicion  that  poison  is 
the  cause  of  the  symptoms.  In  spite  of  the  best  treatment,  death 
ensues ;  here  the  functions  of  the  medical  man  end,  and  those  of  a 
medical  witness  begin.  It  is  utterly  impossible  that  he  can  now  avoid 
giving  evidence,  or  shift  the  responsibility  on  another — the  law  will 
insist  upon  his  appearance,  first  in  the  court  of  the  coroner,  and  after- 
wards at  the  Assizes.  It  will  here  be  assumed  that  as  a  registered 
member  of  the  profession  he  is  fully  competent  to  answer  every  ques- 
tion put  to  him  by  judge  and  counsel  relative  to  the  general  effects 
of  poisons ;  the  quantity  required  to  destroy  life;  and  the  time  within 
which  a  poison  may  prove  fatal.  It  may  be  objected  to  his  evidence, 
that  the  deceased  had  died  from  the  effects  of  disease  and  not  from 


SURGEONS    IN    ACTING    AS    WITNESSES.  19 

poison,  in  which  case  the  cross-examination  will  lead  to  a  searching 
inquiry  into  all  those  diseases  which  resemble  poisoning  in  their 
symptoms  and  post-mortem  appearances  as  well  as  the  means  of 
making  a  certain  distinction  between  them ;  and  the  fallacies  to  which 
the  chemical  processes  for  the  detection  of  poison  are  liable.  On 
another  occasion  a  medical  man  may  be  called  to  render  assistance 
to  one  who  has  been  stabbed  in  a  quarrel,  and  who  speedily  dies  from 
the  wound.  The  office  of  the  surgeon  here  ceases,  while  that  of  the 
medical  jurist  commences.  He  must  now  be  prepared  to  answer 
numerous  questions,  all  bearing  upon  the  legal  proof  of  crime,  all 
necessary  in  law,  although  apparently  superfluous  in  surgery.  Thus 
he  may  be  asked  to  state  the  precise  characters  of  a  wound  inflicted 
upon  the  body  of  a  man  soon  after  death ;  and  by  what  means  a  par- 
ticular wound  was  inflicted?  Was  it  homicidal  or  accidental?  The 
amount  of  blood  lost?  Whether  the  person  could  have  moved  or 
performed  any  act  after  receiving  it?  Are  certain  red  spots  found 
upon  his  clothes,  or  upon  a  knife  belonging  to  him,  owing  to  effused 
blood  or  other  causes?  Whether  any,  and  what  statements  were 
made  by  the  dying  man,  and  what  were  the  precise  circumstances 
under  which  they  were  made  ?  It  need  hardly  be  observed  that  ques- 
tions of  this  nature  are  rarely  noticed,  except  in  a  cursory  manner, 
by  professors  of  chemistry  and  surgery,  and  a  medical  man  is  not 
likely  to  acquire  the  means  of  answering  them  by  intuition.  On  the 
other  hand,  regarding  ourselves  as  living  in  a  civilized  state,  in  which 
the  detection  and  punishment  of  crimes  against  life  and  property  are 
indispensable  to  the  security  of  all,  it  is  impossible  to  overrate  their 
importance.  Unless  a  witness  is  able  to  return  answers  to  these 
questions  when  a  public  necessity  occurs,  a  guilty  man  may  escape 
punishment,  while  an  innocent  man  may  be  condemned.  He  may 
thus  most  seriously  injure  his  own  reputation,  for  it  is  certain  that 
his  qualifications  as  a  physician,  surgeon,  or  general  practitioner, 
however  great,  will  not  shield  him  from  general  reprobation. 

Thus,  then,  it  is  obvious  that  the  duties  of  a  medical  jurist  are  of 
a  highly  responsible  nature  and  of  great  importance  to  society,  while 
the  cases  which  call  them  into  exercise  are  of  purely  accidental  occur- 
rence. A  medical  practitioner  who  thinks  himself  secure  in  the  most 
retired  corner  of  the  kingdom,  is  liable  to  find  himself  suddenly  sum- 
moned as  a  witness  on  a  trial,  to  answer  questions  which  perhaps 
during  a  long  period  of  practice  he  had  been  led  to  regard  as  unim- 
portant. Under  the  circumstances  it  is  scarcely  possible  that  he  can 
avoid  exposing  his  deficiencies,  and  the  final  question  will  be,  Have 
you  ever  attended  to  or  thought  of  these  subjects  before?  A  negative 
answer  to  this  question,  while  it  commonly  brings  with  it  public 
censure,  will  in  most  instances  lead  to  the  acquittal  of  the  accused  in 
spite  of  strong  presumptions  of  guilt. 

I  have  endeavored  to  avoid  overdrawing  this  picture;  its  truth 
will,  I  am  sure,  be  felt  and  acknowledged  by  those  who  have  been 
a  few  years  engaged  in  practice.  The  records  of  our  courts  of  law 
contain  many  unfortunate  exposures,  which  might  have  been  easily 
avoided,  had  the  witnesses  only  availed  themselves  of  the  opportu- 


20  MEDICAL    CONTRASTED    WITH 

nities  afforded  to  them  while  students,  of  acquiring  a  knowledge  of 
the  subject;  but  they  had  unreflectingly  acted  on  the  principle,  that 
medical  jurisprudence  was  a  dry,  dull,  and  useless  study,  and  that 
the  practice  of  it  was  remote  and  speculative.  This  feeling  is,  how- 
ever, fast  disappearing.  Those  who  have  been  compelled  by  circum- 
stances to  give  their  attention  to  it,  have  in  subsequent  cases  taken 
care  to  prepare  themselves  for  the  ordeal  through  which  every  medi- 
cal witness  must  pass. 

Some  medical  men  who  have  treated  legal  medicine  with  indiffer- 
ence have  occasionally  ventured  to  act  as  witnesses,  thinking  that 
the  subjects  on  which  they  were  likely  to  be  examined  were  so  little 
known  to  judge  and  counsel,  that  even  hazardous  or  rash  statements 
would  escape  observation :  such  witnesses,  however,  have  often  found 
to  their  cost  that  they  were  laboring  under  a  fatal  delusion.  Vari- 
ous circumstances  have  led,  in  recent  times,  to  the  acquisition  of 
much  medico-legal  knowledge  by  lawyers,  especially  in  relation  to 
questions  connected  with  wounds,  child-murder  and  poisoning,  and 
they  are  not  slow  in  detecting  and  exposing  a  mere  pretender  who 
attempts  to  shelter  himself  by  vague  or  evasive  statements  and  tech- 
nical language.  Another  fact  must  be  borne  in  mind :  there  are  few 
counsel  engaged  in  any  civil  or  criminal  case  of  importance  who  do 
not  take  care  to  fortify  themselves  under  medical  advice,  with  a  full 
knowledge  of  the  views  of  standard  medical  writers  on  the  subject  in 
dispute;  and  with  these  works  before  them,  and  with  their  prover- 
bial acuteness,  he  must  indeed  be  a  clever  witness  who  can  succeed  in 
passing  off  an  erroneous  or  evasive  answer  to  a  medico-legal  question. 

It  is  a  frequent  charge  against  members  of  the  medical  profession 
that  they  are  the  worst  witnesses  on  matters  of  fact  and  opinion.  I 
believe  this  to  be  an  unmerited  censure.  Those  who  are  ready  to 
make  this  charge  overlook  the  number,  complexity  and  difficulty  of 
the  questions  which  are  put  to  medical  men  compared  with  those 
put  to  other  witnesses.  They  also  forget  that  medical  men  are  much 
more  frequently  summoned  as  witnesses  than  the  members  of  the 
two  other  learned  professions.  Their  evidence  obtains  much  greater 
publicity,  and  is  necessarily  exposed  to  a  wider  circle  of  criticism. 
The  fact  is,  that  good  and  bad  witnesses  are  to  be  met  with  in  every 
profession,  and  under  equal  conditions  there  is  no  reason  to  suppose 
that  one  would  furnish  a  greater  number  of  incompetent  witnesses 
than  another.  It  is  certainly  the  fault  of  medical  men  that  they  are 
not  generally  prepared  for  the  questions  which  are  likely  to  arise  in 
a  case  on  which  they  know  they  will  be  required  to  give  evidence. 
This  want  of  preparation  frequently  applies  to  facts  as  well  as  to 
opinions.  Thus,  in  reference  to  a  case  on  which  a  charge  of  murder 
or  manslaughter  may  be  ultimately  founded,  a  medical  man  who  is 
called  in  omits  to  observe  many  circumstances  because  at  the  time 
they  appear  to  him  to  have  little  importance,  although  at  the  subse- 
quent trial  he  may  find,  to  his  dismay,  that  they  actually  become  the 
turning-points  of  innocence  or  guilt.  Medical  observation  as  a  result 
of  professional  habits  is,  on  these  occasions,  in  general  confined  to 
onlv  one  set  qf  ^circumstances — the  recognition  and  treatment  of  aeci- 


MEDICO-LEGAL    OBSERVATION.  21 

dent  or  disease;  but  medico-legal  observation  should  take  a  much 
wider  range  than  this,  and  should  be  directed  to  all  the  surrounding 
facts  and  incidents  of  a  case.  The  essential  difference  in  the  two 
kinds  of  practice  is,  that  circumstances  which  are  of  no  interest  in  a 
medical  or  surgical  point  of  view,  are  often  of  the  greatest  value  and 
importance  in  legal  medicine.  It  is  obvious  that  if  they  are  not 
observed  by  a  medical  witness  when  he  is  first  summoned  to  the 
injured  person  whether  dying  or  dead,  it  will  be  out  of  his  power  to 
meet  many  of  the  questions  which  must  arise  in  the  progress  of  the 
case.  The  non-observance  of  these  facts  is  a  serious  evil,  and  often 
carries  with  it,  although  unjustly,  an  imputation  of  professional 
ignorance. 

The  first  duty,  therefore,  of  a  medical  jurist  is  to  cultivate  a  faculty 
of  minute  observation  of  medical  and  moral  circumstances.  This, 
when  combined  with  a  general  knowledge  of  what  the  law  requires 
as  evidence,  will  enable  him  to  meet  in  a  satisfactory  manner  all  the 
scientific  questions  that  may  be  necessary  for  the  elucidation  of  a 
case.  The  exercise  of  this  faculty  is  by  no  means  inconsistent  with 
the  performance  of  his  duties  as  a  surgeon.  A  learned  judge  on  one 
occasion  remarked  that  "a  medical  man,  when  he  sees  a  dead  body, 
should  notice  every  thin;/. "  Undoubtedly  he  should  observe  everything 
which  could  throw  a  light  upon  the  production  of  wounds  or  other 
injuries  found  upon  it.  It  should  not  be  left  to  policemen  to  say 
whether  there  were  any  marks  of  blood  on  the  dress  or  on  the  hands 
of  the  deceased,  or  on  the  furniture  in  the  room.  The  dress  of  the 
deceased  as  well  as  the  body  should  be  always  closely  examined  on 
the  spot  by  the  medical  man. 

It  may  stimulate  the  attention  of  a  medical  practitioner  in  refer- 
ence to  these  inquiries  if  he  is  informed  that  the  great  art  of  counsel 
who  defend  persons  charged  with  murder  or  manslaughter,  consists 
in  endeavoring  to  discover  what  he  omitted  to  do.  Although  some- 
times the  omission  may  be  really  of  no  medical  importance  whatever, 
yet  it  is  usually  placed  before  the  jury  in  such  a  strong  light  that 
the  accused  obtains  the  benefit  of  a  doubt.  The  omission  may  be 
attributed  to  professional  ignorance,  or,  what  is  worse,  to  professional 
bias — a  determination  to  find  proofs  of  guilt  against  the  "  unhappy 
prisoner  at  the  bar" — when  the  facts  might  be  innocently  explained 
by  a  want  of  experience  on  the  part  of  the  witness  in  dealing  with 
cases  of  this  nature. 

If  we  except  medical  experts,  who  are  selected  according  to  their 
experience  in  different  branches  of  the  profession,  medical  men  have 
no  option  respecting  medico-legal  practice;  for  the  cases  which  give 
rise  to  medico-legal  questions  are  always  more  or  less  connected  with 
the  practice  of  medicine  and  surgery. 

Thus  before  any  inquiry  is  instituted  by  a  magistrate  or  coroner, 
and  before  any  suspicious  circumstances  have  come  to  light,  a  medical 
man  may  be  summoned  to  a  person  dying  from  the  effects  of  a 
wound,  or  from  the  secret  administration  of  poison.  The  dying 
person  may  make  to  him  a  declaration  or  statement  as  to  the  cir- 
cumstances under  which  the   wound  was  inflicted   or   the   poison 


22      RULES  FOR  OBSERVING   ALLEGED  CASES  OF   POISONING. 

administered :  lie  may  also  mention  the  names  of  the  person  or 
persons  concerned  in  the  assault  or  the  administration.  This  dying 
</'  claraiion  or  statement,  according  to  the  circumstances  under  which 
it  is  made,  may  become  of  material  importance  in  the  prosecution  of 
a  party  charged  with  murder  or  manslaughter.  It  is  therefore  proper 
that  a  practitioner  should  observe  and  make  notes  of  the  exact  condi- 
tion of  the  patient ;  whether,  when  he  makes  the  statement,  he  is 
under  the  conviction  or  belief  that  he  is  dying.  It  has  been  thought 
that  it  was  also  necessary  to  prove  that  the  wounded  man  had  lost 
all  hope  of  recovery :  but  as  a  learned  judge  has  justly  remarked, 
it  is  very  difficult,  if  not  impossible,  to  say  on  these  occasions,  when, 
if  ever,  the  feeling  of  hope  completely  deserts  a  man.  It  is  sufficient 
for  all  legal  purposes,  if  he  expresses  his  belief  that  he  is  dying. 

Hence,  when  the  case  is  likely  to  prove  fatal,  it  is  the  duty  of  the 
medical  man  to  warn  the  patient  in  the  presence  of  his  relatives  or 
friends,  of  his  dangerous  condition.  If  the  wound  or  poison  is  not 
likely  to  prove  rapidly  fatal,  the  attendance  of  a  magistrate  to  take 
down  the  statement  in  due  legal  form,  would  relieve  the  medical 
man  of  all  responsibility.  Should  any  statement,  however,  be  made 
to  him  under  these  circumstances,  it  is  his  duty  to  make,  on  the  spot, 
a  note  of  the  words  actually  used.  There  should  be  no  paraphrase 
or  translation  of  them,  but  they  should  be  the  ipsissima  verba  of  the 
dying  man.  It  is  not  for  the  witness,  but  for  the  court,  to  interpret 
what  is  thus  stated.  A  medical  man  on  these  occasions  should  not 
render  himself  officious  in  extracting  information.  He  may  receive 
that  which  is  voluntarily  uttered,  and,  either  immediately  or  on  the 
earliest  possible  opportunity,  write  down  the  statement  as  it  was 
made.  Any  question  should  be  simply  confined  to  the  purpose  of 
explaining  what  may  appear  to  him  to  be  ambiguous  or  contradictory 
in  the  declaration  itself. 

In  reference  to  persons  who  have  died  from  the  effects  of  wounds, 
poison  or  other  violent  causes,  the  initiatory  proceedings  connected 
with  the  inquiry  usually  take  place  in  the  court  of  the  coroner ;  and 
unless  the  medical  man  in  attendance  is  supposed  to  be  implicated 
by  maltreatment  or  otherwise  in  the  death  of  the  person,  the  duty  of 
making  an  examination  of  the  dead  body  devolves  upon  him.  He 
may  not  have  seen  the  person  while  living ;  and  in  this  case  it  will 
be  necessary  that  he  should  give  his  attention  to  those  circumstances 
which  may  be  of  importance  in  the  future  inquiry.  He  should  note 
as  far  as  it  can  be  ascertained  1.  The  exact  time  of  death,  if  known, 
and  thus  determine  how  long  a  period  the  person  has  survived.  2. 
The  attitude,  position  and  condition  of  the  body.  3.  The  state  of  the 
dress.  4.  All  surrounding  objects.  Any  bottles,  paper-packets,  wea- 
pons, or  spilled  liquids  lying  about  should  be  collected  and  preserved 
and  their  position  with  regard  to  the  body  of  deceased  should  be 
noted.  5.  Any  vomited  matters  near  the  deceased  should  be  col- 
lected. In  making  a  post-mortem  examination  of  the  body  the  follow- 
ing additional  points  should  be  attended  to.  6.  The  external  appear- 
ance of  the  body,  whether  the  surface  is  livid  or  pallid.  7.  Note  the 
state  of  the  countenance.     8.  Note  all  marks  of  violence  on  the  per- 


RULES  FOR  OBSERVING  ALLEGED  CASES  OF  POISONING.      23 

son,  or  discomposure  of  the  dress,  marks  of  blood,  &c.    9.  The  situa- 
tion, form  and  direction  of  all  wounds  should  be  accurately  noticed. 
10.  The  presence  or  absence  of  warmth  or  coldness  in  the  legs,  arms, 
abdomen,  mouth,  or  arm-pits.    11.  The  presence  of  cadaveric  rigidity 
in  any  part  of  the  body.    To  give  any  value  to  the  two  last-mentioned 
characters,  it  is  necessary  for  the  practitioner  to  observe  the  nature 
of  the  floor  on  which  the  body  is  lying,  whether  the  body  is  clothed 
or  naked,  young  or  old,  fat  or  emaciated.     These  conditions  create  a 
difference,  in  respect  to  the  cooling  of  the  body  and  the  access  of 
rigidity.    12.  If  found  dead — When  was  the  deceased  last  seen  living, 
or  known  to  have  been  alive?     13.  Note  all  circumstances  leading 
to  a  suspicion  of  suicide  or  murder.     14.  The  time  after  death  at 
which  the  inspection  is  made.     15.  Observe  the  state  of  the  abdomi- 
nal viscera.     If  the  stomach  and  intestines  are  found  inflamed,  the 
seat  of  inflammation  should  be  exactly  specified ;  also  all  marks  of 
softening,  ulceration,  effusion    of  blood,  corrosion,   or    perforation. 
The  stomach  should  be  removed  and  placed  in  a  separate  vessel,  liga- 
tures being  applied  to  the  two  ends.     If  cut  open  for  examination  at 
this  period,  this  should  be  performed  in  a  clean  dish,  and  with  such 
care  that  none  of  the  contents  are  lost  or  are  allowed  to  mix  with  the 
contents  of  the  intestines.     16.  The  contents  of  the  stomach,  if  this 
organ  is  opened  during  the  inspection,  should  be  collected  in  a  clean 
graduated  vessel :  notice  a,  the  quantity ;  b,  the  odor  tried  by  several 
persons;  c,  the  color;  d,  acid  or  alkaline  reaction;  e,  presence  of 
blood,  mucus,  or  bile ;  /,  presence  of  undigested  food ;  and  here  it 
may  be  as  well  to  observe,  that  the  presence  of  farinaceous  matters 
(bread)  would  be  indicated  by  the  addition  of  iodine  water,  if  the 
contents  were  not  alkaline — of  fat,  by  heat ;  g,  other  special  charac- 
ters.    17.  The  contents  of  the  duodenum  should  be  separately  col- 
lected, ligatures  being  applied  to  it.     18.  Observe  the  state  of  the 
large  intestines,  especially  the  rectum,  and  note  the  condition  of  their 
contents.      The  discovery  of  hardened  feces  in  the  rectum  would 
prove  that  purging  had  not  existed  recently  before  death.     19.  The 
state  of  the  windpipe,  throat,  and  gullet,  whether  there  are  in  these 
parts  any  foreign  substances,  or  marks  of  inflammation  and  corrosion. 
This  is  of  essential  importance,  as  it  throws  a  light  upon  a  variety  of 
questions  which  may  arise  respecting  death  by  suffocation   from 
mechanical  causes,  or  the  nature  of  a  substance  swallowed.     20.  The 
state  of  the  lungs  and  heart;  all  morbid  changes  noted.     21.  The 
state  of  the  brain  and  spinal  marrow.     22.  The  condition  of  the  ute- 
rus, ovaries,  and   genital  organs  should  be  examined,   as,   in   the 
female,  poison  has  been  sometimes  introduced  into  the  system  by  the 
vagina,  or  wounds  have  been  inflicted  internally.    23.  The  liver  with 
the  gall-bladder  should  be  removed  for  a  chemical  examination.    24. 
The  urinary  bladder,  with  any  fluid  contained  in  it,  should  be  removed 
and  placed  in  a  separate  jar. 

Such  are  the  points  to  which,  in  the  greater  number  of  cases  of 
violent  death  a  medical  jurist  should  give  his  attention.  By  means 
of  these  data,  noted  according  to  the  particular  case  to  which  they 
are  adapted,  he  will  in  general  be  enabled,  without  difficulty,  to 


24  INSPECTION    OF    EXHUMED    BODIES. 

determine  the  probable  time  of  death,  and  the  actual  means  by  which 
death  was  brought  about.  He  may  thereby  have  it  in  his  power,  if 
the  case  be  one  of  poisoning,  to  point  out  the  dish  or  article  of  food 
which  had  contained  the  poison,  and  to  throw  light  upon  any  dis- 
puted question  of  suicide  or  murder  in  relation  to  the  deceased. 
Many  cases  of  death  from  wounds  or  poison  are  rendered  obscure, 
owing  to  these  points  not  having  been  attended  to  in  the  first 
instance. 

It  is  not  necessary  in  this  place  to  enter  into  any  details  respecting 
the  mode  of  performing  an  inspection.  This  the  practitioner  will 
have  acquired  during  his  study  of  anatomy,  and  any  additional 
information  required,  will  be  found  in  the  appropriate  sections  of  this 
work.  The  only  essential  points  in  addition  to  those  above  men- 
tioned are,  1.  To  examine  all  the  important  organs  for  marks  of 
natural  disease;  and  2.  To  note  down  any  unusual  pathological 
appearances,  or  abnormal  deviations;  although  they  may  at  the  time 
appear  to  have  no  bearing  on  the  cause  of  death.  It  is  useful  to 
bear  in  mind  on  these  occasions,  that  the  body  is  inspected,  not 
merely  to  show  that  the  person  has  died  from  poison,  but  to  prove 
that  he  has  not  died  from  any  natural  cause.  Medical  practitioners 
commonly  give  their  attention  exclusively  to  the  first  point;  while 
lawyers,  who  defend  accused  parties,  very  properly  direct  a  most 
searching  examination  to  the  last-mentioned  point,  i.e.  the  healthy 
or  unhealthy  state  of  those  organs  which  are  essential  to  life.  The 
usual  causes  of  sudden  death  have  their  seats  commonly  in  the  brain, 
the  heart  and  its  great  vessels,  or  in  the  lungs.  Marks  of  effusion  of 
blood,  congestion,  inflammation,  suppuration,  or  a  diseased  condition 
of  the  valves  of  the  heart,  should  be  sought  for  and  accurately  noted. 
It  has  also  been  recommended  that  an  examination  of  the  spinal 
marrow  should  be  made.  If  the  cause  of  death  be  obscure  after  the 
general  examination  of  the  body,  there  is  good  reason  for  inspecting 
the  condition  of  this  organ. 

Exhumation  of  Bodies.  —  Sometimes  the  inspection  of  a  body  is 
required  to  be  made  long  after  interment.  So  long  as  the  coffin 
remains  entire,  there  may  be  the  expectation  of  discovering  certain 
kinds  of  mineral  poison  in  the  organs ;  but  decomposition  may  have 
advanced  so  far  as  to  destroy  all  pathological  evidence.  The  inspec- 
tion in  such  cases  is  commonly  confined  to  the  abdominal  viscera. 
The  stomach  is  often  found  so  thin  and  collapsed,  that  the  anterior 
and  posterior  walls  appear  to  form  only  one  coat.  This  organ  should 
be  removed  with  the  duodenum,  and  ligatures  should  be  applied  to 
each.  The  liver  and  the  spleen  should  a]  so  be  removed,  in  order  that 
they  may,  if  necessary,  be  separately  analyzed.  If  poison  is  not 
found  in  one  or  more  of  these  parts,  it  is  not  likely  that  it  will  be 
discovered  in  the  body.  It  has  been  recommended  that  a  portion  of 
earth  immediately  above  and  below  the  coffm  should  be  removed  for 
analysis,  as  it  may  contain  arsenic ;  but  this  appears  to  me  to  be  an 
unnecessary  piece  of  refinement  when  the  coffin  is  entire,  or  when 
the  abdominal  parietes  still  cover  the  viscera.  If  decomposition  has 
so  far  advanced  as  to  have  led  to  an  admixture  of  earth  with  the  vis- 


IDENTITY    OF    ARTICLES    FOR    ANALYSIS.  25 

cera,  and  the  poison  is  found  in  minute  quantity  in  the  tissues  only, 
the  source  of  the  poison  may  be  regarded  as  doubtful.  The  body  of 
a  deceased  person,  when  exhumed,  should  be  identified  by  some 
friend  or  relative,  in  the  presence  of  the  medical  examiner.  In  one 
case  of  murder  by  poison,  the  evidence  almost  failed,  owing  to  this 
precaution  not  having  been  taken. 

It  is  important  that  the  viscera  taken  from  a  body  which  has  been 
long  in  the  grave  should  be  sealed  up  immediately.  They  should 
not  be  allowed  to  come  in  contact  with  any  metal,  nor  with  any  sur- 
face except  that  of  clean  glass,  porcelain,  or  wood.  It  has  been 
recommended  that  they  should  be  washed  with  chloride  of  lime,  or 
placed  in  alcohol;  but  this  is  decidedly  improper:  the  use  of  any 
preservative  chemical  liquid  would  not  only  embarrass  the  future 
analysis,  but  would  render  a  special  examination  of  an  unused  por- 
tion of  the  liquid  necessary,  the  identity  of  which  would  have  to  be 
unequivocally  established.  Preservation  from  air  in  clean  glass  ves- 
sels, with  weil-fitted  corks,  covered  with  skin,  or,  what  is  still  better, 
sheet-caoutchouc,  is  all  that  is  required  in  practice. 

Identity  of  Substances. — It  is  necessary  to  observe,  that  all  legal 
authorities  rigorously  insist  upon  proof  being  adduced  of  the  identity 
of  the  vomited  matters  or  other  liquids  taken  from  the  body  of  a 
deceased  person,  when  poisoning  is  suspected.  Supposing  that, 
during  the  examination,  the  stomach  and  viscera  are  removed  from 
the  body,  they  should  never  be  placed  on  any  surface,  or  in  any  ves- 
sel, until  we  have  first  ascertained  that  the  surface  or  vessel  is  per- 
fectly clean.  If  this  point  be  not  attended  to,  it  will  be  in  the  power 
of  counsel  for  the  defence  to  raise  a  doubt  in  the  minds  of  the  jury, 
whether  the  poisonous  substance  might  not  have  been  accidentally 
present  in  the  vessel  used.  This  may  be  regarded  as  a  very  remote 
presumption;  but,  nevertheless,  it  is  upon  technical  objections  of 
this  kind  that  acquittals  follow  in  spite  of  the  strongest  presumptions 
of  guilt.  This  is  a  question  for  which  every  medical  witness  should 
be  prepared,  whether  he  is  giving  his  evidence  at  a  coroner's  inquest, 
or  in  a  court  of  law.  Many  might  feel  disposed  to  regard  matters  of 
this  kind  as  involving  unnecessary  nicety  and  care,  but  if  they  are 
neglected  it  is  possible  that  a  case  may  be  at  once  stopped:  so  that 
the  care  subsequently  bestowed  upon  a  chemical  analysis  will  be 
labor  thrown  away.  Evidence  of  the  presence  of  poison  in  the  con- 
tents of  a  stomach  was  once  rejected  at  a  trial  for  murder,  because 
they  had  been  hastily  thrown  into  a  jar  borrowed  from  a  neighbor- 
ing grocer's  shop ;  and  it  could  not  be  satisfactorily  proved  that  the 
jar  was  clean  and  entirely  free  from  traces  of  poison  (in  which  the 
grocer  dealt)  when  used  for  this  purpose.  When  the  life  of  a  human 
being  is  at  stake,  as  in  a  charge  of  murder  by  poisoning,  the  slightest 
doubt  is  always  very  properly  interpreted  in  favor  of  the  accused. 

Not  only  must  clean  vessels  be  used  for  receiving  any  liquid 
destined  for  subsequent  chemical  analysis,  but  care  must  be  taken 
that  the  identity  of  a  substance  is  preserved,  or  the  most  correct  ana- 
lysis, afterwards  made,  will  be  inadmissible  as  evidence.  The  sus- 
pected substance,  when  once  placed  in  the  hands  of  a  medical  man, 


26  IDENTITY    OF    ARTICLES    FOR    ANALYSIS. 

should  never  be  let  out  of  his  sight  or  custody.  It  should  be  kept 
sealed  under  his  private  seal,  and  locked  up  while  in  his  possession, 
in  a  closet  to  which  no  other  person  has  a  key.  If  he  has  once  let  it 
out  of  his  hands,  and  allowed  it  to  pass  through  the  hands  of  several 
other  persons,  then  he  complicates  the  evidence  for  the  prosecution,  by 
rendering  it  indispensable  for  these  persons  to  state  under  what  cir- 
cumstances it  was  placed  while  in  their  possession.  The  exposure  of 
a  suspected  substance  on  a  table,  or  in  a  closet  or  room,  to  which  many 
have  access,  may  be  fatal  to  its  identity ;  for  the  chemical  evidence, 
so  important  in  a  criminal  investigation,  will  probably  be  altogether 
rejected  by  the  court.  When  any  article  {e.g. a  stomach  or  other 
organ)  is  reserved  for  analysis,  care  should  be  taken  to  attach  imme- 
diately to  it,  or  to  the  vessel  containing  it,  a  parchment  or  wooden 
label,  upon  which  is  plainly  written,  in  ink,  the  name  of  the  deceased 
and  the  date  of  removal,  including  the  day  of  the  week  and  month. 
This  is  especially  necessary  when  there  are  two  or  more  articles  for 
analysis.  I  have  known  the  greatest  inconvenience  to  result  from 
the  neglect  of  this  simple  precaution. 

Preserving  Articles  for  Analysis. — In  removing  viscera  or  liquids 
from  the  body,  and  reserving  them  for  analysis,  it  is  necessary  to 
observe  certain  precautions.  A  clean  vessel  with  a  wide  mouth 
should  be  selected ;  it  should  be  only  sufficiently  large  to  hold  the 
organ  or  liquid  (the  less  air  remaining  in  it  the  better);  it  should  be 
secured  by  a  closely-fitting  cork,  covered  with  fine  skin  or  bladder. 
Another  piece  of  skin  should  then  be  tied  over  the  mouth,  or,  for 
this,  sheet  caoutchouc  or  gutta-percha  may  be  substituted  with  advan- 
tage. It  should  lastly  be  covered  with  tinfoil  and  a  layer  of  white 
leather.  In  this  way  any  loss  by  evaporation  or  decomposition  is 
prevented,  and  the  viscera  may  be  preserved  (in  a  cool  place)  for  some 
time.  If  the  mouth  of  the  vessel  be  too  wide  for  a  cork,  the  other 
articles  cannot  be  dispensed  with.  Paper  only  should  not  be  used ; 
I  have  known  the  appearances  after  death  of  the  viscera  of  an  infant, 
suspected  to  have  died  from  poison,  entirely  destroyed  by  drying, 
from  the  evaporation  which  took  place  through  the  layers  of  paper 
with  which  the  vessel  in  which  they  were  contained  was  covered. 
The  practitioner  should  bear  in  mind  that  all  these  matters  are  likely 
to  come  out  in  evidence ;  and  whatever  is  worth  doing  at  all  is  worth 
doing  well.  For  reasons  already  stated,  antiseptic  chemical  com- 
pounds should  not  be  used.  The  addition  of  a  small  quantity  of 
chloroform  to  the  viscera  will,  without  complicating  the  analysis, 
tend  to  preserve  them. 

The  articles  used  for  the  preservation  of  viscera  should  be  in  all 
cases  scrupulously  examined.  Some  kinds  of  calico  are  dressed  with 
arsenic  and  starch  paste,  and  many  kinds  of  wrapping-paper  as  well 
as  wall-papers  are  strongly  impregnated  with  this  poison.  An  ob- 
servation made  by  Mr.  Aickin,  of  Belfast,  shows  that  this  is  not  an 
unnecessary  caution.  This  gentleman  was  engaged  in  examining  the 
body  of  a  child,  in  order  to  determine  the  cause  of  death.  The  organs 
were  healthy,  and  as  no  sufficient  cause  presented  itself,  he  removed 
the  stomach,  with  a  view  of  making  an  analysis  of  its  contents.     He 


FALLACIES    IN    REFERENCE    TO    CHEMICAL    ANALYSIS.      27 

was  suddenly  called  away ;  and,  to  preserve  the  stomach,  he  wrapped 
it  in  a  piece  of  paper  (used  for  papering  rooms),  placing  it  on  the 
nncolored  side,  and  he  locked  it  in  a  closet  until  the  following  day. 
Assisted  by  a  friend,  he  then  analyzed  the  contents,  and  found  a  trace 
of  morphia  with  a  pretty  large  quantity  of  arsenic.  As  the  symp- 
toms from  which  the  child  had  died  were  not  those  of  poisoning  with 
arsenic,  and  there  were  no  appearances  of  the  action  of  this  substance 
on  the  body,  he  came  to  the  conclusion  that  its  presence  must  have 
been  owing  to  some  extraneous  cause.  He  examined  a  portion  of 
the  wall-paper  in  which  the  stomach  had  been  wrapped,  and  then 
found  that  that  part  of  it  which  was  colored  yellow  was  tinted  with 
sulphide  of  arsenic  or  orpiment !  It  was  therefore  evident,  as  orpi 
ment  contains  white  arsenic,  that  the  stomach  and  its  contents  had 
imbibed  a  portion  of  the  poison  during  the  night.  ("Lancet,"  June 
23,  1855,  p.  632.)  This  satisfactorily  accounted  for  the  presence  of 
arsenic  under  circumstances  which  might  have  given  rise  to  a  false 
charge  of  murder.  Nearly  all  wall-papers  having  any  tinge  of  green 
or  golden  yellow  in  them,  contain  arsenic,  and  this  arsenic  spreads 
by  imbibition  to  other  parts  of  the  paper  not  so  tinted.  It  would,  of 
course,  be  proper  to  avoid  in  all  cases  the  use  of  any  wrapper  having 
upon  it  mineral  colors  of  any  description.  Mr.  Aickin's  case  shows 
in  a  striking  point  of  view  the  danger  of  trusting  to  chemical  analysis 
alone.  Unless  we  look  to  physiology  and  pathology,  a  most  erroneous 
opinion  may  be  expressed. 

The  results  of  an  analysis,  in  the  shape  of  sublimates  or  precipi- 
tates, should  be  preserved  as  evidence,  distinctly  labelled  in  small 
glass  tubes,  hermetically  sealed.  They  can  then,  if  asked  for,  be 
produced  for  examination  at  the  inquest  or  trial. 

On  the  Use  of  Notes. — It  has  already  been  recommended,  as  a  rule 
in  these  criminal  investigations,  that  a  practitioner  should  make  notes 
of  what  he  observes  in  regard  to  symptoms,  appearances  after  death, 
and  the  results  of  a  chemical  analysis.  His  own  observations  should 
be  kept  distinct  from  observation  given  him  by  others.  He  may 
base  his  conclusions  on  the  former,  but  not  on  the  latter.  From  the 
common  forms  of  law  in  this  country,  a  person  charged  with  the 
crime  of  poisoning  may  remain  imprisoned,  if  at  a  distance  from  the 
metropolis,  for  some  months  before  he  is  brought  to  trial.  It  is 
obvious,  however  clear  the  circumstances  may  at  the  time  appear 
to  a  practitioner,  that  it  will  require  more  than  ordinary  powers  of 
memory  to  retain,  for  so  long  a  period,  a  distinct  recollection  of  all 
the  facts  of  the  case.  If  he  is  unprovided  with  notes,  and  his  memory 
is  defective,  then  the  case  will  turn  in  favor  of  the  prisoner,  for  he 
will  be  the  person  to  benefit  by  the  neglect  of  the  witness.  In  adopt- 
ing the  plan  here  recommended,  such  a  result  may  be  easily  prevented. 
It  may  be  remarked  that  the  law  relative  to  the  admissibility  of  notes 
or  memoranda  is  very  strict,  and  in  trials  for  murder  is  rigorously 
enforced  by  the  judges.  In  order  to  render  such  notes  or  memoranda 
admissible,  it  is  indispensably  necessary  that  they  should  be  taken 
on  the  spot  at  the  time  the  observations  are  made,  or  as  soon  after- 
wards as  practicable ;  and,  further,  it  must  be  remembered  that  a 


28  USE    OF    NOTES    IN    EVIDENCE. 

witness  can  refer  to  them  only  to  refresh  his  memory.  If  from  indis- 
tinctness of  writing  or  other  causes,  a  copy  of  the  notes  has  been 
subsequently  made,  a  witness  should  not  destroy  the  original  notes, 
but  have  them  ready  for  production.  [See  on  this  subject  Green- 
leaf's  Evidence,  vol.  i.  §§  436— i39.  Also,  Alison's  Treatise  on  the 
Practice  of  the  Criminal  Law,  pp.  540-542. — P.] 

So  in  reference  to  all  other  written  memoranda  connected  with  the 
case  as  to  the  medicines  prescribed  for  the  deceased,  the  visits  made 
to  him,  &c,  the  witness  should  be  prepared  to  produce  them  and 
explain  any  alterations  or  erasures  which  may  be  found  in  his  books. 
Counsel  are  entitled  to  look  at  and  examine  all  documents  of  this 
kind  which  are  produced  or  used  by  the  witness  in  giving  his 
evidence. 

Medico-legal  Reports. — One  of  the  duties  of  a  medical  jurist  is  to 
draw  up  a  report  of  the  results  of  his  examination :  1,  in  regard  to 
symptoms ;  2,  in  regard  to  appearances  after  death ;  and,  3,  in  regard 
to  the  results  of  an  analysis.  With  respect  to  the  two  first  divisions 
of  the  rej^ort,  I  must  refer  the  reader  to  the  rules  for  investigating 
cases  of  poisoning  (p.  22).  It  need  hardly  be  observed  that  the  time 
at  which  the  person  was  first  seen,  and  the  circumstances  under  which 
the  attendance  of  the  practitioner  was  recpiired,  as  well  as  the  period 
of  death,  should  be  particularly  stated.  The  hour,  the  day  of  the 
week,  and  the  month,  should  be  invariably  mentioned.  Some 
medical  witnesses  merely  state  the  day  of  the  week,  without  that  of 
the  month,  or  vice  versa.  At  a  trial  this  sometimes  creates  great 
confusion,  by  rendering  a  reference  to  almanacs  necessary.  The 
words  yesterday,  next  day,  &c,  should  never  be  used.  The  facts 
which  it  will  be  necessary  to  enter  in  the  report  are  specially  stated 
under  the  heads  of  investigation  (see  p.  24).  If  these  facts  are  not 
observed  in  the  order  there  set  down,  their  value  as  evidence  of  the 
cause  of  death,  or  of  the  criminality  or  innocence  of  particular  per- 
sons, will  be  entirely  lost.  In  drawing  up  a  report  of  symptoms  and 
appearances  after  death,  the  facts  should  be  in  the  first  instance 
plainly  and  concisely  stated  seriatim,  in  language  easily  intelligible 
to  non-professional  men.  A  reporter  is  not  called  upon  to  display 
his  erudition,  but  to  make  himself  understood.  If  technical  terms 
are  employed,  their  meaning  should  be  stated  in  parentheses.  When 
a  subject  is  thoroughly  understood,  there  can  be  no  difficulty  in  ren- 
dering it  in  simple  language ;  and  when  it  is  not  well  understood, 
the  practitioner  is  not  in  a  position  to  make  any  report.  Magistrates, 
coroners,  and  barristers  are  very  acute,  and  easily  detect  ignorance, 
even  when  it  appears  under  the  mask  of  erudition. 

In  recording  facts  a  reporter  should  not  encumber  his  statements 
with  opinions,  inferences,  or  comments.  The  facts  should  be  first 
stated  and  the  conclusions  should  be  reserved  until  the  end  of  the 
report.  The  language  in  which  conclusions  are  expressed,  should 
be  precise  and  clear.  It  must  be  remembered  that  these  are  intended 
to  form  a  concise  summary  of  the  whole  report,  upon  which  the 
judgment  of  a  magistrate,  or  the  decision  of  a  coroner's  jury,  will 
be  ultimately  based.     They  should  be  most  strictly  confined  to  the 


CONSTRUCTION    OF    MEDICO-LEGAL    REPORTS.  29 

matters  which  are  the  subject  of  inquiry,  and  which  have  actually 
fallen  under  the  observation  of  the  witness.  Thus,  they  commonly 
refer  to  the  following  question:  What  was  the  cause  of  death? 
What  are  the  medical  circumstances  which  lead  you  to  suppose  that 
death  was  caused  by  violence  ?  What  are  the  circumstances  which 
lead  you  to  suppose  that  death  was  not  caused  by  natural  disease  ? 
Answers  to  one  or  all  of  these  questions  comprise,  in  general,  all 
that  a  reporter  is  required  to  introduce  into  the  conclusions  of  his 
report. 

The  reporter  must  remember  that  his  conclusions  are  to  be  based 
only  upon  medical  facts,  not  upon  moral  circumstances,  unless  he  is 
specially  required  to  express  his  opinion  with  regard  to  them  when 
they  are  of  a  medico-moral  nature.  Further,  they  must  be  founded 
only  on  what  he  has  himself  seen  or  observed.  Any  information  derived 
from  others  should  not  be  made  the  basis  of  an  opinion  either  in 
evidence  or  in  a  medico-legal  report.  It  is  scarcely  necessary  to  re- 
mark that  a  conclusion  based  upon  mere  probabilities  is  of  no  value 
as  evidence. 

In  drawing  up  a  report  on  the  results  of  a  chemical  analysis,  the 
following  rules  may  be  borne  in  mind.  A  liquid  or  solid  is  received 
for  analysis.  1.  When,  and  of  whom,  or  how  received  ?  2.  In  what 
state  was  it  received — secured  in  any  way",  or  exposed?  3.  If  more 
than  one  substance  received,  each  to  be  separately  and  distinctly 
labelled ;  appearance  of  the  vessel,  its  capacity,  and  the  quantity  of 
liquid  (by  measure)  or  solid  (by  weight)  contained  therein.  4.  Where 
and  when  did  you  proceed  to  make  the  analysis,  and  where  was  the 
substance  kept  during  the  intermediate  period?  5.  Did  any  one 
assist  you,  or  did  you  make  the  analysis  yourself?  6.  Physical 
characters  of  the  substance.  7.  Processes  and  tests  employed  for 
determining  whether  it  contained  poison.  All  the  steps  of  these 
processes  need  not  be  described;  a  general  outline  of  the  analysis 
will  suffice.  The  magistrate  may  thus  satisfy  himself  by  an  appeal 
to  others  (if  necessary)  whether  the  analysis  has  or  has  "not  been 
properly  made.  8.  Supposing  the  substance  to  contain  poison — is 
this  in  a  pure  state  or  mixed  with  any  other  body?  9.  The  strength 
of  the  poison,  if  an  acid,  or  if  it  be  in  solution :  in  all  cases,  the 
quantity  of  poison  found,  determined  if  possible  by  actual  weighing. 
10.  Supposing  no  poison  to  be  contained  in  it,  what  was  the  nature 
of  the  substance  ?  Did  it  contain  anything  of  a  noxious  nature,  i.  e. 
likely  to  injure  health  or  destroy  life?  11.  Could  the  supposed 
poisonous  substance  exist  naturally  or  be  produced  within  the  body? 
12.  Was  it  present  in  any  of  the  liquids  or  solids  employed  in  the 
chemical  analysis  ?  13.  Was  it  contained  in  any  of  the  articles  of 
food  or  medicine  taken  by  the  deceased  ?  14.  Is  its  presence  to  be 
ascribed  to  the  use  of  any  mineral  matter  employed  by  injection 
after  death  for  the  preservation  of  the  body  of  the  deceased  ?  15. 
What  quantity  of  poison  was  actually  separated  in  the  free  or  ab- 
sorbed state  ?  16.  How  much  of  the  substance  found  would,  under 
the  circumstances,  be  likely  to  destroy  life  ? 

There  are  few  reports  in  which  answers  to  some  of  these  questions, 


30  MEDICO-LEGAL    REPORTS. 

although  not  formally  put,  will  not  be  required;  and  unless  the 
whole  of  them  are  borne  in  mind  by  the  operator  at  the  time  an 
analysis  is  undertaken,  those  which  are  omitted  can  never  receive  an 
answer,  however  important  to  the  ends  of  justice  that  answer  may 
ultimately  become. 

There  are  frequently  defects  in  these  reports  which  it  is  desirable 
to  point  out.  The  statements  are  sometimes  drawn  up  in  exaggerated 
language :  at  others  they  are  overloaded  with  technical  and  therefore 
unintelligible  terms,  and  the  writer  is  seldom  sufficiently  careful  to 
keep  his  facts  distinct  from  his  comments.  The  former  may  be  use- 
ful as  evidence;  the  latter  are  inadmissible. 

With  respect  to  the  first  of  these  defects,  it  is  very  much  the 
practice  of  medical  men,  in  drawing  up  reports  of  medical  cases  for 
professional  purposes,  to  use,  unthinkingly,  exaggerated  language. 
Thus,  it  may  be  observed  in  the  description  of  an  ordinary  post- 
mortem examination,  the  lining-membrane  of  the  stomach  is  described 
as  being  "  intensely"  inflamed,  or  some  part  is  "  considerably"  in- 
jected, or  a  cavity  is  "enormously"  distended.  Expressions  thus 
loosely  employed,  convey  to  the  legal  mind  a  widely-different  mean- 
ing from  that  intended  by  the  reporter.  They  create  also  great 
difficulty  in  evidence  if  withdrawn  or  modified,  a  change  which  other 
circumstances  may  show  to  be  necessary,  and  at  the  same  time  they 
place  the  witness  in  an  undesirable  position  before  the  court.  On 
the  other  hand,  if  retained,  they  may  render  the  facts  unsusceptible 
of  explanation  upon  any  theory  of  natural  disease.  Such  descriptions 
obviously  imply  a  comparison  with  similar  conditions  in  numerous 
other  dead  bodies ;  but  what  is  the  standard  by  which  they  are  really 
measured,  and  what  opportunity  has  the  witness  had  of  creating  such 
a  standard  from  his  own  experience  ?  In  general  it  will  be  found 
that  such  expressions  have  been  used  without  proper  consideration 
from  a  habit  acquired  by  the  writer  in  reporting  cases  for  the  infor- 
mation of  medical  men  only.  Let  him  who  is  inclined  to  use  them 
bear  in  mind  that  barristers  look  much  more  closely  to  the  strict 
meaning  of  words  than  medical  men,  and  that  they  are  always  dis- 
posed to  distrust  the  judgment  of  one  who  cannot  speak  or  write 
without  resorting  to  the  use  of  the  superlative  degree. 

The  free  use  of  technical  terms  in  drawing  up  reports  may  be 
attributed  to  a  similar  practice  in  the  profession.  Putting  aside 
those  cases  in  which  a  medical  man  believes  that  he  is  displaying  his 
erudition  by  the  selection  and  use  of  such  terms,  there  can  be  no 
doubt  that  the  greater  number  of  medical  practitioners  fall  into  this 
practice  from  mere  habit.  They  think  they  are  addressing  the  report 
to  the  president  and  members  of  some  medical  society,  instead  of  a 
coroner  and  jury  who  have  never  in  their  reading  or  experience  met 
with  such  terms,  and  to  whom  therefore  they  are  perfectly  unintelli- 
gible. In  a  report  on  the  appearances  in  the  body  of  a  man  who 
had  suffered  from  chronic  insanity,  which  was  submitted  to  me  for 
explanation,  the  following  passage  occurred:  "The  only  morbid  ap- 
pearance in  the  brain  was  an  atheromatous  deposit  in  the  Pons 
Varolii,  near  the  situation  of  the  locus  niger."    In  another  document 


MEDICO-LEGAL    REPORTS.  31 

the  reporter  stated,  for  the  information  of  a  coroner's  jury,  that  the 
"  integuments  of  the  cranium  were  reflected,  and  the  calvarium  was 
exposed."  If  a  reporter  will  use  such  terms  as  these  or  others  of  a 
similar  kind,  such  as  "parietes  of  the  abdomen,"  "epigastrium," 
"hypertrophy  of  the  liver,"  when  it  would  require  no  more  trouble 
to  put  what  he  means  in  plain  English,  he  must  be  prepared  to  have 
his  meaning  perverted  or  wholly  misunderstood.  Setting  aside  the 
men  who  act  as  jurors,  it  may  be  observed  that  educated  persons, 
such  as  coroners  and  magistrates,  do  not  commonly  include  profes- 
sional terms  within  the  range  of  their  studies.  There  are  but  few  of 
them  who  understand  the  difference  between  perineum  and  peri- 
toneum, or  the  meaning  of  the  words  hemispheres  of  the  brain,  pia 
mater,  puncta  cruenta,  corpora  quadrigemina,  centrum  ovale,  &c. 
They  are  not  likely  to  know  the  difference  between  the  cardia  and 
pylorus,  nor  the  nature  or  situation  of  the  duodenum,  jejunum,  ileum 
or  caecum,  and  are  as  ready  to  consider  them  to  be  parts  of  the  liver 
or  urinary  bladder  as  of  the  intestines.  On  one  occasion,  I  heard  a 
learned  judge  ask  for  an  explanation  of  the  meaning  of  the  terms 
"  alimentary  canal."  A  slight  consideration  will  show  to  any  medical 
practitioner  that  refined  professional  language  is  wholly  misplaced 
in  a  report  which  is  intended  to  inform  and  convince  the  minds  of 
ordinary  men  upon  plain  matters  of  fact. 

The  last  point  which  calls  for  comment  in  reference  to  medical 
reports,  is  the  loose  manner  in  which  facts  and  comments  on  facts, 
as  well  as  hearsay  statements,  are  sometimes  found  blended.  If  a 
reporter  takes  care  to  eliminate  facts  from  comment,  his  report  is 
admissible  and  may  be  read  at  the  inquest  or  trial  as  evidence.  The 
facts  are  for  the  jury,  the  comments  upon  the,  facts,  introduced  by 
the  reporter,  may  or  may  not  be  correct,  and  are  therefore  not  evi 
dence.  Their  correctness  or  relevancy  to  the  case  will  be  elicited  in 
the  cross-examination.  As  a  rule,  nothing  should  be  entered  in  a 
report  which  is  not  connected  with  the  subject  of  inquiry,  and  which 
has  not  actually  fallen  under  the  observation  of  the  reporter.  The 
introduction  of  hearsay  statements,  i.  e.  statements  made  by  others, 
or  of  circumstances  which  have  come  to  his  knowledge  through 
public  rumor,  should  be  carefully  avoided. 

Upon  the  medical  report,  and  such  evidence  as  may  be  required  to 
explain  it,  an  accused  person  may  be  committed  for  trial  at  the 
Assizes,  either  by  a  coroner  or  a  magistrate.  In  the  first  stage  of 
the  proceedings,  under  these  circumstances,  the  medical  witness  goes 
before  the  grand  jury,  and  there,  after  the  administration  of  an  oath, 
he  is  required  to  make  a  general  statement  of  what  he  knows  of  the 
matter.  Such  questions  are  put  as  may  be  necessary  to  elucidate  the 
cause  of  death  ;  and  on  the  finding  of  a  true  bill..for  murder  or  man- 
slaughter, the  accused  is  placed  upon  his  trial  before  one  of  the 
learned  judges  of  Assize.  According  to  the  variable  circumstances 
attending  such  cases,  the  medical  evidence  is  called  for  at  an  early 
or  late  stage  of  the  proceedings.  When  it  is  at  all  doubtful  whether 
the  cause  of  death  was  owing  to  any  criminal  act,  it  is  called  for  at 


32  DYING    DECLAKATIONS. 

the  commencement  of  the  case,  in  order  to  lay  a  foundation  for  further 
inquiry. 

It  is  necessary  that  a  medical  witness  should  remember  that  copies 
of  his  report  and  depositions,  either  before  a  coroner  or  magistrate, 
are  usually  placed  in  the  hands  of  counsel  as  well  as  of  the  learned 
judge,  and  that  his  evidence,  as  it  is  given  at  the  trial,  is  compared 
word  for  word  with  that  which  has  been  already  put  on  record. 
There  is  reason  to  believe  that  this  is  not  generally  known  to  mem- 
bers of  the  medical  profession,  and  thus  it  happens  that  either  from 
failure  of  memory,  want  of  accurate  observation,  or  carelessness  in 
giving  evidence  at  a  coroner's  inquest,  medical  witnesses  lay  them- 
selves open  to  severe  censure,  either  by  stating  matters  differently  at 
the  trial,  or  by  giving  a  very  different  complexion  to  the  facts.  Any 
serious  deviations  from  what  is  on  record  will  of  course  tell  unfavor- 
ably for  the  witness,  supply  materials  for  a  severe  cross-examination, 
and  form  an  excellent  ground  of  defence  for  the  prisoner.  The 
witness's  weakness  is  the  prisoner's  opportunity,  and  of  course  his 
counsel  will  not  lose  the  occasion  of  impressing  upon  the  jury  that 
a  man  who  can  on  oath  give  two  different  accounts  of  the  same  trans- 
action, is  not  to  be  believed  on  either. 

[Dying  Declarations. — "  The  general  principle  on  which  this  species 
of  evidence  is  admitted  was  stated  by  Lord  Chief  Baron  Eyre  to  be 
this :  that  they  are  declarations  made  in  extremity,  when  the  party 
is  at  the  point  of  death,  and  when  every  hope  of  this  world  is  gone ; 
when  every  motive  to  falsehood  is  silenced,  and  the  mind  is  induced 
by  the  most  powerful  considerations  to  speak  the  truth.  A  situation 
so  solemn  and  so  awful  is  considered  by  the  law  as  creating  an  obli- 
gation equal  to  that  which  is  imposed  by  a  positive  oath  in  a  court 
of  justice. 

"It  was  at  one  time  held  by  respectable  authorities  that  this  general 
principle  warranted  the  admission  of  dying  declarations  in  all  cases, 
civil  and  criminal ;  but  it  is  now  well  settled  that  they  are  admissible, 
as  such,  only  in  cases  of  homicide,  '  where  the  death  of  the  deceased  is 
the  subject  of  the  charge,  and  the  circumstances  of  the  death  are  the  subject 
of  the  dying  declaration.'1 

"  The  reasons  for  thus  restricting  it  may  be  that  credit  is  not  in  all 
cases  due  to  the  declarations  of  a  dying  person;  for  his  body  may 
have  survived  the  powers  of  his  mind;  or  his  recollection,  if  his 
senses  are  not  impaired,  may  not  be  perfect ;  or,  for  the  sake  of  ease, 
and  to  be  rid  of  the  importunity  and  annoyance  of  those  around  him, 
he  may  say,  or  seem  to  say,  whatever  they  may  choose  to  suggest. 
These  or  the  like  considerations  have  been  regarded  as  counter- 
balancing the  force  of  the  general  principle  above  stated ;  leaving 
this  exception  to  stand  only  upon  the  ground  of  the  public  necessity 
of  preserving  the  lives  of  the  community  by  bringing  manslayers  to 
justice.  For  it  often  happens  that  there  is  no  third  person  present 
to  be  an  eyewitness  to  the  fact,  and  the  usual  witness  in  other  cases 
of  felony,  namelv,  the  party  injured,  is  himself  destroyed." — 1  Green- 
leaf's  Evidence,  §  156. 

"  The  persons  whose  declarations  are  thus  admitted  are  considered 


DYING    DECLARATIONS.  33 

as  standing  in  the  same  situation  as  if  they  were  sworn ;  the  danger 
of  impending  death  being  equivalent  to  the  sanction  of  an  oath.  It 
follows,  therefore,  that  where  the  declarant,  if  living,  would  have 
been  incompetent  to  testify,  by  reason  of  infamy  or  the  like,  his  dying 
declarations  are  inadmissible ;  and,  as  an  oath  derives  the  value  of  its 
sanction  from  the  religious  sense  of  the  party's  accountability  to  his 
Maker,  and  the  deep  impression  that  he  is  soon  to  render  to  Him  the 
final  account ;  tuherever  it  appears  that  the  declarant  was  incapable  of 
this  religious  sense  of  accountability,  whether  from  infidelity,  imbecility 
of  mind,  or  tender  age,  the  declarations  are  alike  inadmissible. 

"  On  the  other  hand,  as  the  testimony  of  an  accomplice  is  admis- 
sible against  his  fellow,  the  dying  declarations  of  a  particeps  criminis 
in  an  act  which  resulted  in  his  own  death,  are  admissible  against  one 
indicted  for  the  same  murder."  lb.  §  157.  On  principle,  therefore, 
the  dying  declarations  of  an  accomplice  should,  to  justify  a  conviction, 
require  the  same  corroboration  that  is  necessary  where  he  testifies  as 
a  living  witness  (see  Joy  on  the  Evidence  of  Accomplices);  but  as 
to  this  the  judges  in  Tinckler's  case  (1  East.  PI.  Cr.,  354-56)  were 
divided,  the  majority,  however,  thinking  that  they  were  sufficient 
without  corroboration.  And  as  husband  and  wife  may  testify  against 
each  other  in  all  cases  of  personal  injuries  inflicted  by  either  upon 
the  other,  the  dying  declarations  of  either  are  admissible  where  the 
other  party  is  charged  with  the  murder  of  the  declarant.  The  People 
v.  Green,  1  Denio  E.  614. 

It  is  essential  to  the  admissibility  of  these  declarations,  and  is  a 
preliminary  fact,  to  be  proved  by  the  party  offering  them  in  evidence,  that 
they  were  made  under  a  sense  of  impending  death. 

It  is  not  essential,  however,  that  the  consciousness  of  impending 
death  should  be  expressed  by  the  dying  man  himself;  it  may  be 
collected  either  from  the  circumstances  of  the  case,  as  the  nature  of 
the  wound  and  state  of  the  body,  or  from  expressions  used  by  the 
deceased.  Com.  v.  Murray,  2  Ash.  41 ;  Com.  v.  Williams,  lb.  69 ; 
State  v.  Gillich,  7  Clarke  (Iowa),  287 ;  State  v.  Nash,  lb.  347.  See 
also  People  v.  Lee,  17  Cal.  76 ;  People  v.  Ybarra,  lb.  166 ;  Kilpatrick 
v.  Commonwealth,  7  Casey,  198. 

The  length  of  time  which  elapses  between  the  declarations  and 
the  death  furnishes  no  rule  as  to  the  admissibility  or  rejection  of  the 
evidence.  In  Woodcock's  case,  2  Leach's  Cr.  Cas.  563,  the  declara- 
tions were  made  forty-eight  hours  before  death ;  in  Tinckler's  case, 
1  East.  P.  C.  345,  ten  days,  and  in  Rex  v.  Mosley,  Cr.  Cas.  97,  eleven 
days  before  death ;  and  all  were  received.  It  is  the  impression  of 
almost  immediate  dissolution,  and  not  the  rapid  succession  of  death 
in  point  of  fact,  that  renders  the  testimony  admissible.  Hence, 
where  declarant  at  the  time  believed  his  death  to  be  impending  and 
certain,  the  declarations  were  competent,  notwithstanding  that  he 
subsequently  revived,  and  thought  he  might  recover.  State  v.  Nash, 
7  Clarke  (Iowa),  347. 

The  language  of  the  text-books,  and  of  the  authorities  generally, 
is,  that  "  where  it  appears  that  the  declarant  had  '  any  hope'  of  re- 
covery, however  slight  it  may  have  been,  and  though  death  actually 
3 


34  DYING    DECLARATIONS. 

ensued  shortly  afterwards,  the  declarations  are  inadmissible."  1 
Greenleaf,  §  158;  Phillips  on  Evidence,  200.  But  in  Regina  v. 
Pym  ("  Law  Times,"  1846,  p.  500),  where  it  appeared  that  the  de- 
clarant had  a  firm  belief  that  death  was  approaching,  although  it 
appeared  that  he  hoped  and  thought  it  not  impossible  that  he  might 
recover,  Erle,  J.,  in  admitting  the  evidence,  said :  "  It  has  no  doubt 
been  held  in  some  cases  that  all  hope  must  be  given  up,  but  this  is 
now  decided  not  to  be  necessary.  Indeed,  if  it  were  so,  no  declara- 
tions could  be  received,  for  scarcely  a  human  being  could  be  found, 
under  any  circumstances,  who  would  not  retain  some  hope.  The  law 
admits  these  declarations,  not  because  recovery  is  impossible,  but 
because  there  is  a  conviction  of  approaching  death." 

The  word  hope  is  used  in  two  senses ;  first,  as  implying  belief,  expec- 
tation ;  and  second,  wish  or  desire.  In  the  latter  sense  it  must  always 
exist,  and  that  seems  to  be  the  meaning  as  used  in  the  case  last  cited. 
Where  it  is  used  as  synonymous  with  belief  or  expectation,  its  ex- 
istence would  render  the  declarations  inadmissible ;  since  "  hoping" 
in  that  sense  to  recover  would  be  wholly  inconsistent  with  the  alleged 
belief  that  death  was  impending. 

The  declarations  are  admissible  only  as  to  those  things  which 
declarant  would  have  been  competent  to  testify  if  sworn  in  the  case, 
viz.,  relevant  facts,  not  mere  matters  of  opinion. 

They  are  admissible  in  favor  of,  no  less  than  against  the  party 
charged  with  the  death. 

It  is  no  objection  to  their  admissibility  that  they  were  elicited  by 
leading  questions,  or  by  pressing  and  earnest  urgings.  They  must, 
however,  be  complete  in  themselves :  for  if  it  appears  that  the  decla- 
rant intended  to  connect  them  with  or  qualify  them  by,  other  state- 
ments, which  he  is  prevented  by  any  cause  from  making,  they  will 
not  be  received.  1  Greenleaf,  §  159. 

The  circumstances  under  which  the  declarations  were  made  are  to 
be  shown  to  the  judge:  it  being  his  province,  and  not  that  of  the 
jury  to  determine  whether  they  are  admissible.  Com.  v.  Hurray,  2 
Ash.  41;  McHugh  v.  State,  31  Alabama,  317;  People  v.  Glenn,  10 
Cal.  32 ;  State  v.  Howard,  32  Vermont,  380. 

Still,  however,  the  credibility  of  the  evidence  is  entirely  with  the 
jury,  who,  if  they  do  not  believe  that  the  deceased  really  was  in  such 
circumstances  as  the  other  witnesses  may  have  testified  to,  may  give 
no  weight  to  the  declarations. 

If  the  statement  of  the  deceased  was  reduced  to  writing,  and  signed 
by  him,  it  must  be  produced,  if  existing,  and  secondary  evidence  of 
the  declarations  cannot  be  admitted.  State  v.  Tweedy,  11  Iowa,  350. 
But  it  is  not  essential  that  a  subscribing  witness  thereto  should  be 
produced,  or  his  absence  accounted  for.  McHugh  v.  State,  31  Ala. 
317.  And  where  the  declarations  had  been  repeated  at  different 
times,  at  one  of  which  they  were  under  oath,  and  informally  reduced 
to  writing  by  one  witness,  and  at  the  others  they  were  not,  it  was  held 
that  the  latter  might  be  proved  by  parol,  if  the  other  could  not  be 
produced.  Bex  v.  Reason,  1  Str.  499,  500;  Slate  v.  Tweedy,  supra.  So, 
if  the  deposition  has  been  taken,  and  is  inadmissible  as  such  for  want 


DYING    DECLARATIONS.  35 

of  compliance  with  some  statutory  requirement,  it  seems  it  may  still 
be  treated  as  a  dying  declaration. 

Great  caution,  however,  is  to  be  observed  in  the  use  of  this  kind 
of  evidence,  because  it  is  to  be  recollected  that  the  accused  may  not 
have  been  confronted  with  the  declarant,  nor  does  he  ever  have  the 
power  of  cross-examination,  which  is  quite  as  essential  to  the  eliciting 
of  all  the  truth  as  the  obligation  of  an  oath  can  be.  Besides  which, 
the  particulars  of  the  evidence,  to  which  the  deceased  has  spoken, 
are  in  general  likely  to  have  occurred  under  circumstances  of  con- 
fusion and  surprise,  calculated  to  prevent  their  being  accurately 
observed;  and  leading  both. to  mistakes  as  to  identity  of  persons,  and 
to  the  omission  of  facts  essentially  important  to  the  completeness 
and  truth  of  the  narrative.  1  Greenleaf,  §  162 ;  Evans's  Pothier  on 
Obligations,  255. 

In  the  case  of  Commonwealth  v.  Lamb,  tried  in  the  Oyer  and  Ter- 
miner of  Philadelphia,  in  March,  1854,  the  deceased,  who  died  from 
the  effects  of  blows  upon  the  head  inflicted  by  a  gang  who  attacked 
him  in  the  dark,  had  declared  positively  that  the  defendant  was  the 
person  who  had  struck  him.  The  declarations  were  not  received 
because  of  failure  in  the  preliminary  proof,  and  the  prosecution  was 
abandoned.  The  defendant  was  a  very  respectable  young  man,  and 
could  have  clearly  established  his  innocence,  but  the  case  showed 
how  little  reliance  can  be  placed  on  this  species  of  evidence,  espe- 
cially in  questions  of  identity.  (See,  also,  a  case  mentioned  in  the 
former  edition  of  this  work,  p.  179.) 

The  objection,  that  receiving  dying  declarations  was  a  violation  of 
the  article  of  the  Declaration  of  Bights  that  every  subject  shall  have 
a  right  to  confront  the  witnesses  against  him  face  to  face  has  been 
made,  but  not  sustained  by  the  courts.  Com.  v.  Carey,  12  Cush. 
(Mass.)  246;  Burrell  v.  State,  18  Texas,  713;  People  v.  Glenn,  10  Cal. 
32 ;  State  v.  Nash,  7  Clarke  (Iowa),  347. 

It  is  to  be  observed  that  while  dying  declarations  are  restricted  to 
the  case  of  trial  for  the  homicide  of  the  declarant,  this  applies  only 
to  declarations  offered  on  the  sole  ground  that  they  were  made  in 
extremis;  for  where  they  constitute  part  of  the  res  gestae,  or  come 
within  the  exception  of  declarations  against  interest,  or  the  like,  they 
are  admissible  as  in  other  cases;  irrespective  of  the  fact,  that  the 
declarant  was  under  apprehension  of  death. 

It  is  evidently,  however,  no  part  of  the  duty  of  the  medical  wit- 
ness or  other  person  present  when  declarations  are  made  to  deter- 
mine whether  they  will  be  admissible  or  not.  This  question  is  to 
be  left  to  the  judges  before  whom  the  case  shall  be  tried ;  and  the 
witness  should  carefully  remember  what  is  stated,  writing  it  down 
immediately,  or  at  the  earliest  moment  possible,  stating  all  that  was 
said,  and  using  the  identical  language  of  the  declarant,  not  simply 
giving  what  he  conceives,  to  be  the  meaning  or  substance  of  it. — P.] 


86  coroner's  inquests. 


CHAPTER   II. 

CORONERS'  INQUESTS. — TRIAL  AT  THE  ASSIZES. — SUBPCENAS. — EXAMI- 
NATION IN  COURT. — DUTIES  OF  MEDICAL  WITNESSES. — RULES  FOR 
THE  DELIVERY  OF  EVIDENCE. 

Coroners'  Inquests.  —  The  proceedings  at  coroners'  inquests  are 
treated  too  lightly  by  medical  men.  The  ignorant  and  uneducated 
class  of  persons  who  often  constitute  the  jury,  as  well  as  the  circum- 
stances under  which  the  inquiry  usually  takes  place,  are  not  calcu- 
lated to  inspire  great  respect  for  these  initiatory  proceedings;  but 
still  by  law  and  custom  coroners'  inquisitions  are  and  have  been  for 
ages  in  this  country,  the  only  tribunals  for  inquiring  into  and  deter- 
mining the  cause  of  death  in  cases  of  suspected  violence ;  and  they 
are  therefore  deserving  of  more  attention  than  is  usually  shown  to 
them  by  medical  witnesses.  As  a  rule,  in  all  inquests  which  are 
likely  to  end  in  a  committal  of  the  accused  person,  a  medical  man 
who  is  giving  his  evidence  before  a  coroner,  in  the  room  of  a  small 
country  inn,  or  in  a  village  school-room,  is  virtually  delivering  it 
before  a  judge  of  assize;  and  this  fact  alone,  if  not  a  respect  for  the 
court,  should  induce  him  to  give  the  evidence  guardedly,  and  with  a 
due  consideration  to  the  serious  results  to  which  it  may  ultimately 
lead.  The  4th  Edward  I.  stat.  2,  on  which  coroners  profess  to  act, 
directs  that  "upon  information,"  they  shall  "go  to  the  place  where 
any  be  slain  or  suddenly  dead,"  and  make  due  inquiry  as  to  the  cause, 
&c,  before  a  jury  selected  from  persons  living  in  the  neighborhood. 
The  information  upon  which  a  coroner  generally  acts  is,  1.  Notice 
from  a  beadle,  or  other  officer  of  the  parish  (whose  zeal  is  sometimes 
stimulated  by  a  fee  or  salary),  of  any  death  from  sudden  or  supposed 
unusual  causes.  2.  Notice  from  a  medical  man  who  may  have  at- 
tended the  deceased,  and  who  communicates  his  suspicion  that  the 
cause  of  death  is  not  natural.  3.  Notice  from  a  registrar  of  deaths 
that  no  cause  has  been  assigned  in  a  particular  case,  or  that  there  has 
been  a  rapid  death  after  a  short  illness.  The  conclusion  to  which 
experience  leads  in  reference  to  these  inquiries  is,  that  the  system 
affords  no  certainty  for  the  detection  of  crime ;  that  it  affords  no  pro- 
tection to  those  who  are  wrongly  charged  with  crime;  and  lastly, 
that  in  some  cases  it  screens  a  criminal  by  a  verdict  based  upon  an 
imperfect  inquiry,  in  which  the  important  medical  facts  are  either 
not  understood,  or  are  misinterpreted  by  the  jury. 

Many  persons  who  occupy  the  office  of  coroner  are  neither  medi- 
cally nor  judicially  qualified  for  the  proper  performance  of  the  duties 
of  the  office.  The  system  of  electing  a  man  to  hold  such  an  office  as 
this  (one  demanding  special  medical  knowledge  of  the  causes  of  death, 


OFFICE    OF    CORONER.  37 

and  good  legal  knowledge  of  the  law  of  evidence)  by  freeholders  of  the 
lowest  degree,  is  so  intrinsically  absurd,  that  it  is  quite  wonderful 
hoAV,  with  improved  civilization,  it  has  maintained  its  ground  in  such 
a  country  as  England.  The  election  of  a  Lord  Chancellor,  of  the 
judge  of  our  courts  of  law,  or  of  County  Court  judges,  might  be  with 
equal  reason  left  in  the  hands  of  voters  of  this  class,  men  who  have 
no  knowledge  of  the  duties  of  the  office,  or  of  the  skill  and  learning 
required  in  one  who  is  really  competent  to  fill  it.  The  election  of  a 
good  and  capable  person  as  coroner  is,  therefore,  a  matter  of  pure 
accident.     No  preliminary  test  of  ability  or  capacity  is  required. 

In  Scotland,  the  office  of  coroner  does  not  exist,  but  in  place  of 
this  there  is  an  officer  named  Procurator  Fiscal,  generally  a  skilled 
solicitor,  nominated  by  competent  authority,  and  not  elected  by  scot 
and  lot  voters.  The  general  order  issued  to  these  officers  by  the  Lord 
Advocate,  enjoins  that  in  cases  where  a  dead  body  is  discovered,  the 
Procurator  Fiscal  shall  obtain  a  medical  report  of  the  cause  of  death ; 
and  in  cases  of  persons  found  dead,  the  body  is  generally  inspected 
for  this  purpose.  This,  however,  is  at  the  option  of  the  appointed 
officer,  the  instruction  being  in  these  words :  Wherever  in  his  opinion 
a  written  medical  report  is  necessary  for  the  due  consideration  of  the 
case,  he,  the  Procurator,  shall  obtain  such  a  report  from  a  duly  quali- 
fied medical  practitioner."  The  usual  practice  in  England  is  to  select 
the  nearest  medical  practitioner,  whether  he  has  had  any  experience 
or  not,  and  often  to  trust  an  important  and  delicate  pathological  and 
chemical  inquiry  in  the  hands  of  one  who  probably  has  never  before 
made  an  inspection  or  an  analysis. 

Under  the  present  system  coroners  are  empowered  by  the  Medical 
Witnesses'  Act  (6  and  7  William  IV.  c.  89)  to  issue  an  order  for  the 
attendance  of  any  legally- qualified  practitioner,  "being  at  the  time  in 
actual  practice  in  or  near  the  place  where  the  death  has  happened;" 
a  fee  of  two  guineas  is  the  maximum  allowed  for  making  a  post-mor- 
tem examination,  and,  if  considered  necessary  by  the  jury,  a  chemical 
analysis  of  the  stomach  and  intestines.  A  penalty  of  five  pounds  is 
attached  to  disobedience  of  this  order,  except  for  reasonable  cause. 
Mr.  Rumsey  has  correctly  represented  the  unsatisfactory  position  in 
which  medical  men  are  placed  by  such  an  arrangement.  He  observes : 
"  It  is  no  discredit  to  a  practitioner  engaged  in  the  toilsome  routine 
of  ordinary  medical  duties,  if  he  should  feel  himself  at  a  loss  when 
called  upon  for  a  decisive  opinion  in  some  obscure  case  of  poisoning 
or  infanticide.  His  scanty  opportunities  for  the  study  of  these  sub- 
jects and  for  making  post-mortem  examinations  cannot  suffice  to 
qualify  him  for  answering  the  delicate  and  important  questions  which 
he  must  answer  before  a  jury  can  find  a  proper  verdict."  .  .  . 
"The  custom  of  indiscriminately  summoning  medical  practitioners  of 
all  sorts,  and  of  all  degrees  of  pathological  knowledge  and  forensic 
skill  has  sadly  depreciated  the  value  of  medical  evidence  in  courts  of 
justice.  Public  confidence  in  the  profession  has  been  shaken,  and  the 
appearance  of  a  '  doctor '  in  the  witness-box  is  but  too  often  a  signal 
for  sport  among  gentlemen  of  the  long  robe."  ("  Essays  on  State 
Medicine,"  p.  356.) 


38  TRIAL    AT    THE    ASSIZES. 

No  medical  man  can  be  compelled  to  undertake  that  which  he  feels 
incompetent  to  perform,  and  some  medical  practitioners  who  have 
felt  this  want  of  experience  have  properly  declined  to  make  chemical 
analyses  involving  so  serious  a  responsibility.  It  is  thus  that,  in 
manv  cases  of  importance,  analyses  for  coroners'  inquests  are  now 
referred  to  chemical  experts,  and  the  practitioner  discharges  himself 
of  that  responsibility  which  the  Medical  Witnesses'  Act  imposes  upon 
him  without  any  adequate  remuneration. 

Before  quitting  this  subject,  it  is  necessary  to  observe  that  medical 
men  are  too  ready  to  give  their  opinion  of  the  cause  of  death  for  a 
coroner's  inquest  without  making  an  inspection  of  the  body.  No 
man  is  compelled  to  give  an  opinion  upon  insufficient  data,  and  if  by 
the  institution  of  a  judicial  inquiry  there  are  grounds  for  believing 
that  a  death  has  not  been  natural,  no  medical  opinion  of  the  cause 
should  be  given  in  the  absence  of  an  inspection.  Such  an  opinion 
must  always  be  conjectural,  and  may  involve  the  medical  man  in  an 
unpleasant  responsibility. 

Trial  at  the  Assizes. — The  next  stage  of  the  proceedings  in  a  crimi- 
nal case  brings  a  medical  witness  before  a  superior  court.  For  this 
purpose  a  subpoena  is  issued.  It  need  hardly  be  observed  that  every 
witness  is  bound  to  obey  a  subpoena,  when  with  it  his  reasonable 
expenses  for  journey,  &c,  are  tendered  to  him,  but  he  is  not  bound 
to  attend  at  the  trial  except  upon  a  subpoena.  [In  criminal  cases  no 
tender  of  fees,  &c,  is  in  general  necessary  on  the  part  of  the  govern- 
ment, in  order  to  compel  its  witnesses  to  attend ;  it  being  the  duty  of 
every  citizen  to  obey  a  call  of  that  description,  and  it  being  also  a 
case  in  which  he  is  himself  in  some  sense  a  party.  But  his  fees  will 
in  general  be  finally  paid  from  the  public  treasury.  In  all  such 
cases,  the  accused  is  entitled  to  have  compulsory  process  for  obtain- 
ing witnesses  in  his  favor.  (1  Greenleaf's  Ev.  §  311.) — P.]  There  are 
some  questions  connected  with  this  subject  which  it  will  be  proper  to 
consider  in  this  place.  If  a  subpoena  is  served  on  an  ordinary  <>r  skilled 
medical  witness,  is  lie  hound  to  obey  it?  In  Betts  v.  Clifford  (Warwick 
Lent  Assizes,  1858)  the  late  Lord  Campbell  stated,  in  answer  to  a 
question,  that  a  scientific  ivitness  was  not  bound  to  attend  upon  being- 
served  with  a  subpoena,  and  that  he  ought  not  to  be  subpoenaed.  If 
the  witness  knew  any  question  of  fact,  he  might  be  compelled  to 
attend,  but  he  could  not  be  compelled  to  give  his  attendance  to  speak 
to  matters  of  opinion. 

In  Rich  v.  Pierpoint,  an  action  for  malapraxis.  Dr.  Lee  was  sum- 
moned against  his  will  to  give  evidence  on  the  part  of  the  plaintiff. 
He  stated  that  on  the  evening  before  the  trial  a  solicitor  called  on 
him,  and  left  a  subpoena  with  him.  Dr.  Lee  would  not  hear  any 
account  of  the  case  which  the  solicitor  proposed  to  give,  and  expressed 
his  resolution  to  have  nothing  to  do  with  the  trial.  The  solicitor 
informed  him  that  he  would  be  required  to  pay  the  usual  penalty  if 
he  did  not  attend.  Pie  went  down  to  Kingston,  and  was  warned  not 
to  leave  the  court  until  the  trial  was  over,  lie  heard  the  evidence 
on  the  part  of  the  plaintiff,  and  upon  this  and  the  medical  evidence 
he  gave  his  opinion — not  much  in  favor  of  the  party  who  summoned 


OBEDIENCE    TO    A    SUBPCEXA.  39 

him,  and  not  much  against  him.  Dr.  Lee  considered  that  he  could 
not  avoid  attending  the  trial  under  these  circumstances.  ("  Medical 
Times  and  Gazette,"  April  12,  1862,  p.  389.) 

In  the  case  of  Webb  v.  Page  ("  Carrington's  and  Kirwan's  Eeports," 
p.  23)  the  late  Mr.  Justice  Maule  ruled  as  follows:  "There  is  a  dis- 
tinction," said  his  lordship,  "between  the  case  of  a  man  who  sees  a 
fact  and  is  called  to  prove  it  in  a  court  of  justice,  and  that  of  a  man 
who  is  selected  bj  a  party  to  give  his  opinion  on  a  matter  on  which 
he  is  peculiarly  conversant  from  the  nature  of  his  employment  in 
life.  The  former  is  bound,  as  a  matter  of  public  duty,  to  speak  to  a 
fact  which  happens  to  have  fallen  within  his  own  knowledge — with- 
out such  testimony  the  course  of  justice  must  be  stopped.  The  latter 
is  under  no  such  obligation;  there  is  no  such  necessity  for  his  evidence, 
and  the  party  who  selects  him  must  pay  him."  In  the  case  referred 
to  by  Mr.  Justice  Maule,  a  skilled  witness  had  been  subpoenaed,  but 
he  refused  to  give  evidence  unless  first  paid  for  his  services  and  loss 
of  time.  ("Medical  Times  and  Gazette,"  April  26,  1862,  p.  432.)  A 
barrister,  who  quotes  this  ruling,  goes  on  to  say:  "There  is  one  rea- 
son why  I  should  not  advise  any  person  in  the  position  of  a  skilled 
witness  totally  to  disregard  a  subpoena.  It  is  quite  clear  that  should 
such  a  person  fail  to  attend  a  trial  no  attachment  could  issue,  even  if 
he  were  called  as  is  usual  upon  the  subpoena,  because  the  party  sub- 
poenaing him  could  not  make  the  requisite  affidavits  that  he  was 
damnified  by  the  witness's  absence,  and  in  what  respect.  But  such 
party  might  bring  an  action  for  damages;  and  although  he  would 
recover  none,  he  might  not  only  worry,  but  might  even  put  the 
defendant  to  a  considerable  expense,  as  taxed  costs  by  no  means 
include  the  entire  costs  in  such  cases.  Although,  therefore,  I  could 
not  advise  a  total  neglect  of  the  subpoena,  the  safest  course  would  be 
to  obey  it,  and  demand  expenses  before  giving  evidence.  Such 
expenses  would  be  only  those  allowed  for  a  professional  witness  (not 
special  fees),  but  if  the  person  so  subpoenaed  were  willing  to  run  the 
risk  of  an  action,  he  might  safely  absent  himself  without  any  fear  of 
an  attachment  from  the  court  for  contempt."  With  regard  to  the  ques- 
tion whether  a  skilled  witness  would  be  permitted  to  demand  a  high 
fee  for  his  attendance  under  such  circumstances,  the  writer  adds: 
"  To  permit  him  legally  to  demand  a  high  fee  would  perhaps  look 
somewhat  like  legally  countenancing  a  bribe."  At  all  events  there 
is  no  such  legal  recognition. 

Lord  Campbell's  dictum  in  reference  to  the  distinction  between 
fact  and  opinion  confers  no  practical  benefit  on  witnesses.  It  is  at 
all  times  difficult  in  science,  and  in  the  medical  sciences  particularly, 
to  separate  them ;  and  if  a  man  appears  to  testify  to  a  medical  or  sci- 
entific fact,  he  cannot  avoid  giving  an  opinion  arising  out  of  the  fact. 
In  a  recent  action  against  a  druggist  for  a  mistake  in  compounding 
medicine,  an  attempt  was  made  to  procure  my  opinion  as  a  skilled 
witness  at  the  trial,  by  reason  of  facts  obtained  from  the  report  of  a 
chemical  analysis,  the  real  object  of  which  was  at  the  time  entirely 
concealed.  The  suit  was  fortunately  compromised,  and  my  attend- 
ance was  not  necessary,  but  such  a  case  should  convey  a  caution  to 


40  SUBPCENAS.      MEDICAL    WITNESSES. 

chemical  experts.  They  may  be  employed  secretly  and  under  untrue 
statements  to  make  analyses ;  these  become  facts  on  which  they  may 
be  summoned  like  ordinary  witnesses  to  give  opinions,  as  skilled  wit- 
nesses, while  the  payment  of  the  usual  fee  for  a  skilled  witness  is 
evaded. 

Medical  Witnesses. — Assuming  that  the  medical  man  has  obeyed 
the  subpcena,  he  will  now  be  required  to  attend  before  the  court,  and 
to  state,  in  the  face  of  adverse  counsel,  the  opinions  which  he  has 
formed  from  the  medical  facts  of  the  case,  as  well  as  the  grounds  for 
these  opinions.  He  will  then,  for  the  first  time,  undergo  the  ordeal 
of  a  public  examination. 

Some  medico- legal  writers  have  considered  it  necessary  to  lay  down 
rules  respecting  the  manner  in  which  a  medical  witness  should  give 
his  evidence;  how  he  is  to  act  on  a  cross-examination,  and  in  what 
way  he  is  to  recover  himself  on  re-examination.  Any  advice  upon 
this  head  appears  to  me  to  be  quite  superfluous ;  since  experience 
shows  that  these  rules,  like  those  given  to  prevent  drowning,  are 
invariably  forgotten  at  the  very  moment  when  the  individual  is  in 
the  situation  in  which  it  is  supposed  he  most  requires  them.  A  man 
who  goes  to  testify  to  the  truth  to  the  best  of  his  ability  should  bear 
in  mind  two  points.  1.  That  he  should  be  well  prepared  on  all  parts 
of  the  subject  on  which  he  is  about  to  give  evidence.  He  should  act 
on  these  occasions  upon  the  advice  contained  in  the  Latin  motto,  ne 
tentes  aut  perfice.  2.  That  his  demeanor  should  be  that  of  an  educated 
man,  and  suited  to  the  serious  occasion  on  which  he  appears,  even 
although  he  may  feel  himself  provoked  or  irritated  by  the  course  of 
examination  adopted.  A  medical  witness  must  not  show  a  testy  dis- 
position in  having  his  professional  qualifications,  his  experience,  his 
means  of  knowledge,  or  the  grounds  for  his  opinions  very  closely 
investigated:  he  should  rather  prepare  himself  to  meet  with  good 
humor  the  attempts  of  an  adverse  counsel  to  involve  him  in  contra- 
diction, and  show  by  his  answers  that  he  has  only  a  desire  to  state 
the  truth.  Law  and  custom  have  long  established  that  a  barrister,  in 
defending  a  prisoner  charged  with  murder,  has  a  right  to  make  use 
of  all  fair  and  even  what  may  appear  to  the  witness  unfair  means  for 
the  defence.  Nothing  can  tend  more  to  lower  a  witness  in  the 
opinion  of  the  court  and  jury,  or  diminish  the  value  of  his  evidence, 
than  the  manifestation  of  a  disposition  to  deal  with  his  examiner  as 
if  he  were  a  personal  enemy,  to  evade  the  questions  put,  or  to  answer 
them  with  flippancy  or  anger.  All  such  exhibitions  invariably  end 
in  the  discomfiture  of  the  witness.  It  has  been  suggested  that  medi- 
cal men  on  these  occasions  might  take  a  lesson  from  lawyers,  and 
observe  how  little  they  allow  forensic  differences,  which  they  put  on 
with  their  professional  costume,  to  influence  them  in  their  intercourse 
with  each  other  or  with  an  adverse  judge  or  jury. 

Medical  men  have  complained,  and  on  many  occasions  justly,  of  the 
license  of  counsel.  On  this  subject  it  may  be  well  to  consider  what  has 
been  said  by  one  of  the  highest  authorities  on  the  bench,  Chief  Jus- 
tice Erie:  "The  law  trusts  the  advocate  with  a  privilege  in  respect 
to  the  liberty  of  speech  which  is  in  practice  bounded  only  by  his  own 


MEDICAL    SECRETS.  41 

sense  of  duty ;  and  he  may  have  to  speak  upon  subjects  concerning 
the  deepest  interests  of  social  life,  and  the  innermost  feelings  of 
the  soul.  The  law  also  trusts  him  with  a  power  of  insisting  upon 
answers  to  the  most  painful  questioning,  and  this  power  again  is  in 
practice  only  controlled  by  his  own  view  of  the  interests  of  truth." 
(Judgment  in  Kennedy  v.  Broun,  1862.)  Thus  it  will  be  seen  that 
almost  unlimited  powers  of  interrogation  are  intrusted  to  counsel  by 
the  law,  and  it  is  a  serious  question  whether  the  unrestricted  use 
(which  it  has  been  justly  remarked  means  only  the  frequent  abuse) 
of  these  enormous  powers  is  necessary  or  even  favorable  to  the 
administration  of  justice. 

One  of  the  most  severe  reprimands  on  this  abuse  came  from  the 
same  learned  judge  in  a  case  which  was  before  him  in  1857 ;  it  was 
addressed  to  a  learned  sergeant  now  deceased,  and  was  to  this  effect — 
A  question  had  been  put  throwing  on  the  witness  an  imputation  for 
which  there  was  really  no  foundation.  The  learned  judge  then  said : 
"The  freedom  of  question  allowed  to  the  bar  was  a  public  nuisance, 
and  the  barrister  who  made  such  an  imputation  ought  to  be  prose- 
cuted. If  a  question  had  relation  to  the  truth,  he  was  most  anxious 
it  should  be  put,  but  to  cast  haphazard  imputations  at  the  suggestion 
of  a  person  (an  attorney)  who  might  have  no  scruples  as  to  what  he 
did,  was  a  degree  of  mischief  that  made  him  wish  that  a  party  should 
be  prosecuted.  He  begged  leave  to  say  that  in  his  experience  he 
had  seen  counsel  so  abuse  their  privilege,  that  he  had  cordially 
wished  a  power  could  be  instituted  that  they  might  be  prosecuted  for 
a  misdemeanor."  It  is  the  general  practice  to  say  that  the  obnoxious 
questions  are  in  the  instructions,  but  a  barrister  can  always  exercise 
a  power  of  putting  or  not  putting  a  question  which  may  be  found  there. 
But  putting  it  he  clearly  adopts  it,  and  frequently  to  the  great  damage 
of  his  own  case.  This  is  at  present  the  only  check  upon  the  practice, 
for  learned  judges  seldom  interfere  unless  directly  appealed  to  by  the 
witness. 

Some  medical  men  have  claimed  a  privilege  not  to  answer  certain 
questions  which  are  put  to  them,  on  the  ground  that  the  matters  have 
come  to  their  knowledge  through  private  and  confidential  communi- 
cations with  their  patients.  It  is  right  to  state  at  once  that  the  law 
concedes  no  special  privilege  of  this  nature  to  members  of  the  medi- 
cal profession.  No  man  is  bound  to  reply  to  any  question  if  the 
answer  would  tend  in  any  way  to  incriminate  himself — for  no  man 
is  compelled  to  be  a  witness  against  himself.  With  this  exception 
all  questions  must  be  answered,  provided  they  are  relevant  to  the 
case,  and  their  irrelevancy  is  a  matter  for  the  consideration  of  the 
learned  judge  who  presides.  A  witness  must  remember,  therefore, 
that  there  are  no  medical  secrets. 

In  the  case  of  the  Duchess  of  Kingston  this  privilege  of  withholding 
statements  was  claimed  by  a  medical  witness  but  rejected.  In  a  case 
in  which  a  female  was  indicted  for  the  murder  of  her  infant,  a  sur- 
geon was  called  to  prove  certain  confessions  made  to  him  by  the 
woman  during  his  attendance.  He  objected,  on  the  ground  that  he 
was  then  attending  her  as  a  private  patient.     The  learned  judge 


42  MEDICAL    PRIVILEGE. 

(Park,  J.)  said  this  was  not  a  sufficient  reason  to  prevent  a  disclosure 
for  the  purposes  of  justice,  and  he  was  ordered  to  answer  the  ques- 
tions. (Beck's  "  Med.  Jurisprudence,"  vol.  ii.  p.  922.)  Any  statements 
therefore  which  are  made  to  physicians  or  surgeons  while  attending 
persons  in  a  private  capacity,  although  they  are  not  to  be  volunteered 
in  evidence,  must  be  given  in  answer  to  questions,  whatever  conse- 
quences may  ensue.  Cases  of  poisoning  and  wounding,  duelling  and 
child-murder,  as  well  as  cases  which  involve  questions  of  life-insu- 
rance, divorce,  or  the  legitimacy  of  offspring,  may  be  materially 
affected  by  the  answers  of  the  medical  man  on  matters  which  have 
been  the  subject  of  private  communications.  A  professional  man 
who  claims  a  privilege  where  none  is  allowed  is  simply  endeavoring 
to  set  himself  above  the  law.  It  is  absurd  to  suppose  that  there  is 
any  real  breach  of  confidence  under  these  circumstances,  because,  as 
Dr.  Gordon  Smith  justly  observes,  "  Society  in  general  receives  the 
authority  of  courts  as  paramount  to  all  obstacles  and  private  conside- 
rations," so  that  in  yielding  to  such  authority,  a  professional  man 
will  be  fully  acquitted  even  in  the  opinion  of  those  who  may  be  the 
sufferers.  The  expressed  opinion  of  the  judge  will  be  a  full  indem- 
nity for  the  witness.  ("Analysis  of  Medical  Evidence,"  p.  98.)  Any 
medical  man,  however,  who  voluntarily  violated  the  confidence 
reposed  in  him  by  a  patient,  or  who  communicated  professional 
secrets  to  counsel  apart  from  a  public  necessity  in  court,  would  justly 
lay  himself  open  to  severe  censure. 

In  Wright  v.  Wilkes  (June,  1865),  a  suit  involving  the  validity  of 
the  will  of  a  lady,  the  only  question  before  the  Vice-Chancellor  (Kin- 
der sley)  was  as  to  the  costs,  occasioned  by  the  refusal  of  a  medical 
witness  to  answer  a  question  as  to  the  disease  of  which  the  testatrix 
died.  The  witness  had  attended  the  testatrix,  and  on  being  asked  of 
what  disease  she  died,  he  refused  to  answer,  on  the  ground  of  profes- 
sional privilege,  and  also  that  the  question  was  irrelevant.  The 
Vice-Chancellor  said,  that  he  could  not  possibly  see  the  relevancy  of 
the  question,  and,  further,  of  what  use  it  was  to  examine  witnesses  at 
all  in  the  cause.  No  reason  was  given  for  so  doing.  The  question  of 
costs  would,  prima  facie,  have  been  left  till  the  hearing  but  that  it 
was  a  dangerous  precedent  to  allow  a  witness  to  decline  answering 
on  such  grounds.  His  honor  was  clearly  of  opinion  that  the  witness 
could  not  claim  professional  confidence  or  irrelevancy  as  an  excuse 
for  not  answering  the  question,  and  he  must  pay  the  costs.  From 
this  judgment  it  will  be  perceived  that,  even  the  refusing  to  answer 
an  irrelevant  question  may  lead  to  the  infliction  of  a  heavy  penalty 
on  a  medical  practitioner.  A  man  who  refuses  to  answer  a  question 
which  the  court  considers  to  be  relevant  and  proper,  may  render 
himself  liable  to  imprisonment  for  contempt  of  court.  [By  the 
Eevised  Statutes  of  New  York  (vol.  ii.  p.  652,  §  103),  and  of  Missouri 
(Code  of  1835,  p.  623,  §  17),  "No  person  duly  authorized  to  practise 
physic  or  surgery  shall  be  allowed  to  disclose  any  information  which 
he  may  have  acquired  in  attending  any  patient  in  a  professional  cha- 
racter, and  which  information  was  necessary  to  enable  him  to  pre- 


MEDICAL    PRIVILEGE.  43 

scribe  for  such  patient  as  a  physician,  or  to  do  any  act  for  him  as  a 
surgeon." — P.] 

This  question  of  medical  privilege  has  presented  itself  on  some 
recent  occasions  in  a  medico- ethical  aspect,  as  where,  for  instance, 
during  his  attendance  on  a  patient  a  suspicion  arises  in  the  mind  of 
a  medical  man  that  the  person  is  undergoing  slow  poisoning.  It  has 
been  supposed  that  when,  under  these  circumstances,  the  poisoner 
was  in  the  medical  profession,  there  would  be  a  breach  of  etiquette 
in  communicating  to  others  the  suspicion  entertained.  There  is  no 
code  of  medical  etiquette  by  which  any  member  of  the  profession  is 
bound  to  conceal  the  fact  of  poisoning  which  he  believes  to  be  going 
on  before  his  eyes,  whether  perpetrated  by  a  medical  man  or  any 
other  person;  and  at  the  same  time  there  is  a  higher  code  of  ethics 
which  makes  the  prevention  of  secret  murder  and  the  safety  of  society 
paramount  to  all  other  considerations. 

A  medical  man  must  take  care  not  to  charge  another  with  a  serious 
crime  upon  loose  suspicions.  If  from  the  nature  of  the  symptoms, 
the  absence  of  any  natural  cause  for  the  illness,  and  the  inefficiency 
of  ordinary  remedies,  he  suspects  that  the  patient  is  under  the  influ- 
ence of  poison,  it  is  his  duty  to  lose  no  time  in  confirming  or  remov- 
ing that  suspicion  by  a  proper  medical  and  chemical  investigation. 
If  his  suspicion  is  confirmed  by  the  discovery  of  poison  in  the  food 
or  urine,  then  steps  must  be  immediately  taken  to  save  the  life  of  the 
patient.  In  Reg.  v.  Wooler  (Durham  Winter  Assizes,  1865),  in  which 
the  prisoner  was  charged  with  the  murder  of  his  wife  by  secretly 
administering  to  her  arsenic,  three  medical  gentlemen  were  in  attend- 
ance. There  was  a  suspicion  that  arsenic  was  being  administered  to 
the  deceased  nineteen  days  before  her  death,  but  the  fact  was  not 
made  known  because  these  gentlemen  were  unable  to  satisfy  them- 
selves conclusively  that  arsenic  was  present  in  the  urine.  They 
appealed  to  a  high  authority  to  aid  them,  but  the  advice  reached 
them  too  late — the  patient  had  died,  and,  as  it  was  clearly  j)roved, 
from  the  effects  of  arsenic.  The  learned  judge  who  tried  this  case  said, 
"  When  the  idea  of  poisoning  struck  them  they  ought  to  have  com- 
municated their  suspicion  to  the  husband  if  they  did  not  suspect  him, 
and  if  they  did  suspect  him,  they  ought  to  have  gone  before  a  magis- 
trate, and  not  have  gone  on  from  the  8th  to  the  27th  of  June  seeing 
the  woman  murdered  before  their  eyes."  Dr.  Christison,  in  comment- 
ing upon  this  case,  very  properly  takes  exception  to  this  advice,  and 
there  can  be  no  doubt  that  any  man  acting  upon  it  would  expose 
himself  to  an  action  for  slander.  "Ideas"  of  poisoning  often  arise  in 
cases  of  disease  where  the  symptoms  deviate  a  little  from  the  ordi- 
nary course,  but  they  are  dismissed  on  further  observation.  If,  in 
the  absence  of  the  means  or  knowledge  of  applying  chemical  tests, 
or  of  taking  the  opinion  of  others  experienced  in  toxicology,  a  medi- 
cal man  charged  the  husband  of  a  lady  with  secret  poisoning,  or  went 
before  a  magistrate  and  charged  him  publicly,  he  would  be  acting 
with  rashness,  ruin  his  own  practice  and  reputation,  and  be  mulct  in 
heavy  damages  for  the  irreparable  injury  done  by  a  false  accusation. 
Such  a  step  should  be  taken  upon  something  more  than  an  idea  or  a 


44  EXAMIXATIOX-IX-CHIEF. 

suspicion.  A  prudent  and  conscientious  man  will  always  await  the 
result  of  a  chemical  analysis  before  giving  publicity  to  a  suspicion 
which  may  after  all  turn  out  to  be  quite  unfounded ;  and  he  will  lose 
no  time  in  obtaining  this  necessary  confirmation  or  a  removal  of  his 
doubts. 

When  the  suspicion  is  confirmed,  there  is  some  difference  of  opinion 
as  to  the  course  to  be  pursued.  Dr.  Christison  advises  that  when  the 
medical  man  is  satisfied  of  the  fact  of  poisoning  he  should  communi- 
cate his  conviction  to  the  patient  himself,  and  that  he  ought  not  to  be 
deterred  by  the  chance  of  injury  to  his  patient  from  making  even  so 
dreadful  a  disclosure.  He  will  have  thus  taken  the  surest  prepara- 
tive step  to  prevent  a  repetition  of  the  poisoning.  Whether  this 
communication  be  made  to  the  patient  or  not,  the  proper  course  will 
be  to  place  the  matter  immediately  in  the  hands  of  a  magistrate  for 
investigation.  Some  years  since  I  was  consulted  in  a  case  of  sup- 
posed slow  poisoning.  The  symptoms  suffered  by  a  lady,  taken  as  a 
whole,  were  not  reconcilable  with  any  disease.  The  medical  gentle- 
man had  an  "idea"  that  poison  might  possibly  be  the  cause,  but 
before  acting  upon  this  idea  he  sent  to  me  a  portion  of  urine  for 
examination.  Antimony  was  found  in  it,  and  the  cause  of  the  symp- 
toms was  at  once  explained.  He  communicated  the  result  of  the  ana- 
lysis to  the  members  of  the  family,  and  the  symptoms  of  poisoning 
ceased  from  that  time!  The  error  committed  by  medical  men  even 
on  these  occasions  is  not  in  claiming  a  privilege  of  concealment,  but 
in  allowing  a  doubt  upon  so  serious  a  question  to  remain  in  their 
minds  for  days  or  weeks. 

This  question  was  again  brought  into  prominence  at  the  trial  of 
Dr.  Pritchard,  at  Edinburgh  (July,  1865),  on  the  charge  of  poisoning 
his  wife  with  antimony.  One  of  the  medical  witnesses,  who  saw  the 
deceased  a  fortnight  before  her  death  and  at  other  times,  stated  in  his 
evidence  at  the  trial  that  he  suspected  she  was  suffering  from  the 
effects  of  antimony  when  he  first  saw  her,  but  it  seems  that  there  the 
matter  was  allowed  to  remain.  No  one  was  accused,  but  no  step  was 
taken  to  prevent  the  continuance  of  the  poisoning,  the  suspicion  of 
which  turned  out  to  be  well-founded.  The  Lord  Justice  Clerk,  who 
tried  this  case,  is  reported  to  have  said  that  no  notions  of  medical 
etiquette  should  be  permitted  to  interfere  with  those  higher  duties 
which  every  right-minded  man  owes  to  his  neighbor,  and  which  are 
to  be  expected  in  a  tenfold  degree  from  every  medical  man,  because 
his  life  is  solemnly  devoted  to  the  preservation  of  life,  and  the  pre- 
vention of  its  destruction. 

Examination-in-chief.  —  The  ordinary  course  of  proceeding  in  a 
criminal  case  is  thus  concisely  stated  by  Mr.  Fitzjames  Stephen 
("Criminal  Law  of  England,"  pp.  168,  282).  After  opening  the  case 
the  counsel  for  the  crown  calls  the  witnesses,  and  examines  them 
according  to  the  rules  of  evidence — that  is,  he  brings  out,  by  ques- 
tions which  do  not  suggest  their  answers,  the  facts  relevant  to  the  issue 
to  be  tried  which  are  within  his  personal  knowledge.  Those  ques- 
tions which  suggest  the  answers  are  called  "leading"  questions. 
With  one  exception  it  is  not  the  practice  to  allow  these  to  be  put  in 


CROSS-EXAMINATION".  45 

this  part  of  the  examination.  The  exception  according  to  Mr.  Ste- 
phen is :  "  When  the  judge  is  satisfied,  either  by  a  witness's  demeanor 
or  by  contradictions  between  the  evidence  and  the  depositions,  that 
he  is  trying  to  keep  back  the  truth  and  favor  the  prisoner,  he  may, 
in  his  discretion,  allow  the  counsel  for  the  crown  to  ask  leading 
questions,  and,  as  the  phrase  is,  to  treat  the  witness  as  hostile." 
When  the  examination-in-chief  is  closed,  the  next  step  is  the  cross- 
examination. 

Cross-examination. — In  this,  the  second  stage,  the  counsel  for  the 
prisoner  extracts  from  the  medical  witness,  by  questions  which  may 
suggest  the  answers  in  the  strongest  form,  any  facts  that  may  appear  to 
be  favorable  to  the  client,  and  which  he  believes  to  be  within  the 
witness's  knowledge.  Leading  questions  are  not  only  allowable  in 
this  part  of  the  examination,  but,  according  to  good  authority,  a 
counsel  for  the  defence  can  hardly  lead  too  much.  The  theory  of  the 
law  is  that  the  witness  is  unfavorable  to  the  prisoner  and  has  come 
to  bear  evidence  against  him.  The  more  he  has  shown  himself  by 
conduct  or  conversation  a  partisan  in  the  case,  the  more  severely  will 
he  be  treated.  Anything  which  he  may  have  said  in  the  hearing  of 
others,  or  published  in  journals,  or  even  written  in  private  letters  (if 
the  contents  transpire)  in  reference  to  the  case  or  the  guilt  of  the 
prisoner,  is  now  brought  to  light,  although  he  may  have  supposed 
that  what  he  did  say  was  in  perfect  confidence.  It  is  at  this  stage  of 
the  case  that  any  exaggerations  which  may  have  been  most  favorably 
received  by  the  counsel  for  the  prosecution  are  reduced  to  their  true 
proportions.  Any  bias  by  which  the  mind  of  a  witness  may  have 
been  influenced,  or  any  imperfection  or  confusion  of  memory  as  to 
facts,  is  here  brought  out.  (Stephen,  p.  177.)  It  is  in  this  part  of  his 
examination  that  the  witness  will  be  closely  questioned  as  to  his 
qualifications,  the  time  during  which  he  has  been  engaged  in  prac- 
tice, the  accuracy  of  his  judgment,  his  general  professional  knowledge, 
and  his  special  experience  in  reference  to  the  matter  in  issue,  the 
number  of  cases  he  has  seen,  &c.  Straightforward  answers  should  be 
given  to  all  questions.  No  harm  can  be  done  to  the  witness  by  the 
answers  unless  they  are  given  evasively,  since  it  is  not  to  be  supposed 
that  the  witness  wishes  to  represent  himself  differently  from  what  he 
is.  If  he  does  make  the  attempt,  he  will  assuredly  fail.  The  most 
striking  distinction  between  the  examination-in-chief  and  cross-ex- 
amination is  in  reference  to  leading  questions.  It  rests  upon  the 
assumption  that  there  is  a  danger  that  a  witness  will  say  whatever  is 
suggested  to  him  by  the  one  side,  and  conceal  everything  that  is  not 
extorted  from  him  on  the  other.  It  need  scarcely  be  observed  that 
witnesses  whose  evidence  is  of  little  importance  in  the  case  are  rarely 
cross-examined.  This  is  reserved  in  its  most  stringent  form  for  those 
whose  facts  and  opinions  are  likely  to  affect  the  fate  of  a  prisoner  in 
a  criminal  trial.  In  dealing  with  a  skilled  witness  whose  evidence 
may  be  of  importance,  the  questions  in  cross-examination  are  usu- 
ally put  by  the  counsel  for  the  prisoner  with  great  caution,  or  the 
answers  brought  out  may  be  more  adverse  to  his  own  case  than  those 
elicited  in  the  examination-in-chief. 


46  PRESENCE    OF    WITNESSES    IN    COURT. 

Re-examination. — The  cross-examination  is  usually  followed  by  a 
re-examination  on  the  part  of  the  counsel  for  the  crown,  or  of  the 
counsel  by  whom  the  witness  has  been  called.  The  object  of  this  is 
to  clear  up  or  explain  any  portion  of  the  evidence  which  may  have 
been  rendered  obscure  or  doubtful  by  the  cross-examination.  It  is 
sometimes  unnecessary  to  put  a  question,  and  if  the  witness  has 
given  his  evidence  consistently  and  fairly  no  questions  may  be  asked. 
As  a  rule  the  re-examination  must  be  confined  to  those  matters  which 
have  arisen  out  of  the  cross-examination.  Any  questions  upon  new 
subjects  may  render  a  further  cross-examination  on  them  necessary. 
In  reference  to  facts,  a  medical  witness  must  bear  in  mind  that  he 
should  not  allow  his  testimony  to  be  influenced  by  the  consequences 
which  may  follow  from  his  statement  of  them,  or  their  probable  effect 
on  any  case  which  is  under  trial.  In  reference  to  opinions,  their  pos- 
sible influence  on  the  fate  of  a  prisoner  should  inspire  caution  in 
forming  them,  but  when  once  formed  they  should  be  honestly  and 
candidly  stated  without  regard  to  consequences.  It  will  be  well  to 
remember,  in  reference  to  each  stage  of  the  examination,  what  a  great 
medical  authority  has  said:  "To  make  a  show  and  appear  learned 
and  ingenious  in  natural  knowledge  may  flatter  vanity.  To  know 
facts,  to  separate  them  from  supposition,  to  arrange  and  connect 
them,  to  make  them  plain  to  ordinary  capacities,  and  above  all  to 
point  out  their  useful  applications,  should  be  the  chief  object  of 
ambition."  (William  Hunter.) 

Quotations  from  Boohs. — It  is  a  not  unfrequent  custom  with  counsel 
to  refer  to  medical  works  during  the  examination  of  a  witness.  He 
is  expected  to  have  a  fair  knowledge  of  the  writings  of  professional 
men  on  the  siibject  of  inquiry.  The  authority  is  mentioned,  the  pas- 
sage is  quoted,  and  the  witness  may  be  then  asked  whether  he  agrees 
with  the  views  of  the  author  or  whether  he  differs,  and  if  so,  his  rea- 
sons. In  cases  connected  with  medical  treatment,  the  views  of  the 
profession  are  and  have  been  so  various,  that  a  barrister  would  have 
no  great  difficulty  in  finding  some  book  to  oppose  to  the  opinions  of 
a  witness.  Standard  works  of  recent  date  are  so  well  known  to  the 
profession  that  there  are  few  medical  men  engaged  in  practice  who 
are  not  well  acquainted  with  and  able  to  explain  the  views  of  the 
writers,  and  how  far  they  agree  or  conflict  with  his  own.  The  wit- 
ness must  be  on  his  guard  that  the  question  is  fairly  put,  and  that  it 
is  properly  taken  with  the  context,  or  he  may  unexpectedly  find 
himself  involved  in  a  difficulty.  On  one  occasion,  I  found  that  a 
learned  gentleman  stopped  in  his  quotation  at  a  comma,  and  on 
another  occasion  the  quotation  ended  at  a  colon — the  remainder  of 
the  sentence  in  each  case  materially  weakening  the  inference  which 
it  was  intended  to  draw  with  the  apparent  sanction  of  the  witness. 

Presence  in  Court. — In  England  medical  and  scientific  witnesses, 
except  under  special  circumstances,  are  allowed  to  be  present  in  court 
and  hear  the  whole  of  the  evidence  in  the  case.  This  is  in  some 
instances  absolutely  necessary  if  the  court  requires  medical  opinions, 
for  unless  the  witnesses  are  fully  acquainted  with  the  facts  they  can 
give  no  opinions,  and  they  can  only  become  fully  acquainted  with 


PRESENCE    OF    WITNESSES    IN    COURT.  47 

the  facts  by  being  allowed  to  be  present  and  hearing  the  evidence  in 
court.  If  excluded,  the  judge  or  counsel  will  be  compelled  to  read 
to  the  witness  notes  of  the  evidence  before  an  opinion  can  be  given, 
and  it  may  then  appear  that  some  small  point  which  counsel  did  not 
think  of  importance  is  omitted;  this  if  known  to  the  witness  might, 
however,  materially  affect  his  opinion.  A  failure  of  justice  is  likely 
to  occur  when  medical  witnesses  are  excluded,  and  it  is  generally 
when  there  is  no  defence  or  a  false  defence  that  the  right  of  excluding 
them  is  exercised.  The  rule  in  Scotland  is  similar;  medical  and  sci- 
entific witnesses  are  allowed  to  be  in  court  during  the  trial. 

The  examination  of  the  witnesses  for  the  crown  is  followed  by  the 
defence  of  the  prisoner,  either  in  person  or  by  his  counsel,  who  acts 
throughout  the  part  of  an  advocate,  simply  securing  for  his  client 
every  advantage  the  facts  or  the  law  may  afford  him.  In  other 
words,  he  sees  that  his  client  is  strictly  tried  according  to  law,  and 
not  condemned  contrary  to  law.  A  key  to  some  of  the  difficulties 
which  medical  witnesses  must  be  prepared  to  encounter  will  be  found 
in  the  exposition  given  by  Mr.  Stephen  of  the  tacit  rules  which  regu- 
late the  duties  of  counsel  for  the  prosecution  and  defence:  "In  prac- 
tice it  is  universally  admitted  that  the  counsel  for  the  prosecution  is 
morally  and  professionally  bound  always  to  keep  in  sight  the  ulti- 
mate object — namely,  the  discovery  of  truth ;  whereas  no  such  obli- 
gation is  laid  upon  the  prisoner  and  those  who  represent  him,  because 
it  is  too  much  to  expect  of  human  nature  that  they  should  discharge 
it,  and  it  is  better  not  to  impose  an  obligation  which  is  sure  to  be 
systematically  violated.  Both  sides,  on  the  other  hand,  are  bound 
in  the  strongest  way  not  to  do  anything  to  propagate  falsehood.  The 
counsel  for  the  crown  is  bound  not  to  suppress  any  fact  within  his 
knowledge  favorable  to  the  prisoner;  and,  on  the  other  hand,  the 
counsel  for  the  prisoner  is  bound  not  to  bring  to  light  facts  within 
his  knowledge  unfavorable  to  the*  prisoner."  "  The  counsel  for  the 
crown  may  not  use  arguments  to  prove  the  guilt  of  the  prisoner 
which  he  does  not  himself  believe  to  be  just,  and  he  is  bound  to  warn 
the  jury  of  objections  which  may  diminish  the  weight  of  his  argu- 
ments; in  short,  as  far  as  regards  the  evidence  which  he  brings  for- 
ward, his  speech  should  as  much  as  possible  resemble  the  summing- 
up  of  the  judge.  He  should  contend  not  for  the  success  of  his  cause 
at  all  events,  but  for  the  full  recognition  by  the  judge  and  jury  of  that 
side  of  the  truth  which  makes  in  favor  of  it.  On  the  other  hand,  the 
counsel  for  the  prisoner  may  use  arguments  which  he  does  not  believe  to 
be  just.  It  is  the  business  of  the  jury,  after  hearing  the  judge,  to  say 
whether  they  are  or  are  not  just."  (Op.  cit.,  pp.  160  and  168.)  The 
last  remark  shows  what  appears  to  be  a  serious  defect  in  the  admin- 
istration of  the  criminal  law.  While  in  a  case  of  misdemeanor  a 
prisoner  may  be  tried  by  a  special  jury,  in  a  case  of  felony,  involving 
an  analysis  of  important  questions  of  medical  science  in  reference  to 
murder  or  manslaughter,  the  trial  takes  place  before  a  common  and 
comparatively  ignorant  jury.  Such  a  jury  is  hardly  in  a  position  to 
cope  with  an  ingenious  counsel,  who  has  it  in  his  power  to  misrepre- 
sent and  distort  medical  facts  and  opinions  in  any  manner  that  he 


48  RULES    RESPECTING    THE 

pleases.  The  defences  made  are  frequently  such  as  no  barrister  would 
venture  to  place  before  a  jury  of  educated  men.  These  "powerful" 
or  "forcible"  addresses,  as  they  are  termed  by  the  press,  full  of  burn- 
ing eloquence  and  impassioned  logic,  have  frequently  withdrawn  the 
attention  of  the  jury  from  the  real  facts,  and  have  procured  verdicts 
of  acquittal  contrary  to  the  evidence  and  all  the  medical  circum- 
stances of  the  case. 

Another  observation  made  by  Mr.  Stephen  more  nearly  concerns 
the  medical  witness:  "There  are  many  obligations  which  effect  each 
side  equally.  Neither  is  at  liberty  to  attempt  to  browbeat,  intimi- 
date, or  confuse  a  witness,  although  they  may  expose  any  real  confu- 
sion which  exists  in  his  mind,  or  test,  by  the  strictest  cross-examina- 
tion, the  accuracy  of  his  statements.  Neither  is  at  liberty  wilfully  to 
misunderstand. a  witness,  or  to  misstate,  in  his  address  to  the  jury,  the 
effect  of  what  he  has  said,  either  by  distortion  or  suppression.  The 
neglect  or  observation  of  these  and  other  rules  of  the  same  kind 
practically  establishes  a  wide  distinction,  and  one  which  is  easily 
recognized,  between  those  who  exercise  a  noble  profession  and  those 
who  disgrace  it."  (Op.  cit.,  p.  168.) 

The  treatment  of  a  medical  witness,  in  passing  through  the  ordeal 
of  an  examination  at  a  criminal  trial,  will  depend  therefore  very 
much  upon  the  class  of  counsel  who  is  opposed  to  him.  Assuming 
that  he  is  properly  prepared  for  the  discharge  of  his  duties,  and  that 
the  questions  put  to  him  are  answered  fairly  and  truly,  according  to 
his  knowledge  and  experience,  without  exaggeration  or  concealment, 
he  has  no  reason  to  fear  any  attempt  at  intimidation.  Barristers,  for 
the  most  part,  know  that  by  this  line  of  conduct  they  lose  more  with 
the  jury  than  they  gain  by  the  attempt  to  confuse  the  witness ;  and 
as  their  ultimate  and  sole  object  is  a  favorable  verdict,  they  will 
generally  avoid  conduct  which  must  necessarily  place  this  verdict  in 
jeopardy. 

The  normal  barrister,  as  depicted  by  Mr.  Fitzjames  Stephen,  is  not 
at  liberty  in  his  address  to  the  jury,  to  misrepresent,  either  by  dis- 
tortion or  suppression,  the  medical  facts  or  opinions  given  in  a  case. 
According  to  my  experience,  however,  misrepresentation  is  a  not 
unfrequent  practice,  and  one  of  which  medical  witnesses  have  very 
strong  reason  to  complain.  Whether  such  misstatements  are  wilful 
or  not  it  may  be  difficult  to  determine,  but  their  effect  on  the  jury  is 
well  known  to  those  who  employ  them,  and  they  frequently  escape 
the  observation  of  the  counsel  on  the  other  side,  and  even  of  the 
learned  judge,  unless  he  is  well  versed  in  medical  subjects.  It  is  also 
worthy  of  remark,  that  if  a  misstatement  is  thus  made,  it  is  by  a 
remarkable  coincidence  always  in  favor  of  the  view  of  the  counsel 
who  makes  it,  when  a  proper  examination  of  his  notes  would,  in 
general  show  him  that  he  was  wrong. 

Then  as  to  the  question  of  intimidation,  this  is  sometimes  carried 
very  far.  On  a  trial  for  murder  by  poisoning,  I  have  heard  a  respect- 
able country  practitioner,  who  had  given  his  evidence  for  the  crown 
in  a  fair  and  proper  manner,  thus  addressed  in  cross-examination  by 
a  learned  counsel,  now  deceased:  "On  your  oath,  sir,  and  in  the  face 


EXAMINATION    OF    WITNESSES.  49 

of  the  whole  profession,  will  you  venture  to  persist  in  that  state- 
ment?" &c.  It  may  be  that  criminal  cases  fall  more  into  the  hands 
of  the  second  class  of  barristers  to  whom  Mr.  Stephen  alludes — 
namely,  those  who  disgrace  a  noble  profession.  But  it  is  a  widely 
spread  opinion  in  the  medical  profession,  that  this  style  of  examining 
educated  men,  who  are  perhaps  compelled  most  unwillingly  to  appear 
on  a  subpoena  to  testify  to  facts,  is  certainly  not  adapted  to  elicit  the 
truth,  but  rather  to  favor  the  escape  of  criminals  and  give  impunity 
to  crime. 

It  may  be  fairly  admitted  that  a  man  who  puts  himself  forward  as 
a  witness,  and  attempts  to  elucidate  what  he  only  succeeds  in  render- 
ing more  obscure,  should  receive  no  favor  at  the  hands  of  the  bar. 
Dr.  El  well,  a  member  of  the  legal  as  well  as  of  the  medical  profes- 
sion, observes  that  "No  witness  is  ever  compelled  to  appear  and  tes- 
tify to  what  he  does  not  know.  He  may  be  compelled  to  attend  in 
court  in  obedience  to  a  subpoena,  but  if  he  attempts  to  testify  upon  a 
subject  requiring  opinions  upon  which  he  has  no  well-settled  or  well- 
defined  ideas,  it  is  his  own  fault,  and  he  alone  is  to  blame ;  for  no  one 
but  himself  can  know  so  well  as  he,  until  he  has  exposed  himself,  how 
unfit  he  is  for  the  occasion."  (Medico-legal  Treatise  on  "  Malpractice 
and  Medical  Evidence,"  by  J.  J.  Ewell,  M.D.,  Member  of  the  Cleve- 
land Bar,  New  York,  1860,  p.  302.)  But  let  us  take  the  case  of  a 
practitioner,  who,  in  a  country  district,  has  gone  through  twenty 
years  of  practice  with  honor  and  credit  in  his  neighborhood,  and  who 
is  suddenly  called  to  a  case  in  which  a  man  is  found  dead  from  a 
wound  in  his  throat.  Under  the  Medical  "Witnesses'  Act  he  is  com- 
pelled to  make  an  examination  of  the  body  for  a  coroner's  inquest. 
At  a  great  loss  of  time,  and  for  no  adequate  remuneration,  he  attends 
the  inquest  and  gives  his  evidence;  he  is  bound  over,  nolens  volens, 
to  appear  for  the  first  time  as  a  witness  at  a  criminal  trial,  and  to  tes- 
tify, 1st,  to  the  throat  being  cut,  and  2dly,  to  give  his  opinion  to  the 
court  on  the  cause  of  death,  and  whether  the  wound  was  inflicted  by 
the  deceased  on  himself,  or  by  another  person.  A  medical  man  who 
limited  himself  to  the  statement  of  the  bare  fact  that  the  deceased's 
throat  was  cut  need  not  appear  at  all,  for  this  evidence  might  be 
supplied  by  a  constable  or  policeman ;  but  the  law  presumes  from  his 
profession,  that  the  medical  man  made  a  proper  examination  of  the 
wound,  with  a  view  to  determine  to  the  best  of  his  ability,  whether 
it  was  the  cause  of  death  and  whether  it  was  or  was  not  self-inflicted. 
It  is  difficult  to  understand  how  a  medical  man,  although  before  this 
occurrence  he  may  never  have  seen  a  case  of  cut-throat,  could  excuse 
himself  from  giving  an  answer  to  these  questions,  both  of  which 
involve  purely  matters  of  opinion.  If  he  excused  himself  altogether 
from  giving  answers,  there  would  be  a  failure  of  justice,  and  no  con- 
viction for  such  a  common  form  of  murder  could  ever  take  place. 
If,  on  the  other  hand,  he  answers  these  questions  to  the  best  of  his 
ability,  he  may  reasonably  complain  that  while  thus  compelled  to- 
appear  as  a  witness  to  testify  to  what  he  does  know,  his  evidence 
should,  by  rules  of  law,  be  made  the  subject  of  abuse  and  ridicule 
before  his  neighbors,  when  he  expresses  his  opinion  from  the  facts;, 
4 


50  RULES    FOR    THE    DELIVERY 

and  that  the  counsel  who  examines  him  legally  possesses  an  unlimited 
power  of  misrepresenting  his  views.  A  medical  man  is  certainly  not 
benefited  by  being  described  as  an  ignoramus  or  a  blunderer  in  his 
profession,  whom  no  one  ought  to  trust.  The  truth  is,  in  medical 
evidence  facts  and  opinions  cannot  be  separated,  and  if  medical  prac- 
titioners were  restricted  in  their  evidence  only  to  those  facts  which 
they  had  observed  in  a  case,  in  which  no  other  professional  man  saw 
the  person  living  or  dead,  it  is  difficult  to  understand  how  crime  could 
be  detected  and  punished.  These  remarks  of  course  do  not  apply  to 
cases  in  which  the  opinions  of  medical  experts  can  be  taken.  Here 
it  would  be  desirable  that  one  who  has  not  had  experience  on  the 
subject  should  avoid  giving  any  opinion ;  he  might  simply  state  the 
facts,  and  decline  from  want  of  experience  to  give  an  opinion  on  the 
conclusions  to  which  they  lead.  In  pursuing  any  other  course,  he 
will  find  that  the  whole  weight  of  the  cross-examination  will  fall 
upon  him. 

There  are  other  remarks  on  this  subject  made  by  Dr.  Elwell,  which 
those  who  are  compelled  to  attend  as  witnesses  in  a  court  of  law  will 
do  well  to  bear  in  mind :  "  However  anxious  an  incompetent  witness 
may  be  to  appear  learned,  and  however  hard  he  may  labor  to  show 
it,  he  will  ever  find  it  a  difficult  business  to  make  the  court  and 
counsel  believe  that  he  is  really  so.  To  appear  really  learned  he 
must  be  able  to  make  the  subject  on  which  he  gives  an  opinion  clear, 
and  to  give  satisfactory  reasons  for  this  opinion.  He  must  be  not  only 
a  thinker,  but  must  satisfy  others  that  he  is  master  of  his  subject. 
Take  almost  any  one  of  the  important  scientific  questions  upon  which 
a  professional  witness  is  called  to  pass  an  opinion,  and  unless  he  has 
looked  at  the  subject  before  with  a  purpose  to  understand  it — comprehend- 
ing its  extent,  weight,  and  relations — he  will  find  it  to  have  suddenly 
assumed  an  importance  he  had  not  suspected,  just  at  the  time  when 
the  discovery  will  add  to  his  confusion.  It  is  better  to  make  this 
discovery  in  the  quiet  stillness  and  security  of  solitude,  than  under 
the  eye  of  a  judge  and  the  severe  scrutiny  of  counsel.  A  man, 
whether  learned  or  not — whether  in  court  or  out  of  court — will  talk 
clearly  upon  a  subject  he  well  understands,  whether  it  is  scientific  or 
otherwise,  but  unless  it  is  clear  in  his  own  mind  his  account  of  it  will 
be  confused  and  unsatisfactory."  (Op.  cit.,  p.  303.)  This  is  undoubtedly 
the  test  to  which  every  man  should  rigorously  submit  himself  before 
entering  the  witness-box.  The  case  should  be  viewed  in  all  possible 
aspects,  and  if  an  opinion  had  been  formed,  it  should  be  dealt  with 
and  criticized  as  if  it  were  that  of  an  adversary.  As  in  controversy, 
a  disputant  should  place  himself  as  much  as  possible  in  the  position 
of  his  antagonist,  and  see  the  question  from  his  point  of  view.  In 
this  kind  of  self-examination  it  may  be  well  to  remember  two  points 
• — 1st,  that  there  is  no  opinion  so  certain  as  that  the  human  mind,  if 
left  to  itself,  will  not  infallibly  raise  a  difference  of  opinion  upon  it ; 
and  2dly,  that  a  man  is  never  so  near  an  error  as  when  he  claims  a 
complete  immunity  from  error. 

Rules  for  the  Delivery  of  Evidence. — There  are  a  few  rules  bearing 
upon  medical  evidence  which,  if  observed,  may  save  the  witness 


OF    MEDICAL    EVIDENCE.  51 

from  interruption  or  reproof  and  place  him  in  a  favorable  position 
with  the  court : — 

1.  The  questions  put  on  either  side  should  receive  direct  answers, 
and  the  manner  of  the  witness  should  not  be  perceptibly  different 
whether  he  is  replying  to  a  question  put  by  the  counsel  for  the  prosecu- 
tion or  for  the  defence. 

For  reasons  elsewhere  assigned  (p.  44),  most  of  the  questions  put 
by  counsel  in  cross-examination  will  admit  of  an  answer  "yes"  or 
"  no."  If,  from  the  ingenious  or  casuistical  mode  in  which  the  ques- 
tion is  framed,  the  witness  should  feel  that  the  simple  affirmative  or 
negative  might  mislead  the  court,  then,  after  giving  the  answer,  he 
can  appeal  to  the  judge  to  allow  him  to  qualify  it,  or  add  to  it  any 
matter  within  his  own  knowledge  and  which  is  at  the  same  time  rele- 
vant to  the  case.  The  witness  must  remember  that  he  takes  an  oath 
to  state  the  truth,  the  ivhole  truth,  and  nothing  but  the  truth.  On  the 
other  hand,  while  the  counsel  for  the  defence  is  bound  not  to  intro- 
duce falsehood,  his  object  is  not  the  discovery  or  development  of 
truth.  Unless  the  witness  is  on  his  guard,  he  may  find,  when  the 
learned  counsel  who  has  cross-examined  him  addresses  the  jury,  that 
his  affirmatives  and  negatives  may  be  worked  into  a  shape  represent- 
ing the  reverse  of  what  he  intended. 

Some  counsel  adopt  the  ingenious  plan  of  compressing  two  or  three 
questions  into  one.  A  witness  unthinkingly  answers  the  last,  or  that 
which  most  fixes  his  attention.  The  same  answer  may  not  be  strictly 
applicable  to  all,  but  the  witness  may  find,  when  too  late,  that  it  is 
made  so  in  the  defence.  In  this  case  he  should  ask  for  a  severance 
of  the  questions  and  give  separate  replies. 

Direct  answers  are  necessary,  because  it  is  only  by  them  that  the 
case  can  be  brought  clearly  before  the  court  and  jury  in  all  its  details. 
Medical  witnesses  sometimes  forget  this,  and  fall  into  answers  to 
questions  floating  in  their  own  minds,  or  which  they  think  are  likely 
to  be  put  to  them.  They  are  also  sometimes  disposed  to  anticipate 
many  questions  by  one  general  answer.  This  simply  creates  confu- 
sion, and  the  witness  will  be  told  by  counsel  to  keep  to  the  question, 
and  that  he  is  coming  to  the  other  matters  presently. 

Care  should  be  taken  by  the  medical  witness  not  to  argue  with  the 
learned  counsel.  Argument  is  not  evidence,  and  the  entering  into 
it  disturbs  the  order  of  the  proceedings.  Arguments  between  coun- 
sel and  witnesses,  and  even  between  medical  witnesses  themselves, 
are  freely  allowed  in  the  French  Courts,  but  in  England  such  a  prac- 
tice is  not  recognized.  The  mode  in  which  questions  are  put  by 
counsel  in  cross-examination  sometimes  tends  to  the  introduction  of 
argument,  but  the  witness  should  avoid  the  temptation  to  enter  into 
it.  What  he  says  under  such  circumstances  is  not  evidence,  except 
in  the  form  of  answers  to  questions,  and  he  is  there  only  for  the  pur- 
pose of  stating  what  is  relevant  to  the  case. 

There  is  a  difference  between  evidence  and  testimony.  A  medical 
witness  sometimes  gives  much  in  the  form  of  testimony  which  amounts 
to  very  little  as  evidence.  When  he  does  not  attend  to  the  questions, 
he  testifies  to  a  variety  of  subjects  which  have  no  bearing  on  the 


52    EULES  FOR  DELIVERY  OF  MEDICAL  EVIDENCE. 

case,  and  do  not  constitute  evidence.     The  decision  on  what  is  and 
what  is  not  evidence  lies  with  the  judge. 

2.  The  replies  should  be  concise,  distinct  and  audible,  and,  except 
where  explanation  may  be  necessary,  they  should  be  confined  strictly 
to  the  terms  of  the  questions.  The  learned  judge  who  tries  the  case, 
generally  takes  full  notes  of  the  medical  evidence — hence  the  neces- 
sity for  a  slow  and  distinct  delivery  of  the  evidence.  Some  witnesses 
have  a  singular  habit  of  not  answering  the  question  which  is  asked 
but  one  which  is  not  asked.  Others  give  an  answer  in  such  a  voluble 
form,  in  the  shape  of  a  small  speech  or  lecture,  that  there  is  great 
difficulty  in  reducing  it  to  its  proper  proportions.  A  witness  who  is 
so  profuse  of  information  generally  supplies  abundant  matter  for  a 
long  and  troublesome  cross-examination. 

It  has  been  a  question  whether  a  witness  should  volunteer  evidence, 
assuming  that  the  examination-in-chief  and  cross-examination  have 
failed  to  bring  out  all  that  he  knows  of  the  case.  If  that  which  he 
has  to  state  is  some  matter  of  fact  within  his  own  knowledge,  or  an 
opinion  based  on  facts  within  his  knowledge,  he  will  be  allowed,  on 
application  to  the  judge,  to  make  the  statement  in  spite  of  the  efforts 
of  counsel  on  either  side  to  shut  it  out. 

It  is  scarcely  necessary  to  observe,  that  the  language  in  which  the 
answers  are  returned  should  neither  be  flippant  nor  metaphorical. 
Counsel  who  are  unacquainted  with  medical  terms  frequently  mis- 
apply them,  or  use  them  in  a  wrong  sense.  There  are  few  barristers 
who  are  aware  that  the  term  "symptom"  is  confined  to  the  living 
body,  and  "  appearance"  to  the  dead  ;  and  the  witness  may  thus  find 
himself  questioned  on  the  "  appearances"  when  he  first  saw  the  pa- 
tient, or  the  "  symptoms"  which  he  observed  on  the  post-mortem 
examination  of  the  stomach  and  bowels.  On  a  trial  for  murder,  in 
which  one  of  the  questions  at  issue  was  whether  dysentery  or  poison 
was  the  cause  of  death,  the  learned  counsel  puzzled  one  of  the  med- 
ical witnesses  by  asking  him  whether  during  his  attendance  he  found 
any  traces  of  "  dysuria"  in  the  feces !  There  is  no  doubt  he  intended 
a  state  of  the  feces,  like  that  met  with  in  dysentery,  but  the  pro- 
fessional term  employed  by  him  signified  a  "  difficulty  in  passing 
urine."  A  judicious  witness  will  avoid  anything  like  a  triumph  over 
his  examiner  under  such  circumstances,  and  simply  put  him  right. 

3.  Answers  to  questions  should  be  neither  ambiguous,  undecided, 
nor  evasive.  An  ambiguous  answer  necessarily  leaves  the  witness's 
meaning  doubtful,  and  calls  for  an  explanation.  An  undecided 
answer — indicated  by  the  words  "I  believe,"  or  "I, think,"  or  "lit 
might  be," — is  not  sufficient  for  evidence.  Did  the  wound  cause 
death  ?  Was  death  caused  by  loss  of  blood  or  poison  ?  If,  by  a 
proper  consideration  of  all  the  medical  tacts,  the  witness  has  come 
to  a  conclusion  on  the  subject,  his  answer  should  be  expressed  in 
plain  and  decided  language,  either  in  the  affirmative  or  negative.  A 
man  who  has  formed  no  conclusion  is  not  in  a  position  to  give  evi- 
dence. No  opinion  should  be  given  for  which  the  witness  is  not  pre- 
pared to  assign  reasons,  and  except  by  permission  of  the  court,  no 
medical  opinion  should  be  expressed  on  facts  or  circumstances  ob- 


TECHNICAL    TERMS.  53 

served  by  others.  A  hesitating  witness  will  be  met  with  the  ques- 
tion, Have  you  any  doubt  about  it  ?  or,  Was  it  so  or  not  ? — to  which 
a  reply  in  the  affirmative  or  negative  must  be  given.  If  the  witness 
fairly  entertains  doubts  about  the  matter  at  issue,  it  is  his  duty  to 
express  them,  and  not  allow  them  to  be  extorted  from  him  piecemeal 
by  a  series  of  questions. 

Chemical  witnesses  have  occasionally  certified  to  the  discovery  of 
"imperceptible,"  "unmistakable,"  or  "undoubted"  traces  of  poison 
in  the  liver,  &c.  Such  terms  naturally  convey  to  the  shrewd  mind  of 
an  examiner  that  the  witness  has  some  lurking  doubt  or  suspicion  of 
mistake  in  his  mind,  for  that  of  which  we  are  sure  requires  no  such 
terms  to  express  our  meaning.  If  poison  has  been  discovered,  the 
statement  of  the  fact  is  sufficient. 

4.  The  replies  should  be  made  in  simple  language,  free  from  tech- 
nicality. Some  remarks  have  been  elsewhere  made  in  reference  to 
the  use  of  technical  terms  in  drawing  up  medico-legal  reports  (p.  30). 
If  medical  men  could  be  made  aware  of  the  ridicule  which  they  thus 
bring  on  their  evidence  otherwise  good,  they  would  at  once  strive  to 
dispense  with  such  language.  A  witness  is  perhaps  unconsciously 
led  to  speak  as  if  he  were  addressing  a  medical  assembly,  instead  of 
plain  men  like  the  members  of  a  common  jury  who  are  wholly 
ignorant  of  the  meaning  of  medical  terms,  and  barristers  who  are 
but  imperfectly  acquainted  with  them.  There  are  few  Assizes  which 
do  not  afford  many  illustrations  of  the  injury  done  to  scientific  evi- 
dence and  the  clear  understanding  of  a  case,  by  the  technical  language 
in  which  it  is  given.  A  court  may  be  told  that  the  "  integuments 
were  reflected  from,  the  thorax,  and  the  costal  cartilages  laid  bare,  when 
a  wound  was  found  which  had  penetrated  through  the  anterior  medi- 
astinum" and  had  involved  the  arch  of  the  aorta,  &c.  A  simple  cut 
in  the  skin  is  described  as  "  an  incision  in  the  integuments."  In  a 
case  of  alleged  child-murder,  a  medical  witness  being  asked  for  a 
plain  opinion  of  the  cause  of  death,  said  that  it  was  owing  "to  atelecta- 
sis and  a._general  engorgement  of  the  pulmonary  tissue."  On  a  trial  for 
an  assault  which  took  place  at  the  Assizes,  some  years  since,  a  sur- 
geon, in  giving  his  evidence,  informed  the  court  that  on  examining 
the  prosecutor,  he  found  him  suffering  from  a  severe  contusion  of 
the  integuments  under  the  left  orbit,  with  great  extravasation  of 
blood  and  ecchymosis  in  the  surrounding  cellular  tissue,  which  was 
in  a  tumefied  state.  There  was  also  considerable  abrasion  of  the 
cuticle."  "Judge:  You  mean,  I  suppose,  that  the  man  had  a  bad 
black  eye.  Witness:  Yes.  Judge:  Then  why  not  say  so  at  once?" 
It  would  be  easy  to  multiply  examples  of  this  kind. 

This  is  not  science,  but  pedantry,  and  if  such  language  is  employed 
by  a  witness  with  a  view  of  impressing  the  court  with  some  idea  of 
his  learning,  it  wholly  fails  of  its  effect.  Barristers  and  reporters 
put  down  their  pens  in  despair,  and  the  time  of  the  court  is  wasted 
until  the  witness  has  condescended  to  translate  his  ideas  into  ordi- 
nary language. 


54  CAUSES    OF    DEATH, 


CHAPTER  III. 

Causes  of  death. — sudden-  death. — syncope,  asphyxia,  coma. — 
signs  or  indications  of  death. — cessation  of  circulation  and 
respiration. — cooling  of  the  body. — cadaveric  rigidity. — 
putrefaction. 

Medical  jurisprudence  takes  cognizance  of  all  violent  causes  of 
death,  and  is  only  indirectly  involved  in  those  cases  of  natural  death 
which  simulate  the  effects  of  violence.  Thus  all  causes  which  ope- 
rate to  produce  death  suddenly,  as  by  syncope,  asphyxia,  or  coma, 
especially  demand  the  attention  of  a  medical  jurist.  These  may  be 
either  natural  or  violent ;  and  the  distinction  between  them  is  of 
importance,  since  the  guilt  or  innocence  of  a  person  charged  with 
crime  may  depend  on  a  correct  determination  of  the  cause. 

The  continuance  of  life  depends  upon  the  proper  and  regulated 
action  of  the  heart,  the  lungs,  and  the  brain;  and  the  interdepend- 
ence of  these  organs  is  such  that  the  arrest  of  the  functions  of  one 
of  them  is  speedily  followed  by  the  arrest  of  the  functions  of  the 
others.  Hence  these  three  organs  have  been  called  the  tripod  of  life. 
When  the  suspension  of  the  motions  of  the  heart  is  the  primary 
cause  of  death,  the  person  is  said  to  die  by  syncope.  The  term 
asphyxia  is  applied  to  death  which  begins  by  the  lungs  ;  and  coma 
to  that  which  arises  from  a  primary  disturbance  of  the  functions  of 
the  brain. 

Syncope  (avyxoittJ). — In  order  that  the  action  of  the  heart  should  be 
maintained,  it  is  necessary  first,  that  the  blood  supplied  to  it  should 
be  in  sufficient  quantity,  and  secondly,  that  this  blood  should  be  of 
proper  quality.  In  death  from  hemorrhage  we  have  an  instance 
of  deficiency,  and  in  death  from  certain  poisons  as  well  as  diseases, 
an  illustration  of  defect  of  blood.  In  ordinary  syncope  (fainting 
or  swooning)  there  is  simply  a  deficiency  in  the  quantity  of  blood 
which  passes  through  the  heart,  although  there  is  no  actual  loss  of 
this  fluid  from  the  circulation.  Certain  diseases  which  affect  the 
muscular  structure  of  the  heart,  as  well  as  its  membranous  valves 
and  bloodvessels,  may  also  lead  to  a  sudden  arrest  of  its  functions. 
These  morbid  conditions  produce  a  mechanical  impediment  to  the 
motions  of  the  organ  by  which  the  blood  is  propelled,  and  death  by 
syncope  is  the  necessary  result. 

When  death  takes  place  by  the  heart,  the  right  and  left  cavities  of 
this  organ  are  found  to  contain  blood  in  the  normal  proportion  in 
which  that  fluid  is  ordinarily  circulated.  This  retention  of  blood  in 
these  cavities  arises  from  the  sudden  stoppage  of  the  heart's  con- 
tractions.    Blood  is  found  in  the  large  veins  (venaa  cava'*,  as  well  as 


DEATH    FROM    SYNCOPE.  55 

in  the  arterial  trunks.  There  is  no  congestion  or  accumulation  of 
blood  in  the  lungs  or  the  brain. 

Asphyxia  (d  priv.  and  otyfos  pulse,  signifying  pulselessness.  This 
state  is  induced  by  any  cause  which  arrests  the  function  of  respira- 
tion. The  term  apncea  (from  d  priv.  and  *»•«'*  I  respire)  is  more 
appropriate;  for  the  state  of  syncope  might  equally  be  called  asphyxia. 
The  various  forms  of  death  by  suffocation,  as  in  the  obstruction  of 
the  air-passages  from  mechanical  causes,  in  drowning,  hanging,  and 
strangulation,  furnish  illustrations  of  death  commencing  by  the  lungs, 
or  asphyxia.  The  effect  of  cutting  off  air  from  the  lungs  is  that  the 
blood  is  not  aerated,  and  it  is  therefore  circulated  in  a  state  unfitted 
to  support  the  nutrition  of  the  heart  and  brain,  without  which  life 
cannot  continue  beyond  a  few  minutes.  It  is  necessarily  distributed 
with  the  impurities  derived  from  the  waste  of  tissue,  and  thus  acts 
as  a  poison  to  all  the  organs.  It  is  incapable  of  sustaining  nerve- 
force  or  muscular  irritability.  It  stagnates  in  the  capillary  vessels 
of  the  lungs,  produces  a  languid  action  of  the  heart  by  its  circula- 
tion through  the  muscular  structure  of  this  organ,  and  it  causes 
insensibility  by  its  distribution  through  the  bloodvessels  of  the  brain. 
The  lungs  are  essential  to  the  circulation  by  purifying  the  blood ;  the 
brain,  from  the  necessity  of  supplying  the  proper  stimulus — nerve- 
force.  Death  from  asphyxia  may  be  therefore  regarded  as  death  from 
defect  of  blood.  The  observations  of  the  late  Sir  B.  Brodie  ("  Lec- 
tures on  Pathology,"  66)  and  others  have  clearly  proved  that  in  spite 
of  the  impurity  of  the  blood,  the  heart  will  continue  to  act  and  the 
circulation  to  be  maintained  for  two  or  three  minutes  or  longer  after 
breathing  has  entirely  ceased.  This  may  be  proved  by  hanging  or 
strangling  an  animal,  and  observing  the  condition  of  the  heart  during 
the  stage  of  insensibility.  As  the  action  of  this  organ  continues 
after  the  animal  has  ceased  to  breathe,  life  is  not  actually  extinct  ; 
and  under  favorable  circumstances,  it  may  be  restored,  if  no  injury 
be  done  to  the  air-cells  of  the  lungs,  so  long  as  this  action  continues. 
Supposing  that  the  suspension  of  respiration  is  complete,  the  action 
of  the  heart  gradually  slackens  and  finally  stops.  It  is  at  this  period 
of  the  complete  arrest  of  the  motions  of  the  heart  that  asphyxia 
passes  into  death.  Apncea  is  determined  by  the  time  at  which  res- 
piration is  completely  arrested.  The  circulation  of  the  unaerated 
blood  through  the  brain  appears  to  annihilate  sensibility,  so  that  no 
consciousness  or  feeling  exists ;  the  person  is,  to  all  appearance,  dead. 
There  are  many  diseases  which  operate  fatally  by  arresting  the  func- 
tions of  the  lungs,  and  these  may  be  regarded  as  furnishing  the 
natural  causes  of  asphyxia.  The  violent  causes,  including  not  only 
the  ordinary  modes  of  suffocation,  but  the  effects  of  certain  poisons, 
are  not  difficult  to  appreciate,  provided  a  true  history  of  the  case  can 
be  obtained. 

In  death  by  the  lungs,  as  the  circulation  of  the  blood  is  primarily 
arrested  in  these  organs,  the  pulmonary  artery,  the  right  cavities  of 
the  heart,  and  the  venee  cavaa  are  found  gorged  with  blood.  The 
pulmonary  veins,  the  left  cavities  of  the  heart,  and  the  aorta,  are 
either  empty  or  contain  but  little  blood.    In  certain  cases  of  asphyxia, 


56  ASPHYXIA    AND    COMA. 

the  right  cavities  of  the  heart,  as  well  as  the  left,  have  been  found 
empty.  "When  the  access  of  air  to  the  lungs  is  suddenly  and  com- 
pletely cut  off,  the  circulation  of  the  blood  is  very  speedily  arrested ; 
but  supposing  the  occlusion  of  the  air-passages  to  be  partial  or 
gradual,  the  circulation  of  the  blood  may  continue  for  a  time,  and 
thus  cause  congestion  of  certain  organs.  Hence  the  appearances  in 
asphyxia  differ  greatly.  A  mixed  condition  under  the  name  of  syn- 
copal asphyxia  has  been  described  by  some  pathologists.  In  this, 
the  cavities  of  the  heart  are  found  empty. 

Coma, — Besides  a  due  supply  of  properly  aerated  blood,  the  brain 
requires  for  the  exercise  of  its  functions  a  proper  quantity  of  blood, 
so  that  either  by  the  sudden  withdrawal  of  this  fluid,  or  by  a  distribu- 
tion of  impure  blood,  these  are  arrested.  A  person  thus  affected  falls 
into  a  state  of  complete  insensibility  (coma),  so  that  it  is  impossible  to 
rouse  him.  The  functions  of  the  heart  and  lungs  are  not  suddenly  ar- 
rested under  these  circumstances.  They  appear  to  be  less  dependent  on 
the  brain  than  the  brain  is  upon  them ;  but  this  is  rather  a  question  of 
degree.  A  due  supply  of  nerve-force  is  required  for  the  action  of  the 
muscles,  whether  of  the  heart  or  of  the  chest ;  and  when  this  is  with- 
drawn, the  heart  ceases  to  pulsate,  and  the  respiratory  muscles  cease 
to  act :  circulation  and  respiration  are  thus  arrested  by  the  absence  of 
innervation.  This  is  sometimes  described  as  death  by  paralysis  of 
the  heart  and  lungs.  The  blood  is  neither  aerated  nor  circulated. 
Sudden  death  from  apoplexy  is  an  illustration  of  death  by  the  brain. 
Coma  may  also  be  a  result  of  the  introduction  of  certain  poisons  into 
the  blood,  and  of  fractures  of  the  skull  leading  to  compression  of  the 
brain  or  destruction  of  its  substance.  In  death  by  the  brain,  the 
appearances  observed  consist  chiefly  in  a  congested  state  of  the  cere- 
bral membranes  and  substance  of  the  brain.  As,  before  death,  the 
breathing  is  affected,  the  lungs  are  congested  and  blood  accumulates 
in  the  cavities  of  the  heart,  more  on  the  right  than  on  the  left  side. 

The  appearances  described  as  characteristic  of  the  different  modes  of 
death  by  the  heart,  lungs,  and  brain,  are  liable  to  variation  by  reason 
of  the  intimate  relations  of  these  organs.  Thus,  there  may  be  a 
mixed  condition  of  syncope  and  asphyxia,  or  of  asphyxia  with  cere- 
bral congestion. 

With  regard  to  the  interruption  of  the  functions  of  the  brain  as  a 
result  of  pressure  by  the  effusion  of  blood  or  serum,  it  is  to  be  ob- 
served that  a  very  small  quantity  effused  at  the  base  or  in  the  sub- 
stance of  the  medulla  oblongata,  is  sufficient  to  cause  death ;  while 
generally  speaking  a  larger  quantity  is  required  to  be  effused  in  the 
membranes,  ventricles,  or  substance  of  the  brain,  in  order  to  produce 
a  fatal  result.  In  cases  of  chronic  hydrocephalus,  in  which  the  brain 
has  resisted  the  pressure  of  a  large  accumulation  of  serum  for  many 
years,  a  slight  and  sudden  increase  in  the  quantity  at  any  period  of 
life  may  lead  to  coma  and  death  by  apoplexy.  This  condition  may 
be  mistaken  for  narcotic  poisoning. 

All  causes  of  death,  whether  from  disease  or  violence,  are  referable 
to  an  effect  produced  primarily  on  the  heart,  the  lungs,  or  the  brain ; 
but,  as  it  has  been  elsewhere  stated,  death  does  not  take  place  until 


INDICATIONS    OF    DEATH.  57 

the  action  of  the  heart  has  entirely  ceased.  The  arrest  of  the  circu- 
lation produces  an  immediate  impression  upon  the  functions  of  the 
brain  and  lungs ;  while  the  lungs  and  brain  are  affected  and  can  only 
affect  each  other  indirectly  through  the  medium  of  the  circulation  ; 
hence,  systemic  death,  or  the  death  of  the  body,  is  resolvable  into 
death  by  syncope  or  a  failure  of  the  action  of  the  heart,  and  this 
depends  in  all  cases  either  upon  defect  or  deficiency  of  blood. 

The  natural  causes  of  sudden  death  may  be  generally  traced  to  some 
injury  or  impediment  to  the  action  of  the  heart,  lungs,  or  brain.  It 
would  be  foreign  to  the  objects  of  this  manual  to  give  a  description 
of  them.  The  violent  causes  are  those  which  demand  the  especial 
attention  of  a  medical  jurist ;  they  will  be  considered  hereafter.  In 
its  relations  to  medicine  and  medical  jurisprudence  the  subject  of 
sudden  death  has  been  most  fully  treated  by  Herrich  and  Kopp 
("Der  plotzliche  Tod  aus  ineren  Ursachen,"  Regensburg,  1848);  as 
well  as  M.  Devergie  ("  Ann.  d'Hyg."  1838,  2,  145).  To  these  works 
I  must  refer  the  reader  for  further  information  on  the  causes,  as  well 
as  on  the  appearances  met  with  in  the  bodies  of  persons  dying  sud- 
denly from  natural  causes. 

The  violent  causes  of  death,  whether  sudden  or  protracted,  which 
chiefly  require  the  skill  of  a  medical  jurist  for  their  elucidation,  are 
poisoning,  wounds,  and  personal  injuries,  such  as  burns  and  scalds, 
as  well  as  those  forms  of  death  which  commence  by  the  lungs,  including 
drowning,  hanging,  strangulation,  and  suffocation.  In  nearly  all  cases, 
the  body  of  the  deceased  is  produced,  and  a  medical  opinion  can  be 
based  upon  a  careful  examination. 

Signs  or  Indications  of  Death. — The  verification  of  death  is  occa- 
sionally a  duty  thrown  on  the  medical  jurist.  Certain  signs  or  indi- 
cations have  been  pointed  out  as  proving  that  death  is  real,  and  not 
apparent.     These  are  taken  in  the  order  of  their  importance. 

1.  The  cessation  of  circulation  and  respiration. — The  heart  is  consid- 
ered to  be  the  organ  in  which  life  begins  and  ends — the  prirnum  vivens 
and  ultimurn  moriens — the  first  to  live  and  the  last  to  die.  The  proof 
of  death  is  the  proof  of  cessation  of  the  heart's  action  for  a  certain 
period.  The  more  visible  indication  of  death  is  the  cessation  of 
breathing,  and  in  the  opinion  of  the  late  Sir  B.  Brodie,  the  entire 
cessation  of  breathing  alone  may  be  regarded  as  a  decisive  test  of  the 
extinction  of  life.  The  movements  of  respiration  cannot  be  over- 
looked by  any  one  who  does  not  choose  to  overlook  them,  and  the 
heart  never  continues  to  act  for  more  than  four  or  five  minutes  after 
respiration  has  ceased.  The  proofs  of  the  continued  action  of  this 
organ  are,  however,  less  obvious  to  the  unskilled  observer,  than  the 
movements  of  the  chest ;  hence  the  visible  cessation  of  these  move- 
ments, i.  e.,  of  breathing,  for  a  period  of  five  minutes  furnishes  a 
certain  proof  that  the  person  is  really  dead.  But  the  skilled  observer 
would  apply  the  test  of  auscultation,  and  before  giving  an  opinion 
would  satisfy  himself  of  the  permanent  cessation  of  the  heart's  action. 
It  is  impossible  to  admit  that  the  heart  can  remain  for  even  half  an 
hour  in  a  state  of  inaction  in  a  human  being,  and  then  spontaneously 
recover  its  activity. 


58  CADAVERIC    RIGIDITY. 

2.  Cooling  of  the  body. — The  average  temperature  of  the  interior  of 
the  living  body  in  health,  varies  from  98°  to  100°,  and  this  it  retains 
so  long  as  life  continues,  whether  the  temperature  of  the  air  is  below- 
zero  or  above  140°.  It  is  liable  to  be  increased  in  some  diseases,  and 
to  be  diminished  in  others.  In  a  case  of  typhoid  fever,  the  blood  was 
found  to  have  a  temperature  of  113°.  When  life  is  extinguished,  the 
body  gradually  loses  the  heat  which  it  possessed  at  the  moment  of 
death,  just  like  so  much  inert  organic  matter  artificially  raised  to  the 
same  temperature,  and  it  cools  down  to  the  temperature  of  the  air  to 
which  it  is  exposed.  The  time  usually  assigned  for  the  cooling  of  the 
dead  human  body  is  from  fifteen  to  twenty  hours,  but  it  varies  accord- 
ing to  the  condition  of  the  body  at  the  time  of  death,  the  mode  of 
death,  and  the  circumstances  under  which  it  has  been  placed.  Thus, 
if  exposed  naked  to  a  cold  atmosphere,  the  cooling  is  very  rapid. 
If  the  body  is  well  covered,  the  cooling  takes  place  slowly.  When 
death  has  taken  place  suddenly,  from  accident,  apoplexy,  or  acute 
disease,  a  body  has  been  observed  to  retain  its  heat  for  a  long  period. 

3.  Cadaveric  rigidity.  Rigor  mortis. — In  from  five  to  six  hours  after 
death,  and  generally  while  the  body  is  in  the  act  of  cooling,  the 
muscles  of  the  limbs  are  observed  to  become  hard  and  contracted  in 
the  attitude  in  which  the  body  is  placed;  the  joints  are  stiff,  and  the 
trunk  firm  and  unyielding.  This  peculiar  condition  is  known  under 
the  name  of  cadaveric  rigidity.  The  first  effect  of  death  from  any 
cause  is  in  most  cases  a  general  relaxation  of  the  whole  of  the  mus- 
cular system.  The  lower  jaw  drops,  the  eyelids  lose  their  tension, 
the  limbs  are  soft  and  flabby,  and  the  joints  are  quite  flexible.  The 
muscular  tissue  may  be  considered  as  passing  through  three  stages  in 
a  dead  body.  1.  It  is,  at  first,  flaccid  but  contractile,  although  it  may 
be  remarked  that  muscles  contracted  by  living  force  in  the  act  of 
dying,  do  not  necessarily  become  relaxed  in  death ;  2.  It  becomes 
rigid  and  incapable  of  contraction;  and  3.  It  is  once  more  relaxed, 
and  does  not  regain  its  power  of  contractility.  The  body  now  passes 
into  the  first  stage  of  putrefaction.  The  first  stage  defines  the  du- 
ration of  muscular  irritability;  the  second  stage,  that  of  cadaveric 
rigidity;  and  the  third,  that  of  the  commencement  of  chemical 
changes  or  putrefaction. 

At  a  certain  period  after  death,  the  heart  is  found  rigid  and  firmly 
contracted.  If  examined  at  this  time,  it  may  appear  to  be  in  a  state 
of  spasm,  and  to  have  its  walls  thickened,  while  the  cavity  of  the  left 
ventricle  may  be  described  as  being  much  smaller  than  in  the  normal 
state.  Mr.  Paget  has  pointed  out  that  this  natural  condition  of  the 
heart  after  death  has  led  to  pathological  mistakes,  the  walls  being 
described  as  thickened  and  the  cavities  diminished  in  size,  and  the 
heart  itself  as  being  in  a  state  of  concentric  hypertrophy  from  disease. 
On  the  other  hand,  the  perfect  relaxation  of  the  heart  which  follows 
at  a  later  period  after  death,  has  beeu  mistaken  for  and  described  as 
a  morbid  flabbiness  and  flaccidity.  Spasm  and  paralysis  cannot  be 
inferred  to  have  existed  when  we  discover  these  conditions  of  the 
heart  in  the  recently  dead  body. 

Under  the  action  of  poisons  like  strychnia,  and  those  alkaloids 


PUTREFACTION.  59 

which  cause  death  bj  convulsions,  the  more  violent  and  frequent  the 
convulsions,  the  sooner  cadaveric  rigidity  sets  in.  Whatever  exhausts 
muscular  irritability  before  death  appears  to  accelerate  cadaveric 
rigidity  in  the  muscles  after  death. 

In  those  instances  in  which  muscular  irritability  at  the  time  of 
death  is  slight,  either  in  consequence  of  a  bad  state  of  nutrition  or 
of  exhaustion  from  over-exertion,  or  from  convulsions  caused  by 
disease  or  poison,  it  is  observed  that  cadaveric  rigidity  sets  in  and 
ceases  soon,  and  putrefaction  appears  and  progresses  quickly.  (Brown 
Sequard,  "Proc.  E.  S.,"  May,  1861.)  For  a  similar  reason  it  takes 
place  at  an  earlier  period  in  the  very  young  and  the  old  than  in  an 
adult  in  the  prime  of  life. 

If  we  allow  a  proper  interval  to  elapse  after  the  supposed  death  of 
a  person,  there  can  be  no  difficulty  in  solving  the  question,  whether 
the  body  is  really  dead,  even  before  any  of  those  changes  which  arise 
from  putrefaction  have  manifested  themselves.  The  circumstances 
on  which  we  may  rely  as  furnishing  conclusive  evidence  of  death, 
are  the  following:  1.  The  absence  of  circulation  and  respiration  for 
at  least  an  hour,  the  stethoscope  being  employed  if  necessary ;  2.  The 
gradual  cooling  of  the  body  to  the  temperature  of  the  air,  the  trunk  re- 
maining warm  while  the  members  are  cold ;  and  3.  As  the  body  cools, 
a  gradual  supervention  of  a  rigid  state  of  the  muscles,  successively 
attacking  the  limbs  and  trunk,  and  ultimately  spreading  through  the 
whole  muscular  system.  When  these  conditions  are  observed,  the 
proofs  of  death  are  conclusive ;  it  is  unnecessary  to  wait  for  any  sign 
of  putrefaction.  These  changes  are  as  certainly  the  forerunners  of 
putrefaction  as  the  process  of  putrefaction  is  itself  the  forerunner  of 
the  entire  destruction  of  the  body.  I  believe  it  may  be  safely  said 
that  there  has  not  been  a  single  instance  of  resuscitation  after  rigidity 
had  once  commenced  in  a  body.  During  the  raging  of  epidemics,  if 
additional  evidence  be  required  for  early  burial,  it  might  be  obtained 
by  exposing  a  superficial  muscle  to  the  galvanic  stimulus.  If  the 
fibres  do  not  contract,  death  is  certain.  If  they  do,  this  is  no  proof 
that  the  person  can  be  restored  to  active  life ;  but  further  time  may 
be  allowed  before  the  body  is  committed  to  the  grave. 

Putrefaction. — By  putrefaction  we  are  to  understand  those  chemi- 
cal changes  which  spontaneously  take  place  in  dead  animal  matter, 
during  which  offensive  gases  are  evolved.  The  ultimate  effect  of  these 
changes  is,  after  a  longer  or  shorter  period,  to  reduce  the  organic  to 
the  condition  of  inorganic  compounds,  consisting  chiefly  of  water, 
ammonia,  and  carbonic  acid.  It  is  in  the  stage  of  transition  that 
noxious  effluvia  are  evolved  from  which  the  process  derives  its  name, 
these  consist  of  compounds  of  nitrogen,  sulphur,  phosphorus,  and 
carbon  with  hydrogen. 

I'll  is  process  does  not  begin  to  manifest  itself  in  the  dead  body 
until  after  the  cessation  of  cadaveric  rigidity,  and  generally  about 
the  third  day.  It  is  then  observed,  if  the  body  has  been  exposed  to 
the  atmosphere  in  an  apartment  of  mean  temperature  (60°),  that  the 
limbs  and  trunk  become  supple  and  pliant,  and  yield  a  faint  odor. 
The  skin  covering  the  abdomen  becomes  of  a  pale  greenish  color, 


60  PUTREFACTION    OF    THE    BODY. 

which  gradually  deepens.  A  similar  discoloration  slowly  makes  its 
appearance  in  the  chest,  between  the  ribs,  in  the  face,  the  neck,  the 
legs,  and  lastly,  in  the  arms.  The  color  appears  to  depend  on  the 
decomposition  and  infiltration  of  the  animal  fluids,  especially  the 
blood,  into  the  skin.  In  the  neck  and  limbs  it  is  observed  to  be 
more  marked  in  the  situation  of  the  large  venous  trunks ;  and  some- 
times, indeed,  the  course  of  the  superficial  veins  is  accurately  traced 
out  by  greenish-blue  or  dark  lines,  which  have  been  mistaken  for 
marks  of  violence.  Gaseous  products  are  formed,  not  only  in  the 
hollow  organs  of  the  abdomen,  but  beneath  the  skin  generally,  so 
that  on  making  an  incision,  the  edges  of  the  skin  are  rapidly  forced 
apart  or  everted.  The  reaction  of  this  confined  gas  accounts  for  the 
occasional  escape  of  alimentary  and  fecal  matter  from  the  outlets :  as 
also  for  the  escape  of  blood  some  days  after  death  from  wounds  in- 
volving any  of  the  large  veins. 

Putrefaction  takes  place  with  variable  rapidity.  It  commonly 
shows  itself  about  the  second  or  third  day  in  warm  weather,  and 
about  the  fifth  or  sixth  day  in  cold  weather.  In  some  instances, 
however,  the  body  has  been  found  in  an  advanced  state  of  putrefac- 
tion in  the  short  period  of  sixteen  hotirs  after  death,  and  in  others  the 
process  has  been  greatly  protracted.  The  time  of  its  appearance  is 
dependent  on  the  duration  of  cadaveric  rigidity,  and  the  condition  of 
the  body  at  the  time  of  death. 


DEFINITION    OF    A    POISON.  61 


POISONING. 


CHAPTEE  IV. 

Definition  of  the  teem  poison. — deadly  poisons. — mechanical 
irkitants. — influence  of  habit  and  idiosyncrasy. — classifi- 
cation.—  special  characters  of  irritant,  corrosive,  and 
neurotic  poisons. 

Definition. — A  Poison  is  commonly  defined  to  be  a  substance, 
which,  when  administered  or  taken  in  small  quantity,  is  capable  of 
acting  deleteriously  on  the  body ;  in  popular  language,  this  term  is 
applied  only  to  those  substances  which  destroy  life  in  small  doses. 
This  popular  view  of  the  nature  of  a  poison  is  too  restricted  for  the 
purposes  of  medical  jurisprudence.  It  would  obviously  exclude 
numerous  compounds,  the  poisonous  properties  of  which  cannot  be 
disputed — as,  for  example,  the  salts  of  copper,  tin,  zinc,  lead  and 
antimony;  these,  generally  speaking,  act  as  poisons  only  when  ad- 
ministered in  large  doses.  Some  substances,  such  as  nitre,  have  not 
been  observed  to  have  a  noxious  action  except  when  taken  in  large 
quantity,  while  arsenic  acts  as  a  poison  in  a  small  dose ;  but  in  a 
medico-legal  view,  whether  a  man  dies  from  the  effects  of  an  ounce 
of  nitre,  or  two  grains  of  arsenic,  the  responsibility  of  the  person 
who  criminally  administers  the  substance,  is  the  same.  Each  may 
be  regarded  as  a  poison,  differing  from  the  other  only  in  its  degree 
of  activity,  and  in  its  mode  of  operation.  The  result  is  the  same ; 
death  is  caused  by  the  substance  taken,  and  the  quantity  required  to 
destroy  life,  even  if  it  could  be  always  accurately  determined,  cannot 
enable  us  to  distinguish  a  poisonous  from  a  non-poisonous  substance. 
If,  then,  a  medical  witness  be  asked  "  what  is  a  poison  ?"  he  must 
beware  of  adopting  this  popular  definition,  or  of  confining  the  term 
poison  to  a  substance  which  is  capable  of  operating  as  such  in  a  small 
dose  taken  at  once. 

In  legal  medicine,  it  is  difficult  to  give  such  a  definition  of  a  poison 
as  shall  be  entirely  free  from  objection.  Perhaps  the  most  compre- 
hensive which  can  be  suggested  is  this :  "A  poison  is  a  substance 
which,  when  absorbed  into  the  blood,  is  capable  of  seriously  affecting 
health  or  of  destroying  life."  There  are  various  channels  by  which 
poisons  enter  the  blood ;  some  are  in  the  form  of  gases  or  vapors ; 
these  operate  rapidly  through  the  lungs;  others  are  liquid  or  solid, 
and  these  may  reach  the  blood  either  through  the  skin  or  through  a 


62  MEDICINES    AXD    POISOXS. 

wound ;  but  more  commonly  through  the  lining  membrane  of  the 
stomach  or  bowels,  as  when  they  are  taken  or  administered  in  the 
ordinary  manner.  The  latter  chiefly  give  rise  to  medico-legal  inves- 
tigations. Some  substances  act  as  poisons,  by  any  one  of  these 
channels ;  thus  arsenic  is  a  poison  whether  it  enters  the  blood  through 
the  lungs,  the  skin,  or  the  stomach  and  bowels ;  but  such  poisons 
as  those  of  the  viper,  of  rabies,  and  of  glanders,  appear  to  affect  the 
body  only  through  a  wound  in  the  skin.  When  introduced  into  the 
stomach,  these  animal  poisons  have  been  found  to  be  inert.  In  adopt- 
ing the  above  definition  of  a  poison  in  a  medical  sense,  it  is  proper 
to  remark  that  there  are  some  substances  which  are  regarded  as 
poisons,  although  absorption  into  the  blood  does  not  appear  to  be 
necessary  to  their  action.  The  mineral  acids  and  alkalies  belong  to 
this  class  of  bodies.  They  are  corrosive  poisons;  they  operate  inju- 
riously by  causing  the  destruction  of  living  parts ;  and  whether 
applied  to  the  skin,  the  stomach,  or  (in  the  form  of  vapor)  to  the  air- 
cells  of  the  lungs,  they  destroy  life  by  the  local  changes  to  which 
they  give  rise,  and  the  inflammation  which  is  a  consequence  of  their 
action. 

It  is  not  easy  to  define  the  boundary  between  a  medicine  and  a 
poison.  It  is  usually  considered  that  a  medicine  in  a  large  dose  is  a 
poison,  and  a  poison  in  a  small  dose  is  a  medicine;  but  a  medicine 
such  as  tartarized  antimony  may  be  easily  converted  into  a  poison, 
by  giving  it  in  small  doses  at  short  intervals,  either  under  states  of 
the  body  not  adapted  to  receive  it,  or  in  cases  in  which  it  exerts  an 
injuriously  depressing  effect.  Some  deaths  have  been  lately  occa- 
sioned by  this  wilful  misuse  of  antimony  in  doses  which  might  be 
described  as  medicinal,  although  in  the  cases  referred  to,  no  other 
intention  could  have  existed,  in  the  secret  administration  of  this 
substance,  than  that  of  destroying  life.  A  person  may  die  either 
from  a  large  dose  of  a  substance  given  at  once,  or  from  a  number  of 
small  doses  given  at  such  intervals  that  the  system  cannot  recover 
from  the  effects  of  one  before  another  is  administered.  This  remark 
applies  to  a  great  number  of  medicines  which  are  not  commonly  in- 
cluded in  a  list  of  poisons. 

In  reference  to  the  medical  definition  of  a  poison,  it  is  necessary  to 
observe  that  the  law  does  not  regard  the  manner  in  which  the  sub- 
stance administered  acts.  If  it  be  capable  of  destrojung  life  or  of 
injuring  health,  it  is  of  little  importance,  so  far  as  the  responsibility 
of  a  prisoner  is  concerned,  whether  its  action  on  the  body  is  of  a 
mechanical  or  chemical  nature,  and  whether  it  operates  fatally  by 
absorption  into  the  blood  or  not.  Thus  a  substance  which  simply 
acts  mechanically  on  the  stomach  or  bowels  may,  if  wilfully  adminis- 
tered with  intent  to  injure,  involve  a  person  in  a  criminal  charge,  as 
much  as  if  he  had  administered  arsenic  or  any  of  the  ordinary  poi- 
sons. It  is,  then,  necessary  that  we  should  consider  what  the  law 
strictly  means  by  the  act  of  poisoning.  If  the  substance  criminally 
administered,  destroys  life,  whatever  may  be  its  nature  or  mode  of 
operation,  the  accused  is  tried  on  a  charge  of  murder  or  manslaughter, 
and  the  duty  of  a  medical  witness  consists  in  showing  that  the  sub- 


THE    ADMINISTERING    OF    POISON.  63 

stance  taken  was  the  certain  cause  of  death.  If,  however,  death  be 
not  the  consequence,  then  the  accused  may  be  tried  for  the  attempt 
to  murder  by  poison  (24  &  25  Vict.  c.  100,  s.  11,  Aug.  1861).  The 
words  of  this  statute  are  general,  and  embrace  all  kinds  of  substances 
whether  they  are  popularly  or  professionally  regarded  as  poisons 
or  not.     Thus  it  is  laid  down  that — 

"  Whosoever  shall  administer,  or  cause  to  be  administered  to  or 
taken  by  any  person,  any  poison,  or  other  destructive  thing,  with  intent 
to  commit  murder,  shall  be  guilty  of  felony/' 

Whether  the  administering  be  followed  by  any  bodily  injury  or 
not,  the  act  is  still  a  felony,  provided  the  intent  has  been  to  commit 
murder.  The  attempt  to  administer  or  the  attempt  to  cause  to  be 
administered  to,  or  to  be  taken  by  any  person,  any  poison  or  other 
destructive  thing,  with  the  like  intent,  although  no  bodily  injury  be 
effected,  is  also  a  felony  (s.  14).  If  any  doubt  formerly  existed 
whether  the  external  application  of  poisons,  e.  g.,  by  wounds  or  ulce- 
rated surfaces,  would  be  included  in  the  words  "administering  or 
taking,"  they  are  now  entirely  removed  by  the  Criminal  Law  Consoli- 
dation Act  (Aug.  1861).  The  22d  section  specially  applies  to  such 
an  offence,  and  the  15th  section  provides  that  "  Whosoever  shall,  by 
any  means  other  than  those  specified  in  any  of  the  preceding  sections 
of  this  act,  attempt  to  commit  murder,  shall  be  guilty  of  felony." 
Mr.  Greaves  justly  remarks,  with  regard  to  this  important  addition 
to  the  statute  law,  that  "  the  malicious  may  now  rest  satisfied  that 
every  attempt  to  murder  which  their  perverted  ingenuity  may  devise, 
or  their  fiendish  malignity  suggest,  will  fall  within  some  clause  of 
this  act,  and  may  be  visited  with  penal  servitude  for  life."  ("  Notes 
on  Crim.  Law  Consolidation,"  p.  49.)  Under  Sec.  22  of  this  statute,  in 
reference  to  attempted  poisoning,  some  offences  are  comprised,  which 
formerly  escaped  punishment :  "  Whosoever  shall  unlawfully  apply  or 
administer  to,  or  cause  to  be  taken  by,  or  attempt  to  apply  or  admin- 
ister to,  or  attempt  to  cause  to  be  administered  to  or  taken  by  any 
person,  any  chloroform,  laudanum,  or  other  stupefying  or  overpower- 
ing drug,  matter,  or  thing,  with  intent,  in  any  of  such  cases,  thereby 
to  enable  himself  or  any  other  person  to  commit,  or  with  intent,  &c, 
to  assist  any  other  person  in  committing  any  indictable  offence,  shall 
be  guilty  of  felony."  A  case  under  this  section  of  the  new  statute 
was  referred  to  me  in  September,  1863.  A  medical  gentleman  was 
charged  with  "  attempting  to  cause  to  be  administered"  to  an  infant  a 
poisonous  dose  of  laudanum.  It  was  stated  by  a  woman  who  nursed 
the  child  that  the  accused  delivered  to  her  two  bottles  containing 
a  brown  liquid,  labelled  "  one  teaspoonful  every  three  hours,"  and 
directed  her  to  give  it  to  the  child.  None  was  given.  Some  months 
after  the  death  of  the  child  from  natural  causes,  this  charge  was 
raised,  and  the  bottles,  still  full  of  liquid,  were  produced  as  evidence 
against  the  accused.  On  analysis  I  found  that  the  prescribed  dose 
contained  about  five  minims  of  laudanum,  or  nearly  one-half  grain  of 
opium — a  dose  likely  to  prove  fatal  to  an  infant  only  a  month  old. 
Assuming  the  statement  of  the  nurse  who  made  the  charge  to  be  true, 
the  only  inference  to  be  drawn  from  the  prescription  of  such  a  dose 


64  ADMINISTERING    OF    POISONS. 

for  an  infant  by  a  medical  man,  would  be  that  be  intended  to  destroy 
the  life  of  the  child.  The  charge  fell  to  the  ground,  as  clear  proof 
was  given  that  the  woman  who  made  it  was  not  to  be  believed  on  her 
oath,  and  that  it  had  originated  in  a  desire  to  extort  money. 

[The  Revised  Criminal  Code  of  Pennsylvania,  passed  March  31, 
1860,  contains  various  provisions  upon  the  subject  of  the  use  of  poi- 
sons, which  are  substantially  the  same  as  the  provisions  of  the  English 
statutes  mentioned  in  the  text.  (See  §§  81-83).  Section  70  forbids  the 
sale  of  morphia,  strychnia,  arsenic,  prussic  acid,  or  corrosive  sublimate, 
except  upon  the  prescription  of  a  physician  or  on  the  personal  appli- 
cation of  some  respectable  inhabitant  of  full  age.  In  all  cases,  the 
word  "  poison"  to  be  legibly  marked  on  the  label  of  the  vessel  in 
which  it  is  contained.  A  memorandum  of  all  sales  other  than  under 
prescription  of  a  physician  to  be  kept  in  a  register,  with  name  and 
residence  of  purchaser,  quantity  sold,  and  date.  ,  Penalty  for  breach, 
a  fine  not  exceeding  $50. — P.] 

Poison  is  not  always  administered  with  intent  to  murder.  On  many 
occasions  it  has  been  mixed  with  food,  and  thus  administered  with 
a  view  to  injure  or  annoy  a  person.  Cantharides  have  been  thus  fre- 
quently given,  and  in  one  instance  (Nov.  1859)  eight  members  of  a 
family  suffered  from  severe  symptoms  of  poisoning  by  reason  of  the 
wanton  administration  of  this  drug.  In  April,  1860,  several  members 
of  a  family  suffered  from  severe  sickness,  as  a  result  of  tobacco  having 
been  put  into  water  contained  in  a  teakettle ;  and  tartar  emetic  has  been 
in  some  cases  dissolved  in  beer  or  other  liquids  as  a  mere  frolic  with- 
out any  proved  or  probable  intention  on  the  part  of  the  offender  to 
destroy  life.  The  case  of  Mc Mullen  (Liverpool  Autumn  Assizes,  1856) 
revealed  an  extensive  system  of  poisoning  in  the  northern  counties,  in 
which  tartar  emetic  was  the  substance  employed.  This  drug,  mixed 
with  cream  of  tartar,  was  openly  sold  by  druggists  under  the  name 
of  "  quietness  powders,"  and  the  evidence  established  that  women 
gave  these  powders  to  their  husbands  Avith  a  view  to  cure  them  of 
habits  of  drunkenness.  Hitherto,  when  the  intent  of  murder  was 
not  proved,  the  offender  has  escaped,  although  great  bodily  injury 
may  have  been  done  by  his  wanton  or  malicious  act.  Sections  23.  24, 
and  25  of  the  Consolidation  Act,  c.  100,  provides  for  this  omission : — 

"23.  Whosoever  shall  unlawfully  and  maliciously  administer  to, 
or  cause  to  be  administered  to  or  taken  by  any  other  person,  any 
poison  or  other  destructive  or  noxious  thing,  so  as  thereby  to  endanger 
the  life  of  such  person,  or  so  as  thereby  to  inflict  upon  such  person 
any  grievous  bodily  harm,  shall  be  guilty  of  felony." 

"24.  Whosoever  shall  unlawfully  and  maliciously  administer  to,  or 
cause  to  be  administered  to  or  taken  by  any  other  person,  any  poison 
or  other  destructive  or  noxious  thing,  with  intent  to  injure,  aggrieve, 
or  annoy  such  person,  shall  be  guilty  of  a  misdemeanor." 

"  25.  If,  upon  the  trial  of  any  person  charged  with  the  felony  above 
mentioned,  the  jury  shall  not  be  satisfied  that  such  person  is  guilty 
thereof,  but  shall  be  satisfied  that  he  is  guilty  of  the  misdemeanor 
above  mentioned,  then  and  in  every  such  case  the  jury  may  acquit 


INFLUENCE    OF    HABIT    ON    POISONS.  65 

the  accused  of  such  felony,  and  find  him  guilty  of  such  misde- 
meanor." 

It  will  be  perceived  that  the  words  of  the  statute  leave  the  ques- 
tion "  What  is  a  poison  ?"  to  depend  upon  the  medical  evidence 
adduced  :  and  in  order  to  include  all  substances  of  an  injurious  nature, 
although  they  may  not  be  strictly  speaking  poisons,  the  words  "  de- 
structive or  noxious  thing"  are  employed.  Hence,  on  these  occasions, 
a  medical  witness  must  be  prepared  to  prove  that  the  substance  was 
either  a  poison  or  a  destructive  or  noxious  thing.  In  a  trial  which 
took  place  at  the  Essex  Lent  Assizes,  1850  {Reg.  v.  Hayivard),  a 
woman  was  charged  with  administering  white  precipitate  to  her  hus- 
band with  intent  to  kill.  She  was  acquitted  on  the  ground  that  there 
was  no  evidence  to  show  that  white  precipitate  was  either  a  poison 
or  a  destructive  thing.  It  is,  however,  placed  beyond  doubt  that  this 
substance  is  not  only  capable  of  producing  all  the  eifects  of  an  irri- 
tant poison,  but  of  destroying  human  life ;  hence,  this  acquittal  was 
based  on  a  pure  mistake.  White  hellebore,  Lobelia  inflata,  and  Oil  of 
turpentine  have  been  erroneously  pronounced  not  to  be  poisons  under 
similar  circumstances ;  in  fact,  when  this  question  is  raised,  unless 
the  medical  evidence  received  by  a  court  be  very  closely  investi- 
gated, great  mistakes  may  arise,  owing,  perhaps  to  want  of  expe- 
rience or  want  of  reflection  on  the  part  of  those  to  whom  the  ques- 
tion is  put. 

Mechanical  Irritants. — The  substance  administered  may  not  be  a 
poison  in  the  medical  signification  of  the  term,  and  it  may  not  be 
popularly  considered  as  such :  yet,  when  taken,  it  may  be  noxious  to 
health  or  destructive  to  life.  We  have  examples  of  substances  of 
this  description  in  iron-filings,  powdered  glass,  sponge,  pins  and 
needles,  and  such  like  bodies,  which  have  been  administered  with 
the  wilful  design  of  injuring,  and  have  on  various  occasions  given 
rise  to  criminal  charges.  In  cases  of  this  kind,  the  legal  guilt  of  a 
prisoner  may  often  depend  on  the  meaning  assigned  by  a  medical 
witness  to  the  words  destructive  thing.  Thus,  to  take  an  example, 
liquid  mercury  might  be  poured  down  the  throat  of  an  infant,  with 
the  deliberate  intention  to  destroy  it.  A  question  of  a  purely 
medical  nature  will  then  arise  whether  mercury  be  a  "  destructive 
thing"  or  not ;  and  the  conviction  of  a  prisoner  will  probably  depend 
on  the  answer.  Should  a  difference  of  opinion  exist,  an  occurrence 
by  no  means  unusual  in  medical  evidence,  the  prisoner  will,  accord- 
ing to  the  humane  principle  of  our  law,  receive  the  benefit  of  the 
doubt. 

Influence  of  Habit  on  Poison. — Habit,  it  is  well  known,  diminishes 
the  effects  of  certain  poisons  :  thus  it  is  that  opium,  when  frequently 
taken  by  a  person,  loses  its  effects  for  a  time,  and  requires  to  be 
administered  in  a  much  larger  dose.  Indeed,  confirmed  opium-eaters 
have  been  enabled  to  take  at  once,  a  quantity  of  the  drug  which 
would  have  infallibly  killed  them,  had  they  commenced  with  it  in  the 
first  instance.  Even  infants  and  children,  who  are  well  known  to  be 
especially  susceptible  of  the  effects  of  opium,  and  are  liable  to  be 
poisoned  by  small  doses,  may,  by  the  influence  of  habit,  be  brought 


66  INFLUENCE    OF    HABIT    OX    POISOXS. 

to  take  the  drug  in  very  large  quantities.  This  is  well  illustrated 
by  a  statement  made  by  Mr.  Grainger,  in  the  "  Eeport  of  the  Child- 
ren's Employment  Commission."  It  appears  that  the  system  of  drug- 
ging children  with  opium  in  the  factory  districts,  commences  as  soon 
after  birth  as  possible ;  and  the  dose  is  gradually  increased  until  the 
child  takes  from  fifteen  to  twenty  drops  of  laudanum  at  once !  This 
has  the  effect  of  throwing  it  into  a  lethargic  stupor.  Healthy  child- 
ren of  the  same  age  would  be  killed  by  a  dose  of  five  drops.  The 
same  influence  of  habit  is  manifested  more  or  less  in  the  use  of 
tobacco,  alcohol,  ether,  chloroform,  morphia,  strychnia,  and  other 
alkaloids.  Dr.  Christison  has  remarked  that  this  influence  is  chiefly 
confined  to  poisons  derived  from  the  organic  kingdom :  it  is  so  lim- 
ited with  regard  to  mineral  substances  that  it  can  scarcely  be  said  to 
exist.  It  is  stated  on  respectable  authority  that  certain  peasants  in 
Styria  are  addicted  to  the  practice  of  arsenic-eating,  and  that  they 
carry  it  on  for  many  years  without  suffering  from  the  usual  effects  of 
this  poison.  Dr.  Roscoe  has  published  a  case  in  which,  according  to 
information  supplied  to  him,  a  Styrian  peasant  took  in  one  day  four 
grains  and  a  half,  and  on  the  day  following  five  grains  and  a  half  of 
arsenic,  crushing  the  mineral  between  his  teeth  and  swallowing  it. 
The  day  after  he  had  swallowed  the  second  dose,  the  man  left  the 
place  in  his  usual  health  and  there  is  no  further  record  of  him.  Dr. 
C.  Maclagan  states  that  he  saw  a  Styrian  peasant,  aet.  26,  swallow 
between  four  and  five  grains  of  white  arsenic  in  powder.  In  two 
hours  some  urine  which  he  passed  contained  arsenic.  This  man 
suffered  no  ill  effects;  he  stated  that  he  had  taken  arsenic  for  a  year 
and  a  half  without  any  injury  to  his  health.  He  took  at  first  rather 
less  than  a  grain  every  fortnight.  In  another  case  a  man,  ast.  16, 
swallowed  six  grains.  In  three  quarters  of  an  hour  it  was  found  that 
arsenic  was  eliminated  with  the  urine.  ("  Ed.  Med.  Journ."  Sept. 
1864,  p.  200.)  Dr.  Knapp  informed  Dr.  Maclagan,  that  a  man  once 
took  in  his  presence  seven  and  a  half  grains  of  arsenic,  and  no  inju- 
rious effects  were  produced  ("  Ed.  Med.  Journ."  Jan.  1865,  p.  669. 
Such  cases  as  these  admit  of  no  explanation  on  English  experience. 
Habit  appears  to  have  so  little  influence  on  arsenic,  under  the  most 
careful  medicinal  use  of  it  in  this  country,  that  I  believe  no  medical 
practitioner  has  ever  succeeded  in  causing  a  patient  to  take  two  grains 
at  a  dose,  the  smallest  quantity  yet  known  to  have  destroyed  life.  Mr. 
Hunt,  who  has  had  a  large  experience  in  the  use  of  this  mineral, 
fixes  the  maximum  dose  to  be  given  with  safety,  at  one  grain. 

The  following  case,  reported  in  the  same  journal  (August,  1861,  p. 
116),  by  Dr.  Parkes,  of  Halifax,  shows  the  danger  incurred  by  this 
practice.  A  man  who  had  taken  arsenic  for  a  period  of  three  or  four 
years  died  under  the  usual  symptoms  of  chronic  poisoning.  As  far 
as  it  could  be  ascertained,  the  daily  dose  taken  by  deceased  for  the 
last  five  months  of  his  life,  was  from  two  to  three  grains.  From  the 
beginning  of  the  practice  he  had  suffered  from  symptoms  of  poison- 
ing with  arsenic,  which  gradually  assumed  the  form  of  arsenical 
cachexia ;  but  he  referred  the  symptoms  to  other  causes,  and  con- 
cealed the  practice  from  his  friends.     His  system  never  became  habit- 


INFLUENCE    OF    I DIOS YNCEASY.  67 

"imted  to  the  poison.  This  is  a  result  which  may  be  generally  ex- 
pected. If  the  exceptional  cases  observed  in  Styria  are  supposed  to 
prove  that  arsenic  may  be  taken  in  large  doses  with  impunity  they 
would  lead  to  error.  Such  cases  have  no  practical  bearing  in  legal 
medicine.  If  the  practice  of  arsenic-eating  produces  no  symptoms, 
then  no  question  of  poisoning  can  arise.  If,  as  in  the  above  case, 
it  does  produce  symptoms,  then  it  falls  within  the  range  of  ordinary 
experience. 

The  only  form  in  which  I  have  known  the  question  of  habit  to  be 
seriously  raised  in  medical  jurisprudence  is  this :  whether,  while  the 
more  prominent  effects  of  a  poison  are  thereby  diminished,  the  insid- 
ious or  latent  effects  on  the  constitution  are  at  the  same  time  counter- 
acted. The  answer  is  of  some  importance  in  relation  to  the  subject 
of  life  insurance: — for  the  concealment  of  the  practice  of  opium- 
eating  by  a  person  whose  life  was  insured,  has  already  given  rise  to 
an  action,  in  which  medical  evidence  on  this  subject  was  rendered 
necessary.  As  a  general  principle,  we  must  admit  that  habit  cannot 
altogether  counteract  the  insidious  effects  of  poisons ;  and  that  the 
practice  of  taking  them  is  liable  to  give  rise  to  disease  or  to  impair 
the  constitution. 

Infltience  of  Idiosyncrasy. — Idiosyncrasy  differs  from  habit : — it 
does  not,  like  habit,  diminish  the  effect  of  a  poison:  for  it  is  not 
commonly  found  that  any  particular  state  of  body  is  a  safeguard 
against  the  effects  of  these  powerful  agents.  Some  constitutions  are 
observed  to  be  much  more  affected  than  others  by  certain  poisons : 
thus  opium,  arsenic,  mercury,  lead,  and  antimony  are  substances  of 
this  description,  and  this  difference  in  their  effect  is  ascribed  to  idio- 
syncrasy. Dr.  Christison  mentions  a  remarkable  instance,  in  which  a 
gentleman  unaccustomed  to  the  use  of  opium,  took  nearly  an  ounce 
of  laudanum  without  any  effect.  ("  On  Poisons,"  33.)  This  form  of 
idiosyncrasy  is  very  rare.  Certain  substances  generally  reputed  harm- 
less, and,  indeed,  used  as  articles  of  food,  are  observed  to  affect  some 
persons  like  poisons.  This  is  the  case  with  pork,  certain  kinds  of 
shell-fish,  and  mushrooms.  There  may  be  nothing  poisonous  in  the 
food  itself;  but  it  acts  as  a  poison  in  particular  constitutions — whether 
from  its  being  in  these  cases  a  poison  per  se,  or  rendered  so  by  changes 
during  the  process  of  digestion,  it  is  difficult  to  say.  The  subject  of 
idiosyncrasy  is  of  importance  in  a  medico-legal  view  when  symptoms 
resembling  those  of  poisoning,  follow  a  meal  consisting  of  a  partic- 
ular kind  of  food.  In  such  a  case,  without  a  knowledge  of  this 
peculiar  condition,  we  might  hastily  attribute  to  poison,  effects  which 
were  really  due  to  another  cause.  It  would  appear  that  in  some  in- 
stances idiosyncrasy  may  be  acquired — i.  e.  a  person  who,  at  one 
period  of  his  life,  had  been  in  the  habit  of  partaking  of  a  particular 
kind  of  food  without  injury,  may  find  at  another  period  that  it  will 
disagree  with  him.  When  pork  has  been  disused  as  an  article  of 
diet  for  many  years  it  cannot  always  be  resumed  with  impunity.  In 
cases  in  which  the  powers  of  life  have  become  enfeebled  by  age,  the 
susceptibility  of  the  system  to  poisons  is  increased :  thus  aged  per- 
sons may  be  killed  by  comparatively  small  doses  of  arsenic  and 


OS  CORROSIVE    AND    IRRITANT    POISONS. 

opium.  Cases  of  acquired  idiosyncrasy  are  very  rare:  it  appears  to 
be,  if  we  may  so  apply  the  term,  a  congenital  condition.  There  are, 
however,  certain  diseases  which  appear  to  confer  a  power  of  support- 
ing large  and  even  poisonous  doses  of  some  substances.  Very  large 
doses  of  opium  have  been  taken  without  producing  dangerous  symp- 
toms by  persons  laboring  under  tetanus  and  hydrophobia.  This 
condition  is  called  tolerance.  It  has  been  witnessed  in  diseases  of  the 
lungs  in  reference  to  the  use  of  antimonial  medicines. 

Classification  of  Poisons. — Poisons  have  been  divided  into 
three  classes,  according  to  their  mode  of  action  on  the  system  ; 
namely,  Irritants,  Narcotics,  and  Narcotico-Irritants."  This 
classification  is  a  modification  of  that  originally  proposed  by  Orrlla. 
The  Narcotics  and  Narcotico-irritants  may,  however,  be  regarded  as 
constituting  one  large  class,  the  Neurotics,  as  their  special  action  is 
to  affect  directly  one  or  more  parts  of  the  nervous  system.  The 
Neurotic  poisons  admit  of  a  subdivision  into  Cerebral,  Spinal,  and 
Cerebro- spinal,  according  to  whether  the  poisonous  substance  affects 
directly  the  brain,  the  spinal  marrow,  or  both  of  these  organs. 

Irritants. — The  irritants  are  possessed  of  these  common  charac- 
ters. When  taken  in  ordinary  doses,  they  occasion  speedily  violent 
vomiting  and  purging.  The  symptoms  are  either  accompanied  or 
followed  by  pain  in  the  stomach  and  bowels.  The  peculiar  effects  of 
the  poison  are  manifested  chiefly  on  these  organs,  which,  as  their 
name  implies,  they  irritate  and  inflame.  Many  substances  belonging 
to  this  class  of  poisons  possess  corrosive  properties;  such  as  the 
strong  mineral  acids,  caustic  alkalies,  bromine,  corrosive  sublimate, 
and  others.  These,  in  the  act  of  swallowing,  are  commonly  accom- 
panied by  an  acrid  or  burning  taste,  extending  from  the  mouth  down 
the  gullet  to  the  stomach.  Some  irritants  do  not  possess  any  corro- 
sive action — of  which  we  have  examples  in  arsenic,  the  poisonous 
salts  of  baryta,  carbonate  of  lead,  and  cantharides ;  these  are  often 
called  pure  irritants.  They  exert  no  destructive  chemical  action  on 
the  tissues  with  which  they  come  in  contact ;  they  simply  irritate  and 
inflame  them. 

Difference  between  Corrosive  and  Irritant  Poisons. — As  a  result  of  the 
action  of  corrosive  poisons,  symptoms  are  commonly  manifested  imme- 
diately, because  mere  contact  produces  the  destruction  of  a  part.  In 
the  action  of  the  purely  irritant  poisons,  the  symptoms  are  generally 
more  slowly  manifested,  rarely  showing  themselves  until  at  least 
half  an  hour  has  elapsed  from  the  time  of  swallowing  the  substance. 
Of  course,  there  are  exceptions  to  this  remark ;  for  sometimes  irri- 
tants act  speedily,  though  rarely  with  the  rapidity  of  corrosive 
poisons.  It  is  important  in  a  practical  view,  to  ascertain  whether,  in 
an  unknown  case,  the  poison  which  a  person,  requiring  immediate 
treatment,  may  have  swallowed,  is  irritant  or  corrosive.  This  may 
be  commonly  determined  by  a  knowledge  of  the  time  at  which  the 
symptoms  appeared  after  the  suspected  substance  was  taken.  "We 
may  thus  often  easily  distinguish  between  a  case  of  poisoning  from 
arsenic  and  one  from  corrosive  sublimate.  There  is  also  another 
point  which  may  be  noticed.     As  the  corrosive  substance  exerts  a 


neurotic  roisoxs.  69 

decidedly  chemical  action,  an  examination  of  the  mouth  and  throat 
may  enable  us  in  some  cases  to  solve  the  question. 

It  has  already  been  stated  that  there  are  many  irritant  poisons 
which  have  no  corrosive  properties,  but  every  corrosive  may  act  as 
an  irritant.  Thus  the  action  of  corrosive  sublimate  is  that  of  an 
irritant  poison,  as,  while  it  destroys  some  parts  of  the  coats  of  the 
stomach  and  intestines,  it  irritates  and  inflames  others.  So  again 
most  corrosive  poisons  may  lose  their  corrosive  properties  by  dilu- 
tion with  water,  and  then  they  act  simply  as  irritants.  This  is  the 
case  with  the  mineral  acids,  and  bromine.  In  some  instances,  it  is 
not  easy  to  say  whether  an  irritant  poison  possesses  corrosive  proper- 
ties or  not.  Thus  oxalic  acid  acts  immediately,  and  blanches  and 
softens  the  mucous  membrane  of  the  mouth  and  throat,  but  I  have 
not  met  with  any  decided  marks  of  chemical  corrosion  produced  by 
it  in  the  stomach  or  viscera.  Irritant  poisons,  for  the  most  part, 
belong  to  the  mineral  kingdom ;  and  they  may  be  divided  into  the 
Non-Metallic  and  Metallic  irritants.  There  are  a  few  derived  from  the 
animal  and  vegetable  kingdoms ;  but  these,  if  we  except  cantharides, 
are  not  often  employed  criminally.  Some  of  the  gases  likewise 
belong  to  the  class  of  irritant  poisons. 

Neurotics. — Neurotic  poisons  act  upon  the  nervous  system,  and 
their  operation  is  confined  chiefly  to  the  brain  and  spinal  marrow. 
Either  immediately  or  some  time  after  the  poison  has  been  swallowed, 
the  patient  suffers  from  headache,  giddiness,  numbness,  paralysis, 
stupor,  and  in  some  instances,  convulsions.  They  have  not  an  acrid 
burning  taste  like  the  corrosive  irritants ;  and  they  rarely  give  rise 
to  vomiting  or  purging.  When  these  symptoms  follow  the  ingestion 
of  the  poison  into  the  stomach,  the  effect  may  be  generally  ascribed 
either  to  the  form  or  quantity  in  which  it  has  been  taken,  and  the 
mechanical  effect  on  the  stomach  thereby  produced,  or  to  the  poison 
being  combined  with  some  irritating  substance,  such  as  alcohol.  The 
pure  narcotics,  or  Cerebral  poisons,  are  not  found  to  irritate  or  iuflame 
the  stomach  and  bowels. 

Notwithstanding  the  well-defined  boundary  thus  apparently  exist- 
ing between  these  two  classes  of  poisons,  it  must  not  be  supposed 
that  the  substances  arranged  in  each  class,  always  act  in  the  manner 
indicated.  Some  irritants  have  been  observed  to  affect  the  brain  or 
the  spinal  marrow,  and  this  may  be  either  a  primary  or  a  secondary 
consequence  of  their  action.  Arsenic  and  oxalic  acid,  although 
classed  as  irritants,  have  in  some  instances  given  rise  to  symptoms 
closely  resembling  those  of  narcotic  poisoning ;  namely,  coma,  pa- 
ralysis, and  tetanic  convulsions.  In  a  case  of  poisoning  by  arsenic, 
which  occurred  to  Dr.  Morehead,  of  Bombay,  the  symptoms  of  nar- 
cotism were  so  strongly  marked,  that  it  was  believed  at  first  the  man 
had  taken  a  narcotic.  ("  Med.  Gaz."  vol.  43,  p.  1055.)  I  have  met 
with  a  case  of  poisoning  by  arsenic  in  which  there  was  paralysis  of 
the  limbs,  with  an  entire  absence  of  purging,  during  the  eight  days 
that  the  deceased  survived.  On  the  other  hand,  in  a  case  of  poisoning 
by  a  large  dose  of  opium,  there  was  an  absence  of  the  usual  symp- 
toms of  cerebral  disturbance,  and  the  presence  of  others  resembling 


70  EVIDENCE    OF    POISONING    IN    THE    LIVING. 

those  of  irritant  poisoning — namely,  pain  and  vomiting.  Thus,  then, 
we  must  not  allow  ourselves  to  be  misled  by  the  idea  that  the  symp- 
toms are  always  clearly  indicative  of  the  kind  of  poison  taken.  The 
narcotic  or  cerebral  poisons  are  few  in  number,  and  belong  to  the 
vegetable  kingdom.  Some  of  the  poisonous  gases  possess  a  narcotic 
action. 

Narcotico- Irritants.  [Spinal  and  Cerebrospinal  Poisons?) — Poisons 
belonging  to  this  class  have,  as  the  name  implies,  a  compound  action. 
They  are  chiefly  derived  from  the  vegetable  kingdom.  At  variable 
periods  after  they  have  been  swallowed,  they  give  rise  to  vomiting 
and  purging,  like  irritants ;  and  sooner  or  later  produce  stupor,  coma, 
paralysis  and  convulsions,  owing  to  their  effects  on  the  brain  and 
spinal  marrow.  In  the  state  of  vegetables,  as  leaves,  seeds,  or  roots, 
they  possess  the  property,  like  irritants,  of  irritating  and  inflaming 
the  stomach  and  bowels.  As  familiar  examples  we  may  point  to 
nux  vomica,  monkshood,  hemlock,  and  poisonous  mushrooms.  This 
class  of  poisons  is  very  numerous,  embracing  a  large  variety  of  well- 
known  vegetable  substances ;  but  they  rarely  form  a  subject  of  diffi- 
culty to  a  medical  practitioner.  The  fact  of  the  symptoms  occurring 
after  a  meal  at  which  some  suspicious  vegetables  may  have  been 
eaten,  coupled  with  the  nature  of  the  symptoms  themselves,  will 
commonly  indicate  the  class  to  which  the  poison  belongs.  Some  of 
these  poisons  have  a  hot  acrid  taste  ;  others,  like  aconite  or  monks- 
hood, produce  a  sense  of  numbness  or  tingling,  while  others  again 
have  an  intensely  bitter  taste,  as  nux  vomica,  strychnia,  veratria,  and 
picrotoxia.     Strychnia  may  be  regarded  as  a  pure  spinal  poison. 


CHAPTEE    V. 

Evidence  of  poisoning  in  the  living  body. — action  of  poisons 
inckeased  or  diminished  by  disease. — symptoms  connected 
with  food  or  medicine. — several  persons  attacked  simul- 
taneously.— evidence  from  the  detection  of  poison  in  the 

FOOD. 

We  now  proceed  to  consider  the  evidence  of  poisoning  in  the  liv- 
ing body.  To  the  practitioner  the  diagnosis  of  a  case  of  poisoning 
is  of  great  importance,  as  by  mistaking  the  symptoms  produced  by 
a  poison  for  those  arising  from  natural  disease,  he  may  omit  to 
employ  the  remedial  measures  which  have  been  found  efficacious  in 
counteracting  its  effects,  and  thus  lead  to  the  certain  death  of  the 
patient.  To  a  medical  jurist  a  correct  knowledge  of  the  symptoms 
furnishes  the  chief  evidence  of  poisoning,  in  those  cases  in  which 
persons  are  charged  with  the  malicious  and  unlawful  administration 
of  poison.  The  symptoms  produced  during  life,  constitute  also  an 
important  part  of  the  evidence  in  those  instances  in  which  a  poison 


INFLUENCE    OF    DISEASE.  71 

proves  fatal.  At  present,  however,  we  will  suppose  the  case  to  be, 
that  poison  has  been  taken  and  the  patient  survives.  Most  toxico- 
logical  writers  have  laid  down  certain  characters  whereby  it  is  said 
symptoms  of  poisoning  may  be  distinguished  from  those  of  disease. 

1.  In  poisoning,  the  symptoms  appear  suddenly,  while  the  individual 
is  in  health. — It  is  the  common  character  of  most  poisons,  when  taken 
in  the  large  doses  in  which  they  are  usually  administered  with  crim- 
inal intent,  to  produce  serious  symptoms,  either  immediately  or 
within  a  very  short  period  after  they  have  been  swallowed.  Their 
operation,  under  such  circumstances,  cannot  be  suspended,  and  then 
manifest  itself  after  an  indefinite  interval ;  although  this  was  for- 
merly a  matter  of  universal  belief,  and  gave  rise  to  many  absurd 
accounts  of  what  was  termed  slow  poisoning. 

The  symptoms  of  poisoning  by  nicotina,  prussic  acid,  oxalic  acid, 
or  the  salts  of  strychnia,  appear  immediately,  or  generally  within  a 
very  few  minutes  after  the  poison  has  been  swallowed.  In  an  ex- 
ceptional case,  in  which  the  dose  of  prussic  acid  was  small,  and 
insufficient  to  produce  death,  the  poison  was  supposed  by  the  patient 
not  to  have  begun  to  act  until  after  the  lapse  of  fifteen  minutes. 
("  Ed.  Med.  and  Surg.  Journ."  vol.  59,  p.  72.)  The  symptoms  caused 
by  arsenic  and  other  irritants,  and,  indeed,  by  all  poisons  generally, 
are  commonly  manifested  in  from  half  an  hour  to  an  hour.  It  is 
rare  that  the  appearance  of  symptoms  is  protracted  for  two  hours, 
except  under  certain  peculiar  states  of  the  system.  It  is  said  that 
some  narcotic  poisons,  such  as  the  poisonous  mushrooms,  may  remain 
in  the  stomach  twelve  or  twenty-four  hours  without  giving  rise  to 
symptoms ;  and  this  is  also  affirmed  to  be  the  case  with  some  animal 
irritants,  such  as  decayed  meat ;  but  with  regard  to  the  first  point,  it 
has  been  shown  by  Dr.  Peddie  that  mushrooms  have  produced  symp- 
toms in  half  an  hour;  and  a  case  has  fallen  under  my  own  observa- 
tion, in  which  the  symptoms  from  noxious  animal  food  came  on 
within  as  short  a  time  after  the  meal,  as  is  commonly  observed  in 
irritant  poisoning  by  mineral  substances.  In  some  cases  of  poison- 
ing by  phosphorus,  no  symptoms  have  occurred  until  after  the  lapse 
of  several  hours. 

Influence  of  Disease. — A  diseased  state  of  the  body  may  render  a 
person  comparatively  unsusceptible  of  the  action  of  certain  poisons, 
while  in  other  instances  it  may  increase  their  action,  and  render  them 
fatal  in  small  doses.  In  dysentery  and  tetanus  a  person  may  take, 
without  being  materially  affected,  a  quantity  of  opium  sufficient  to 
kill  an  adult  in  average  health.  In  mania,  cholera,  hysteria,  and 
delirium  tremens,  large  doses  of  opium  may  be  borne  with  compara- 
tive impunity  (p.  65).  In  a  case  of  hemiplegia,  a  woman  set.  29,  took 
for  six  days,  three  grains  of  strychnia  daily  without  injurious  conse- 
quences— the  dose  having  been  gradually  raised  ("  Gaz.  Med."  Mai 
1845) ; — while  one  grain  of  strychnia  is  commonly  regarded  as  a 
fatal  dose  to  a  healthy  adult.  In  a  case  of  tetanus,  Dupuytren  gave 
as  much  as  two  ounces  of  opium  at  a  dose  (60  grammes),  without 
serious  consequences.  (Flandin,  "Traite  des  Poisons,"  vol.  1,  p.  231.) 
It  has  also  been  remarked  that  persons  affected  with  tetanus  are  not 


72  IXFLUEXCE    OF    DISEASE. 

easily  salivated  by  mercury.  The  morbid  state  appears  to  create  the 
power  of  resisting  the  ordinary  effects  of  poisons.  ("  Colles's  Lec- 
iures,"  vol.  1,  p.  77.)  The  effect  of  certain  diseases  of  the  nervous 
system,  as  well  as  of  habit,  either  in  retarding  the  appearance  of 
symptoms  or  in  blunting  the  operations  of  a  poison,  it  is  not  difficult 
to  appreciate ;  they  are  cases  which  can  present  no  practical  difficulty 
to  a  medical  jurist.  On  the  other  hand,  in  certain  diseased  states  of 
the  system,  there  may  be  an  increased  susceptibility  of  the  action  of 
poison.  Thus,  in  those  persons  who  have  a  disposition  to  apoplexy, 
a  small  dose  of  opium  may  act  more  quickly  and  prove  fatal.  In  a 
person  laboring  under  inflammation  of  the  stomach  or  bowels,  there 
would  be  an  increased  susceptibility  of  the  effects  of  arsenic,  anti- 
mony, or  other  irritants.  In  debility  from  any  cause  these  mineral 
substances  would  also  act  injuriously  even  in  ordinary  doses.  Anti- 
mony is  a  most  powerful  depressant,  and  might,  by  its  effect  on  the 
heart,  cause  death  by  syncope.  The  influence  of  disease  in  increas- 
ing the  operation  of  poison,  has  been  noticed  in  cases  of  diseased 
kidney  (granular  degeneration),  in  which  small  doses  of  mercury 
have  produced  severe  salivation,  leading  to  exhaustion  and  death. 
In  diseases  of  the  lungs  affecting  aged  persons,  opium  in  medicinal 
doses,  has  been  observed  to  exert  a  poisonous  action.  The  effect  of 
the  drug  appears  to  be  intensified  by  the  disease.  This  observation 
applies  equally  to  morphia.  Chloroform  vapor  in  ordinary  quantity 
has  been  found  to  produce  fatal  effects,  in  cases  in  which  there  was 
latent  disease  of  the  heart  or  of  the  coronary  arteries  of  this  organ. 
A  fatty  condition  of  the  muscular  tissue  leading  to  great  feebleness 
of  the  heart's  action,  appears  to  be  highly  favorable  to  death  by 
s}Tncope,  under  the  use  of  chloroform.  A  knowledge  of  these  facts 
is  of  importance  in  reference  to  charges  of  malapraxis  when  death 
has  arisen  from  ordinary  or  extraordinary  doses  of  medicines, 
administered  to  persons  laboring  under  disease.  In  such  cases,  an- 
other mode  of  treatment  should  be  substituted,  or  a  smaller  dose  than 
usual  given,  and  its  effects  carefully  watched.  In  some  instances, 
however,  full  and  large  doses  of  powerful  drugs  have  been  recklessly 
given,  and  when  a  fatal  result  has  followed,  there  has  been  a  strong 
disposition  to  refer  death  to  the  supposed  disease,  of  which,  however, 
sometimes  no  trace  could  be  found  in  the  body.  An  experienced 
physician,  well  acquainted  with  pathological  anatomy,  informs  me 
that  since  the  use  of  chloroform  has  become  general,  and  deaths 
under  its  use  are  not  unfrequent,  a  fattiness  and  flabbiness  of  the 
muscular  structure  of  the  heart  has  been  sought  for  and  almost  uni- 
versally found !  The  fatal  result  has  not  been  attributed  to  its  real 
cause,  the  imprudent  or  careless  administration  of  chloroform,  but  to 
some  minute  structural  changes  revealed  by  the  microscope  in  the 
substance  of  the  organ. 

Symptoms  appear  during  a  state  of  health. — Symptoms  of  poisoning 
may  manifest  themselves  in  a  person  while  in  a  state  of  perfect  health, 
without  any  apparent  cause.  This  rule  is,  of  course,  open  to  nume- 
rous exceptions,  because  the  person  on  whose  life  an  attempt  has  been 
made,  may  be  actually  laboring  under  disease ;  and  under  these  cir- 


EVIDENCE    OF    POISONING.  73 

cumstances  the  symptoms  may  be  so  obscure  as  to  disarm  all  suspicion. 
"When  poison  is  exhibited  in  medicine,  a  practitioner  is  very  liable  to 
be  deceived,  especially  if  the  disease  under  which  the  person  is  labor- 
ing is  of  an  acute  nature,  and  is  attended  by  symptoms  of  disorder  in 
the  alimentary  canal.  Several  cases  of  poisoning  have  occurred  in 
which  arsenic  was  criminally  substituted  for  medicine,  and  given  to 
the  parties  while  laboring  under  a  disorder  of  the  bowels.  We  are, 
however,  justified  in  saying,  with  respect  to  this  character  of  poison- 
ing, that  when  in  a  previously  healthy  person,  violent  vomiting  and 
purging  occur  suddenly  and  without  any  assignable  cause,  such  as 
pregnancy,  disease,  or  indiscretion  in  diet,  to  account  for  them,  there 
is  strong  reason  to  suspect  that  irritant  poison  has  been  taken.  When 
the  person  is  already  laboring  under  disease,  we  must  be  especially 
watchful  on  the  occurrence  of  any  sudden  change  in  the  character  or 
violence  of  the  symptoms,  unless  such  change  can  be  easily  accounted 
for  on  common  or  well-known  medical  principles.  In  most  cases  of 
criminal  poisoning  we  meet  with  alarming  symptoms  without  any  ob- 
vious or  sufficient  natural  causes  to  explain  them.  The  practitioner 
will,  of  course,  be  aware  that  there  are  certain  diseases  which  are  liable 
to  occur  suddenly  in  healthy  people,  the  exact  cause  of  which  may  not 
at  first  sight  be  apparent ;  therefore  this  criterion  is  only  one  out  of 
many  on  which  a  medical  opinion  should  be  founded. 

2.  In  poisoning  the  symptoms  appear  soon  after  a  meal,  or  soon  after 
some  kind  of  food  or  medicine  has  been  taken. — This  is  by  far  the  most 
important  character  of  poisoning  in  the  living  body.  It  has  been 
already  stated  that  most  poisons  begin  to  operate  within  an  hour  after 
they  have  been  swallowed ;  and  although  there  are  few  exceptions  to 
this  remark,  yet  they  occur  under  circumstances  easily  to  be  appre- 
ciated by  a  practitioner.  Thus,  then,  it  follows  that,  supposing  the 
symptoms  under  which  a  person  is  laboring,  to  depend  on  poison,  the 
substance  has  most  probably  been  swallowed,  either  in  food  or  medi- 
cine, from  half  an  hour  to  an  hour  previously.  It  must  be  observed, 
however,  that  causes  may  occur  in  which  the  poison  has  not  been 
introduced  by  the  mouth.  Oil  of  vitriol  and  other  corrosive  liquids 
have  been  thrown  up  the  rectum  in  injections,  and  have  thus  caused 
death ;  the  external  application  of  arsenic,  corrosive  sublimate,  and 
cantharides  to  ulcerated  surfaces  has  destroyed  life.  In  one  case, 
arsenic  was  introduced  into  the  vagina  of  a  female,  and  she  died  in 
five  days  under  all  the  symptoms  of  arsenical  poisoning.  (Schneider, 
"Ann.  der.  ges.  Staatsarzneikunde,"  i.  299.)  Such  cases  are  rare, 
but,  nevertheless,  the  certainty  that  they  have  occurred,  where  their 
occurrence  could  hardly  have  been  anticipated,  shows  that  in  a  sus- 
picious case  a  practitioner  should  not  deny  the  fact  of  poisoning, 
merely  because  it  may  be  proved  that  the  person  could  not  have 
taken  the  poison  in  the  usual  way,  by  the  mouth.  Again,  persons 
may  be  destroyed  by  the  vapors  of  ether,  chloroform,  prussic  acid, 
or  other  powerful  volatile  poisons,  introduced  into  the  body  through 
the  lungs.  Such  a  mode  of  suicide,  or  murder,  might  disarm  suspi- 
cion, from  the  fact  of  no  noxious  material  being  found  in  the  stomach. 

Let  us  suppose,  however,  the  circumstances  to  have  been  such  that 


74  TIME    OF    OCCURRENCE    OF    SYMPTOMS. 

these  secret  means  of  destruction  could  not  have  been  resorted  to, 
and  that  the  poison  is  one  of  those  most  commonly  selected  by  a 
murderer,  such  as  arsenic,  tartar  emetic,  oxalic  acid,  or  corrosive  sub- 
limate, then  we  may  expect  that  this  character  of  poisoning  will  be 
made  evident  to  us,  and  that  something  must  have  been  swallotced  by 
the  patient  shortly  before  the  alarming  symptoms  appeared.  By  ob- 
servations attentively  made,  it  may  be  in  our  power  to  connect  the 
appearance  of  the  symptoms  with  the  use  of  a  particular  article  of 
food,  and  thus  indirectly  lead  to  the  detection  of  a  criminal.  Sup- 
posing that  many  hours  have  passed  since  food  or  medicine  was  taken 
by  the  patient,  without  any  effect  ensuing — it  is  probable  that  the 
symptoms  are  due  to  natural  causes  and  not  to  poison.  When  symp- 
toms resembling  those  of  poisoning  speedily  follow  the  ingestion  of 
food  or  medicine,  there  is,  however,  reasonable  ground  for  suspicion; 
but  caution  should  be  observed  in  drawing  inferences,  since  the  most 
extraordinary  coincidences  sometimes  present  themselves.  In  the 
case  of  Sir  Theodosius  Boughton,  who  was  poisoned  by  his  brother-in- 
law,  Donnellan,  in  1781,  the  fact  of  alarming  symptoms  coming  on  in 
two  minutes  after  the  deceased  had  swallowed  what  was  supposed  to 
be  a  simple  medicinal  draught,  was  a  most  important  part  of  the  evi- 
dence against  the  prisoner.  There  is  no  doubt  that  laurel- water  had 
been  substituted  for  the  medicine  by  the  prisoner,  and  that  this  had 
caused  the  symptoms  which  preceded  death.  The  practice  of  substi- 
tuting poisonous  mixtures  for  medicinal  draughts  or  powders  is  by 
no  means  unusual,  although  it  might  be  supposed  to  indicate  a  degree 
of  refinement  and  knowledge  not  commonly  to  be  found  among  crim- 
inals. Medical  practitioners  are  thus  apt  to  be  imposed  upon,  and 
the  following  case,  related  by  a  deceased  judge,  will  serve  as  a  caution : 
An  apothecary  prepared  a  draught,  into  which  another  person  put 
poison,  intending  thereby  to  destroy  the  life  of  the  patient  for  whom 
the  medicine  was  prescribed.  The  patient,  not  liking  the  taste  of  the 
draught,  and  thinking  there  was  something  suspicious  about  it,  sent 
it  back  to  the  apothecary,  who,  knowing  the  ingredients  of  which  he 
had  composed  it,  and  wishing  to  prove  to  his  patient  that  he  had  done 
nothing  wrong,  drank  it  himself,  and  died  from  the  effects.  He  was 
thus  the  unconscious  agent  of  his  own  death ;  and  although  the  draught 
was  intended  for  another,  the  party  who  poisoned  it  was  held  guilty 
of  murder.  This  case  contains  a  warning  to  medical  witnesses.  It 
is  not  unusual,  on  trials  for  poisoning,  when  the  poison  is  conveyed 
through  medicine,  to  find  a  medical  witness  offering  to  swallow  his 
own  draught  in  a  court  of  law,  in  order  to  furnish  a  convincing  prac- 
tical illustration  of  the  innocence  of  the  medicine !  It  need  hardly  be 
observed  that  an  exhibition  of  this  kind  is  never  required  of  a  medical 
witness.  If  any  doubt  be  raised  of  the  innocent  properties  of  a  draught 
or  powder,  a  chemical  analysis  of  its  contents  will  be  far  more  satis- 
factory, and  attended  with  no  kind  of  risk  to  the  practitioner. 

On  the  other  hand,  the  occurrence  of  symptoms  resembling  those 
produced  by  poisoning,  soon  after  food  or  medicine  has  been  taken, 
may  be  a  pure  coincidence.  In  such  a  case,  poison  is  always  sus- 
pected by  the  vulgar;  and  it  will  be  the  duty  of  a  medical  jurist  to 


EVIDENCE    OF    POISONING    FROM    SYMPTOMS.  75 

guard  against  the  encouragement  of  such  a  suspicion,  until  he  has 
strong  grounds  to  believe  it  to  be  well  founded.  No  public  retracta- 
tion or  apology  can  ever  make  amends  for  the  injury  which  may  in 
this  way  be  inflicted  on  the  reputation  of  another ;  for  those  who  hear 
the  accusation  may  never  hear  the  defence.  In  all  such  cases,  a  prac- 
titioner may  entertain  a  suspicion,  but,  until  confirmed  by  facts,  he 
should  avoid  expressing  it,  or  giving  it  publicity.  When  death  is  not 
a  consequence,  it  is  difficult  to  clear  up  such  cases,  except  by  the  aid 
of  a  chemical  analysis  ;•  but  this,  as  we  know,  is  not  always  applicable. 
If  death  ensue,  the  real  cause  is  usually  apparent,  and  a  suspicion  of 
poisoning  is  thus  often  removed  by  an  examination  of  the  body. 

3.  In  poisoning,  when  several  partake  at  the  same  time  of  the  same 
food  or  medicine  [mixed  with  poison)  all  suffer  from  similar  symptoms. — 
This  character  of  poisoning  cannot  always  be  procured :  but  it  fur- 
nishes good  evidence  of  the  fact  when  it  exists.  Thus,  supposing 
that  after  a  meal  made  by  several  persons  from  the  same  dish,  only 
one  suffers,  the  suspicion  of  poisoning  is  considerably  weakened. 
The  poisoned  article  of  food  may  be  detected  by  observing  whether 
they  who  suffer  under  any  symptoms  of  poisoning  have  partaken  of 
one  particular  solid  or  liquid  in  common.  In  a  case  of  accidental 
poisoning  at  a  dinner-party,  a  medical  man  who  was  present  observed 
that  those  who  suffered  had  taken  port-wine  only ;  the  contents  of  the 
bottle  were  examined,  and  found  to  be  a  saturated  solution  of  arsenic 
in  wine.  In  general,  considerable  reliance  may  be  placed  upon  this 
character,  because  it  is  improbable  that  any  common  cause  of  disease 
should  suddenly  attack  with  violent  symptoms  of  a  similar  character, 
many  healthy  persons  at  the  same  time,  and  within  a  short  period 
after  having  partaken  of  food  together.  We  must  beware  of  sup- 
posing that,  when  poison  is  really  present,  all  will  be  attacked  with 
precisely  similar  symptoms ;  because  there  are  many  circumstances 
which  may  modify  their  nature  and  progress.  In  general  that  person 
who  has  partaken  most  freely  of  the  poisoned  dish  will  suffer  most 
severely ;  but  even  this  does  not  always  follow.  There  is  a  well- 
known  case,  recorded  by  Bonnet,  where,  among  several  persons  who 
partook  of  a  dish  poisoned  with  arsenic,  they  who  had  eaten  little  and 
did  not  vomit,  speedily  died ;  while  others  who  had  partaken  largely  of 
the  dish,  and  had  in  consequence  vomited  freely,  recovered. 

It  was  just  now  remarked,  that  there  is  no  disease  resembling  poi- 
soning which  is  likely  to  attack  several  healthy  persons  at  the  same 
time  and  in  the  same  manner.  This  is  undoubtedly  true  as  a  general 
principle,  but  the  following  case  will  show  that  mistakes  may  occa- 
sionally arise  even  under  these  circumstances.  It  occurred  in  London 
during  the  prevalence  of  the  malignant  cholera  in  1832.  Four  of  the 
members  of  a  family,  living  in  a  state  of  great  domestic  unhappiness, 
sat  down  to  dinner  in  apparently  good  health :  some  time  after  the 
meal,  the  father,  mother,  and  daughter  were  suddenly  seized  with 
violent  vomiting  and  purging.  The  evacuations  were  tinged  with 
blood,  while  the  blueness  of  the  skin,  observed  in  cases  of  malignant 
cholera,  was  absent.  Two  of  these  persons  died.  The  son,  who  was 
known  to  have  borne  ill-will  against  his  father  and  mother,  and  who 


76  DISCOVERY    OF    POISOX    IN    FOOD. 

suffered  no  symptoms  on  this  occasion,  was  accused  of  having  poi- 
soned them.  At  the  inquest,  however,  it  was  clearly  shown  by  the 
medical  attendant,  that  the  deceased  persons  had  really  died  of  malig- 
nant cholera,  and  there  was  no  reason  to  suspect  that  any  poison  had 
been  administered  to  them.  In  this  instance  it  will  be  perceived  that 
symptoms  resembling  those  of  irritant  poison,  appeared  suddenly  in 
several  individuals  in  perfect  health,  and  shortly  after  a  meal.  We 
hereby  learn  that  the  utility  of  any  rules  for  investigating  cases  of 
poisoning,  depends  entirely  on  the  judgment  and  discretion  with 
which  they  are  applied  to  particular  cases. 

It  is  well  to  bear  in  mind,  in  conducting  these  inquiries,  that 
symptoms  resembling  those  produced  by  irritant  poison,  may  be 
sometimes  traced  to  food.  Meat,  rendered  unwholesome  by  disease 
or  decay,  pork,  bacon,  sausages,  cheese  and  bread,  as  well  as  certain 
kinds  of  shell-fish,  may  give  rise  to  symptoms  of  poisoning,  and  even 
cause  death.  Such  cases  may  be  regarded  as  poisoning  by  animal  or 
vegetable  irritants.  All  the  characters  above  described,  as  indicative 
of  poisoning,  may  be  observed,  and  the  difficulty  of  forming  an  opin- 
ion is  often  increased  by  the  fact  that  some  of  the  persons  attacked, 
may  have  previously  partaken  of  the  same  kind  of  food  without 
inconvenience. 

4.  The  discovery  of  poison  in  tkefood  taken,  or  in  the  matters  vom  tied. — 
One  of  the  strongest  proofs  of  poisoning  in  the  living  subject,  is 
the  detection  of  poison  by  chemical  analysis,  or,  if  of  a  vegetable 
nature,  by  a  microscopical  examination,  either  in  the  food  taken  by 
the  person  laboring  under  its  effects,  or  in  the  matters  vomited,  or, 
after  the  lapse  of  a  few  hours,  in  the  urine.  The  evidence  is  of  course 
more  satisfactory  when  the  poison  is  detected  in  the  matters  vomited 
or  in  the  urine,  than  in  the  food;  because  this  will  show  that  it  has 
really  been  taken,  and  it  will  readily  account  for  the  symptoms.  If 
the  vomited  matters  have  been  thrown  away,  we  must  examine  the 
food  of  which  the  patient  may  have  partaken.  Should  the  results  in 
both  cases  be  negative,  and  no  trace  of  poison  be  found  in  the  urine, 
it  is  probable  that  the  symptoms  were  due  to  disease. 

In  investigating  a  case  of  poisoning  in  a  living  subject,  a  medical 
jurist  must  remember,  that  poisoning  is  sometimes  feigned,  and  at 
others  imputed.  It  is  easy  for  an  artful  person  to  put  poison  into 
food,  as  well  as  to  introduce  it  into  the  matters  vomited  or  discharged 
from  the  bowels,  and  to  accuse  another  of  having  administered  it. 
There  are  few  of  these  accusers  who  go  so  far  as  to  swallow  poison 
under  such  circumstances,  as  there  is  a  great  dread  of  poisonous  sub- 
stances among  this  class  of  criminals;  and  it  will  be  at  once  appa- 
rent, that  it  would  require  a  person  well  versed  in  toxicology,  to  feign 
a  series  of  symptoms  which  would  impose  upon  a  practitioner  at  all 
acquainted  with  the  subject.  In  short,  the  difficulty  reduces  itself  to 
this :  What  inference  can  be  drawn  from  a  chemical  detection  of  poi- 
son in  food  ?  All  that  a  medical  man  can  say  is,  whether  poison  is 
or  is  not  present  in  a  particular  article  of  food :  he  must  leave  it  to 
the  authorities  of  the  law  to  develop  the  alleged  attempt  at  admin- 
istration.    If  the  poison  has  been  actually  administered  or  taken, 


FEIGNED    AND    IMPUTED    POISONING.  77 

then  we  should  expect  to  find  that  the  person  had  suffered  from  the 
usual  symptoms.  The  absence  of  these  symptoms  would  be  a  strong 
fact  against  the  alleged  administration.  The  detection  of  poison  in 
the  matters  vomited,  affords  no  decisive  proof  that  it  has  been  swal- 
lowed, except  under  two  circumstances :  1.  When  the  accuser  has 
previously  labored  under  the  usual  symptoms  of  poisoning,  in  which 
case  there  can  be  no  feigning,  and  the  question  of  imputation  is  a 
matter  to  be  established  by  general  evidence.  2*.  When  the  matters 
are  actually  vomited  into  a  clean  vessel  in  the  presence  of  the  medical 
attendant  himself,  or  of  some  person  on  whose  testimony  perfect  reli- 
ance can  be  placed.  The  detection  of  absorbed  poison  in  the  urine, 
furnishes  a  clear  proof  that  poison  has  been  taken,  that  it  has  passed 
into  the  blood,  and  has  been  subsequently  eliminated. 

When  a  medical  man  is  called  to  a  case  of  suspected  poisoning,  it 
is  necessary  that  he  should  know  to  what  points  he  ought  to  give  his 
attention.  It  is  very  proper  that  every  effort  should  be  made  by  him 
to  save  life  when  the  individual  is  living:  but  while  engaged  in  one 
duty,  it  is  also  in  his  power  to  perform  another,  supposing  the  case 
to  be  one  of  suspected  criminal  poisoning,  namely,  to  note  down 
many  circumstances  which  may  tend  to  detect  the  perpetrator  of  a 
crime.  There  is  no  person  so  well  fitted  to  observe  these  points  as  a 
medical  man ;  but  it  unfortunately  happens,  that  many  facts  import- 
ant as  evidence  are  often  overlooked.  The  necessity  for  observing 
and  recording  them  is  not  perhaps  generally  known.  A  medical  man 
need  not  make  himself  officious  on  such  occasions,  but  he  would  be 
unmindful  of  his  duty  as  a  member  of  society,  if  he  did  not  aid  the 
cause  of  justice  by  extending  his  scientific  knowledge  to  the  detec- 
tion of  crime.  It  is  much  to  the  credit  of  the  medical  profession, 
that  the  crime  of  murder  by  poisoning,  a  form  of  death  from  which 
no  caution  or  foresight  can  protect  a  person,  is  so  frequently  brought 
to  light,  by  the  announcement  of  suspicious  facts  of  a  medical  nature 
to  magistrates  and  coroners ;  and  on  several  occasions  the  highest 
compliments  have  been  passed  by  judges  on  medical  men  who  have 
been  thus  indirectly  the  means  of  bringing  atrocious  criminals  to  the 
bar  of  justice. 

The  following  appear  to  me  to  be  the  principal  points  which  de- 
mand the  attention  of  a  medical  jurist  in  all  cases  of  suspected  poi- 
soning :  1.  With  respect  to 

Symptoms. — 1.  The  time  of  their  occurrence — their  nature.  2. 
The  exact  period  at  which  they  were  observed  to  take  place  after  a 
meal,  or  after  food  or  medicine  had  been  taken.  8.  The  order  of 
their  occurrence.  4.  Whether  there  was  any  remission  or  intermission 
in  their  progress,  or,  whether  they  continued  to  become  more  and 
more  aggravated  until  death.  5.  Whether  the  patient  had  labored 
under  any  previous  illness.  6.  Whether  the  symptoms  were  observed 
to  recur  more  violently  after  a  particular  meal,  or  after  any  particular 
kind  of  food  or  medicine.  7.  Whether  the  patient  has  vomited : — 
the  vomited  matters,  if  any  (especially  those  first  ejected),  should  be 
procured :  their  odor,  color,  and  acid  or  alkaline  reaction  noted,  as 
well  as  their  quantity.     8.  If  none  be  procurable,  and  the  vomiting 


78  EVIDENCE    OF    POISONING    IN    THE    DEAD    BODY. 

lias  taken  place  on  the  dress,  furniture,  or  floor  of  a  room — then  a 
portion  of  the  clothing,  sheet,  or  carpet,  may  be  cut  out  and  reserved 
for  analysis  ; — if  the  vomiting  has  occurred  on  a  deal  floor,  a  portion 
of  the  wood  may  be  scraped  or  cut  out : — or  if  on  a  stone  pavement, 
then  a  clean  sponge  soaked  in  distilled  water  may  be  used  to  remove 
any  traces  of  the  substance.  The  vessel  in  which  vomited  matters 
have  been  contained  will  often  furnish  valuable  evidence,  since  heavy 
mineral  poisons  fall  to  the  bottom,  or  adhere  to  the  sides.  9.  En- 
deavor to  ascertain  the  probable  nature  of  the  food  or  medicine  last 
taken,  and  the  exact  time  at  which  it  was  taken.  10.  Ascertain  the 
nature  of  all  the  different  articles  of  food  used  at  a  meal.  11.  Any 
suspected  articles  of  food,  as  well  as  the  vomited  matters  should  be 
sealed  up  as  soon  as  possible  in  clean  glass  vessels,  labelled,  and  re- 
served for  analysis.  12.  Note  down  in  their  own  words,  all  explana- 
tions voluntarily  made  by  persons  present,  or  who  are  supposed  to 
be  concerned  in  the  suspected  poisoning.  13.  Whether  more  than 
one  person  partook  of  the  food  or  medicine : — if  so,  whether  all  these 
persons  were  affected,  and  how  ?  14.  Whether  the  same  kind  of  food 
or  medicine  had  been  taken  before  by  the  patient  or  other  persons 
without  ill  effects  following. 


CHAPTER   YL 
On  the  evidence  of  poisoning  in  the  dead  BODY. — PERIOD  AT 

WHICH  POISONS  PROVE  FATAL. CHRONIC  POISONING. — APPEAR- 
ANCES PRODUCED  BY  THE  DIFFERENT  CLASSES  OF  POISONS. — RED- 
NESS OF  THE  MUCOUS  MEMBRANE  MISTAKEN  FOR  INFLAMMATION. — 
ULCERATION  AND  CORROSION. — SOFTENING. — PERFORATION  OF  THE 
STOMACH  FROM  POISON  AND  DISEASE. 

Supposing  that  the  person  is  dead,  and  we  are  required  to  deter- 
mine whether  the  case  is  one  of  poisoning  or  not,  we  must,  in  the 
first  instance,  endeavor  to  ascertain  all  the  particulars  which  have 
been  considered  in  the  last  chapter,  as  indicative  of  poisoning  in  the 
living  body.  Should  the  deceased  have  died  from  poison,  the  cir- 
cumstances of  the  attack,  and  the  symptoms  preceding  death,  ought 
to  correspond  with  the  characters  already  described ;  and  in  these 
investigations,  it  is  well  to  bear  in  mind  the  following  rule :  There 
is  no  one  symptom  or  pathological  condition  which  is  peculiar  to 
poisoning;  but  at  the  same  time  there  is  probably  no  disease  which 
presents  all  those  characters  which  are  met  with  in  a  special  case  of 
poisoning.  The  additional  evidence  to  be  derived  from  the  death  of 
a  person,  may  be  considered  under  the  following  heads : — 

1  The  time  at  which  death  takes  place  after  the  first  occurrence  of  symp- 
toms.— This  question  requires  examination,  because  the  more  com- 
mon poisons,  when  taken  in  fatal  doses,  generally  cause  death  within 


TIME    IN    WHICH    POISONS    PROVE    FATAL.  79 

definite  periods  of  time.  By  an  attention  to  this  point,  we  may,  in 
some  instances,  be  enabled  to  negative  a  charge  of  poisoning,  and  in 
others  to  form  an  opinion  of  the  kind  of  poison  which  has  been  taken. 
In  a  court  of  law,  a  medical  practitioner  is  often  required  to  state 
the  usual  period  of  time  within  which  poisons  prove  fatal.  It  is  to  be 
observed  that,  not  only  do  poisons  differ  from  each  other  in  this  re- 
spect, but  the  same  substance,  according  to  the  form  or  quantity  in 
which  it  has  been  taken,  may  differ  in  the  rapidity  of  its  action.  A 
large  dose  of  prussic  acid,  i.  e.  from  half  an  ounce  to  an  ounce,  may 
destroy  life  in  less  than  two  minutes.  In  ordinary  cases  of  poisoning 
by  this  substance  a  person  dies,  i.  e.  all  signs  of  life  have  commonly 
ceased,  in  from  ten  to  twenty  minutes:  if  he  survives  half  an  hour, 
there  is  some  hope  of  recovery.  In  the  cases  of  seven  epileptics, 
accidentally  poisoned  by  a  similar  dose  of  this  acid  in  one  of  the 
Parisian  hospitals,  the  first  died  in  about  twenty  minutes,  the  seventh 
survived  three-quarters  of  an  hour.  Oxalic  acid,  one  of  the  most 
energetic  of  the  common  poisons,  when  taken  in  a  dose  of  from  half 
an  ounce  to  an  ounce,  may  destroy  life  in  from  ten  minutes  to  an 
hour:  if  the  poison  is  not  perfectly  dissolved  when  swallowed,  it  is 
a  longer  time  in  proving  fatal.  The  strong  mineral  acids,  in  poison- 
ous doses,  destroy  life  in  about  eighteen  or  twenty-four  hours.  Ar- 
senic, under  the  form  of  arsenious  acid  (white  arsenic),  operates 
fatally  in  from  eighteen  hours  to  three  or  four  days.  It  has,  how- 
ever, in  more  than  one  instance,  killed  a  person  in  two  hours.  Opium, 
either  as  a  solid  or  under  the  form  of  laudanum,  commonly  proves 
fatal  in  from  six  to  twelve  hours ;  but  it  has  been  known,  in  several 
instances,  to  destroy  life  in  less  than  three  hours :  they  who  survive 
the  effects  of  this  poison  for  twelve  hours,  are  considered  to  have  a 
fair  chance  of  recovery.  This  must  be  understood  to  be  merely  a 
statement  of  the  average  results,  as  nearly  as  we  are  warranted  in 
giving  an  opinion;  but  the  medical  jurist  will  of  course  be  aware 
that  the  fatal  period  may  be  protracted  or  shortened,  according  to  all 
those  circumstances  which  have  been  elsewhere  stated  to  affect  the 
action  of  poisons. 

There  are  various  forms  which  this  question  may  assume.  It  may 
be  said  that  the  death  of  a  person,  alleged  to  have  taken  poison,  has 
occurred  either  too  rapidly  or  too  slowly  to  justify  a  suspicion  of 
poisoning.  The  following  case  will  serve  as  an  illustration  :  A 
woman  of  the  name  of  Russell  was  tried  and  convicted  at  the  Lewes 
Summer  Assizes,  in  1826,  for  the  murder  of  her  husband,  by  poison- 
ing him  with  arsenic.  The  poison  was  detected  in  the  stomach ;  but 
the  fact  of  poisoning  was  disputed  by  some  medical  witnesses,  for 
this  among  other  reasons,  that  the  deceased  had  died  three  hours 
after  the  only  meal  at  which  the  poison  could  have  been  adminis- 
tered to  him.  The  authority  of  Sir  A.  Cooper  and  others  was  cited 
to  show  that,  according  to  their  experience,  they  had  never  known  a 
case  of  poisoning  by  arsenic  to  have  proved  fatal  in  less  than  seven 
hours.  This  may  be  admitted,  but,  at  the  same  time,  there  was  suffi- 
cient authority  on  the  other  side  to  establish  that  some  cases  had 
actually  proved  fatal  in  three  or  four  hours.     So  far  as  this  objection 


80  SLOW    OR    CHRONIC    POISONING. 

was  concerned,  the  prisoner  was  properly  convicted.  In  reference  to 
the  medical  question  raised  at  this  trial,  I  may  observe  that  two  dis- 
tinct cases  have  since  occurred  in  which  the  individuals  died  certainly 
within  two  hours  after  taking  arsenic ;  and  several  instances  have 
been  reported,  in  which  death  has  taken  place  in  from  three  to  four 
hours  after  the  administration  of  this  poison.  It  seems  extraordinary 
in  the  present  day,  that  any  attempt  should  have  been  made  by  a 
professional  man  to  negative  a  charge  of  criminal  poisoning  upon  so 
weak  a  ground  as  this ;  but  this  opinion  was  expressed  many  years 
ago,  when  the  facts  connected  with  poisoning  were  but  little  known. 
It  is  quite  obvious  that  there  is  nothing,  so  far  as  we  know,  to  pre- 
vent arsenic  from  destroying  life  in  an  hour,  or  even  within  a  shorter 
period.  A  case  will  be  hereafter  related,  in  which  death  took  place 
from  arsenic  probably  within  twenty  minutes.  These  matters  can  be 
settled  only  by  a  careful  observation  of  numerous  cases,  and  not  by 
any  d  priori  reasoning,  or  by  a  limited  individual  experience. 

In  all  instances  of  sudden  death  there  is  generally  a  strong  ten- 
dency on  the  part  of  the  public  to  suspect  poisoning.  They  never 
can  be  brought  to  consider  that  persons  may  die  a  natural  death  sud- 
denly, as  well  as  slowly  ;  or,  as  we  shall  presently  see,  that  death  may 
really  take  place  slowly,  and  yet  be  due  to  poison.  This  prejudice 
continually  gives  rise  to  the  most  unfounded  suspicions  of  poisoning, 
and,  at  the  same  time,  leads  to  cases  of  chronic  or  slow  poison  being 
frequently  mistaken  for  natural  disease.  One  of  the  means  recom- 
mended for  narcotic  poisoning  from  apoplexy  or  disease  of  the  heart, 
is  the  difference  in  the  rapidity  with  which  death  takes  place.  Thus, 
apoplexy  or  disease  of  the  heart  may  prove  fatal  either  instantly  or 
within  an  hour.  The  only  poisons  likely  to  operate  with  such  fatal 
rapidity,  are  prussic  acid  or  nicotina.  Poisoning  hy  opium  is  com- 
monly protracted  for  five  or  six  hours.  This  poison  has  never  been 
known  to  destroy  life  instantaneously,  or  within  a  few  minutes. 
Thus,  then,  it  may  happen  that  death  will  occur  with  such  rapidity 
as  to  render  it  impossible,  under  the  circumstances,  to  attribute  it  to 
narcotic  poison. 

Chronic  poisoning.— When  a  poison  destroys  life  rapidly,  it  is  called 
a  case  of  acute  poisoning,  to  distinguish  it  from  the  chronic  form,  *".  e. 
in  which  death  takes  place  slowly.  Chronic  poisoning  is  a  subject 
which  has  of  late  frequently  required  medico-legal  investigation. 
Most  poisons,  when  their  effects  are  not  rapidly  manifested,  owing 
either  to  the  smallness  of  the  dose  or  to  timely  treatment,  are  capable 
of  slowly  undermining  the  powers  of  life,  and  killing  the  patient  by 
producing  emaciation  and  exhaustion.  This  is  sometimes  observed 
in  the  action  of  arsenic,  corrosive  sublimate,  and  tartarized  antimony, 
but  it  has  been  remarked  also  in  cases  of  poisoning  by  the  mineral 
acids  and  caustic  alkalies.  Death  is  here  an  indirect  consequence : 
in  poisoning  by  the  acids  or  alkalies,  either  stricture  t)f  the  gullet  is 
induced,  or  the  lining  membrane  of  the  stomach  is  destroyed,  and 
the  process  of  digestion  impaired,  a  condition  which  leads  to  ex- 
haustion and  death.  The  time  at  which  these  indirect  effects  may 
prove  fatal,  is  of  course  liable  to  vary.     A  person  has  been  known 


EVIDENCE  FROM  APPEARANCES.  81 

to  die  from  a  stricture  of  the  gullet,  brought  on  by  sulphuric  acid, 
eleven  months  after  the  poison  was  swallowed ;  and  there  is  no  reason 
to  doubt  that  instances  may  occur  of  a  still  more  protracted  nature. 
In  cases  of  chronic  poisoning  there  is  sometimes  great  difficulty  in 
assigning  death  exclusively  to  the  original  action  of  the  poison,  since 
the  habits  of  life  of  the  person,  a  tendency  to  disease,  and  other 
circumstances,  may  have  occurred  either  to  accelerate  or  produce  a 
fatal  result.  To  connect  a  stricture  of  the  gullet  proving  fatal,  with 
the  effects  of  poisoning  by  a  mineral  acid,  it  would  be  necessary  to 
show  that  there  was  no  tendency  to  this  disease  before  the  acid  was 
administered ;  that  the  symptoms  appeared  soon  after  the  first  effects 
of  the  poison  went  off;  that  these  symptoms  continued  to  become 
aggravated  until  the  time  of  death,  and  lastly  that  there  was  no  other 
cause  to  which  death  could  with  any  probability  be  referred.  These 
remarks  apply  equally  to  the  secondary  fatal  effects  of  any  poison, 
such,  for  instance,  as  the  salivation  occasionally  induced  by  corrosive 
sublimate,  and  the  exhaustion  and  depression  which  are  caused  by 
tartarized  antimony,  when  the  acute  symptoms  of  poisoning  by  these 
substances  have  passed  away. 

The  characters  of  chronic  poisoning  have  of  late  years  acquired 
a  special  interest  for  the  medical  jurist.  There  is  a  difficulty  about 
them  which  no  accuracy  of  observation  or  judgment  can  surmount. 
The  poison  or  poisons,  if  found  in  the  dead  body  at  all,  must  neces- 
sarily exist  in  fractional  parts  of  a  grain.  This  alone  will  be 
sufficient  to  create  a  doubt  whether  death  has  been  caused  by  the 
poison,  although  it  is  quite  consistent  with  medical  experience  that  a 
person  may  die  from  chronic  poisoning,  and  little  or  none  of  the 
poison  be  found  in  the  body  after  death.  In  the  case  of  Mrs. 
James  {Reg.  v.  Winslow),  not  more  than  the  tenth  part  of  a  grain 
was  found  in  the  whole  of  the  tissues  of  the  body ;  in  the  case  of 
Isabella  Banks  {Reg.  v.  Smethurst),  the  quantity  was  greater  than 
this,  but  less  than  a  grain  altogether ;  while  in  the  case  of  Mrs.  Peters, 
of  Yeovil,  examined  by  Mr.  Herapath,  none  was  found  in  the  body, 
although  this  chemist  had  extracted  a  quantity  of  antimony  as  sul- 
phide from  the  urine  of  deceased,  in  less  than  nine  days  before  death. 
In  this  case  Dr.  Garland  had  also  found  antimony  in  the  evacuations 
during  life,  and  had  referred  the  intermittent  irritation  of  the  stomach 
and  bowels,  from  which  deceased  had  suffered,  to  the  secret  use  of 
this  mineral.  The  jury  returned  a  verdict  that  deceased  had  died  from 
disease,  and  that  death  was  accelerated  by  some  irritant.  ("  Lancet," 
August  4th,  1860,  p.  119.)  On  some  recent  trials  for  poisoning  {Reg. 
v.  William  Palmer,  C.  C.  C.  1856),  it  has  been  a  contested  scientific 
question,  whether  a  person  can  die  from  poison  and  no  trace  of  the 
poison  remain  in  the  body.  Mr.  Herapath's  evidence  in  Mrs.  Peters' 
case  not  only  now  proves  the  affirmative,  but  goes  to  show  that  anti- 
mony may  act  fatally  and  be  entirely  eliminated  from  the  system  in 
about  a  week.  ("  Med.  Times  and  Gaz."  Aug.  25,  Sept.  15,  and  29,. 
1860,  pp.  190,  271,  317.) 

2.  Evidence  from  Appearances  in  the  Body. — One  of  the  chief  means 
of  determining  whether  a  person  has  died  from  poison,  is  an  exami- 
6 


82  CHANGES    PRODUCED    BY    IRRITANT    POISONS. 

nation  of  the  body  after  death.  In  relation  to  external  appearances, 
there  are  none  indicative  of  poisoning  upon  which  we  can  safely  rely. 
It  was  formerly  supposed  that  the  bodies  of  persons  who  were  poi- 
soned, putrefied  more  rapidly  than  those  of  others  who  had  died 
from  natural  disease ;  and  evidence  for  or  against  poisoning  was  at 
one  time  derived  from  the  external  appearance  of  the  body.  This 
is  now  known  to  be  an  error  ;  the  bodies  of  persons  poisoned  are  not 
more  rapidly  decomposed,  cseteris  paribus,  than  those  of  others  who 
have  died  a  sudden  and  violent  death  from  any  cause  whatever. 

Irritant  poisons  act  chiefly  upon  the  stomach  and  intestines,  which 
they  irritate,  inflame,  and  corrode.  We  may  likewise  meet  with  all 
the  consequences  of  inflammation,  such  as  softening,  thickening, 
ulceration,  perforation,  or  gangrene.  Sometimes  the  coats  of  the 
viscera  are  thickened,  at  other  times  thinned  and  softened,  by  the 
action  of  an  irritant. 

Neurotic  [Cerebral  and  Spinal)  poisons  do  not  commonly  leave  any 
well-marked  appearances  in  the  bod}'.  The  stomach  and  intestines 
present  no  unnatural  changes.  There  may  be  greater  or  less  fulness 
of  the  vessels  of  the  brain  and  spinal  marrow,  as  well  as  of  their 
membranes ;  but  even  this  is  often  so  slight  as  to  escape  notice,  un- 
less attention  be  particularly  directed  to  these  organs.  Effusion  of 
blood  is  rarely  found. 

The  Narcotico -irritant  or  Cerebrospinal  poisons  may  affect  either 
the  brain  or  the  stomach  and  bowels,  and  commonly  all  these  parts 
according  to  their  peculiar  mode  of  action. 

It  is  important  to  bear  in  mind,  that  both  Irritants  and  Neurotics 
may  destroy  life  without  leaving  any  appreciable  changes  in  the  body. 
To  such  cases  as  these,  the  remarks  about  to  be  made  do  not  apply. 
The  proofs  of  poisoning  must,  in  such  exceptional  cases,  be  procured 
entirely  from  other  sources.  Any  evidence  derivable  from  the  ap- 
pearances in  the  body  of  a  person  poisoned,  will  be  imperfect  unless 
we  are  able  to  distinguish  them  from  those  analogous  changes  often 
met  with  as  the  results  of  ordinary  disease.  These  are  confined  to 
the  mucous  membrane  of  the  stomach  and  bowels.  They  are  red- 
ness, ulceration,  softening,  and  perforation.  Each  of  these  conditions 
may  depend  upon  disease,  as  well  as  upon  the  action  of  irritant  poi- 
sons. 

Redness. — It  is  a  main  character  of  the  irritants  to  produce,  as  a 
result  of  inflammation,  redness  of  the  mucous  or  lining  membrane 
of  the  stomach  and  small  intestines.  This  redness,  when  first  seen, 
is  usually  of  a  deep  crimson  color,  becoming  brighter  by  exposure  to 
air.  It  may  be  diffused  over  the  whole  mucous  membrane;  at  other 
times  it  is  seen  in  patches,  dots,  or  lines  (striae),  spread  irregularly 
over  the  surface  of  the  stomach.  It  is  sometimes  met  with  at  the 
smaller,  but  more  commonly  at  the  larger  end  of  this  organ,  and 
again  we  occasionally  find  the  folds  or  prominences  only  of  the  mu- 
cous membrane  presenting  this  red  or  inflamed  appearance.  Redness 
•of  the  mucous  membrane  may,  however,  be  due  to  gastritis  or  gastro- 
enteritis as  a  result  of  disease ;  and  in  order  to  assign  the  true  cause 
-of  the  inflammation,  it  will  be  necessary  to  have  an  account  of  the 


REDNESS  OF  THE  MUCOUS  MEMBRANE.        83 

symptoms  preceding  death,  or  some  chemical  proof  of  the  existence 
of  irritant  poison  in  the  contents  of  the  stomach  or  in  the  tissues  of 
the  body. 

In  the  healthy  state,  the  mucous  membrane  of  the  stomach  is  pale 
and  white,  or  nearly  so,  except  during  digestion,  when  it  is  slightly 
reddened ;  and  some  observers  have  remarked  that  a  slight  redness 
has  often  remained  in  the  stomachs  of  those  who  have  died  during  the 
performance  of  the  digestive  process.  When  in  contact  with  the 
spleen  or  liver,  after  death,  the  stomach  is  apt  to  acquire  a  deep  livid 
color  from  the  transudation  of  blood ;  and  it  is  well  known  that  the 
bowels  acquire  a  somewhat  similar  color  from  the  gravitation  of 
blood  which  always  takes  place  after  death.  None  of  these  appear- 
ances are  likely  to  be  mistaken  for  the  action  of  an  irritant  poison. 

There  is  an  important  class  of  cases  in  which  redness  of  the  mucous 
membrane  of  the  stomach  is  found  after  death,  not  dependent  on  the 
action  of  poison  or  on  any  easily  assignable  cause.  These  cases, 
owing  to  their  being  so  little  known,  and  involved  in  much  obscurity, 
deserve  the  attention  of  a  medical  jurist,  since  the  appearances  closely 
resemble  those  produced  by  irritant  poison.  A  person  may  die 
without  suffering  from  any  symptoms  of  disordered  stomach  ;  but  on 
an  inspection  of  the  body,  a  general  redness  of  the  mucous  mem- 
brane of  this  organ  will  be  found,  not  distinguishable  from  the  red- 
ness which  is  so  commonly  seen  in  arsenical  poisoning.  Several 
cases  of  this  kind  have  occurred  at  Guy's  Hospital :  and  drawings 
which  have  been  made  of  the  appearance  presented  by  the  stomach, 
are  preserved  in  the  Museum  collection. 

The  redness  of  the  lining  membrane  of  the  stomach,  in  cases  of 
poisoning,  is  so  speedily  altered  by  putrefaction,  when  circumstances 
are  favorable  to  this  process,  as  frequently  to  render  it  impossible  for 
a  witness  to  speak  with  any  certainty  upon  its  cause.  Putrefactive 
infiltration  from  the  blood  contained  in  the  adjacent  viscera  and  mus- 
cles, will  give  a  reddish- colored  appearance  to  a  stomach  otherwise 
in  a  healthy  condition.  Great  dispute  has  arisen  respecting  the  length 
of  time  during  which  redness  of  the  stomach  produced  by  an  irritant 
will  be  recognizable  and  easily  distinguishable  from  putrefactive 
changes.  It  is  sufficient  to  say,  that  no  certain  rule  can  be  laid  down 
on  the  subject :  it  must  be  left  to  the  knowledge  and  discretion  of 
the  witness.  I  have  distinctly  seen  the  well-marked  appearances  of 
inflammation  produced  by  arsenic  in  the  stomach  and  duodenum  in 
an  exhumed  body  twenty-eight  days  after  interment  {Reg.  v.  Jen- 
nings, Berks  Lent  Ass.  1845) ;  and  in  another  instance,  referred  to 
me  by  Mr.  Lewis,  the  coroner  for  Essex,  in  August,  1846,  the  reddened 
state  of  the  mucous  membrane,  in  a  case  of  arsenical  poisoning,  was 
plainly  perceptible  on  removing  a  layer  of  arsenic,  nineteen  months 
after  interment.  (See,  on  this  question,  a  case  of  suspected  poison- 
ing by  Orfila,  "  Annales  d'Hyg."  1839,  vol.  1,  p.  127.)  If,  however, 
there  should  be  a  reasonable  doubt  respecting  the  cause  of  redness, 
and  no  poison  is  detected,  it  would  be  unsafe  to  rely  upon  this  ap- 
pearance alone  as  evidence  of  poisoning. 

Ulceration. — In  irritant  poisoning  the  stomach  is  occasionally  found 


84  ULCERATION,    SOFTEXIXG    AXD 

ulcerated ;  but  this  is,  comparatively  speaking,  a  rare  occurrence. 
Iu  such  cases  the  mucous  membrane  is  removed  in  small  distinct  cir- 
cular patches,  under  the  edges  of  which  the  poison  (arsenic)  may  be 
found.  Ulceration  of  the  stomach  is  a  more  common  result  of  dis- 
ease, than  of  the  action  of  poison.  As  a  consequence  of  disease,  it 
is  very  insidious,  going  on  often  for  Aveeks  together,  without  giving 
any  indication  of  its  existence,  except  perhaps  slight  gastric  disturb- 
ance with  occasional  nausea,  vomiting,  and  loss  of  appetite.  In  this 
case,  the  ulceration  is  commonly  seen  in  small  circumscribed  patches. 
It  is  worthy  of  remark,  as  a  means  of  distinction,  that  ulceration  has 
never  been  known  to  take  place  from  arsenic  or  any  irritant  poison, 
until  symptoms  indicative  of  irritant  poisoning  have  occurred.  In 
ulceration  from  disease,  the  mucous  membrane  is  commonly  only 
reddened  in  the  neighborhood  of  the  ulcer.  Iu  ulceration  from  poi- 
son, the  redness  is  generally  diffused  over  other  parts  of  the  stomach, 
as  well  as  over  the  duodenum  and  small  intestines.  A  case,  how- 
ever, occurred  in  Guy's  Hospital,  some  years  ago,  in  which,  with  a 
small  circular  patch  of  ulceration  near  the  cardiac  opening,  the  whole 
mucous  membrane  was  red  and  injected ;  but  this  singular  condition 
of  the  stomach, -so  closely  resembling  the  effects  of  an  irritant  poi- 
son, was  unaccompanied  by  any  marked  symptoms  of  irritation  during 
life.  The  history  of  a  case  previous  to  death  will  thus  commonly 
enable  us  to  determine  to  what  cause  the  ulceration  fouDd,  may  be 
due.  Care  must  be  taken  to  distinguish  ulceration  from  corrosion. 
Ulceration  is  a  vital  process :  the  substance  of  a  part  is  removed  by 
the  absorbents  as  a  simple  result  of  inflammation.  Corrosion,  on 
the  other  hand,  is  a  chemical  action ;  the  parts  are  removed  by  the 
immediate  contact  of  the  poison :  they  are  decomposed  :  their  vitality 
is  destroyed,  and  they  combine  with  the  corrosive  matter  itself. 
Ulceration  requires  time  for  its  establishment,  while  corrosion  is 
either  an  instantaneous  or  a  very  rapid  effect. 

Softening. — The  coats  of  the  stomach  are  not  unfrequently  found 
so  soft  as  to  yield  and  break  down  under  very  slight  pressure ;  and 
this  may  be  the  result  either  of  poisoning,  of  some  spontaneous 
morbid  change  in  its  structure  during  life,  or  of  the  solvent  action  of 
the  gastric  juice  after  death.  As  this  condition  of  the  stomach,  when 
caused  by  poison,  is  produced  by  those  substances  only  which  possess 
corrosive  properties,  it  follows  that  in  such  cases  traces  of  their  ac- 
tion will  be  perceived  in  the  mouth,  throat,  and  gullet.  In  softening 
from  disease,  the  change  will  be  confined  to  the  stomach  alone,  and 
it  is  commonly  found  only  at  the  cardiac  or  greater  end  of  the  organ. 
When  softening  is  really  caused  by  an  irritant  poison,  it  is  genera  Un- 
attended by  other  striking  and  unambiguous  marks  of  its  operation. 
Softening  is  not  to  be  regarded  as  a  common  character  of  poisoning : 
it  is  only  an  occasional  appearance.  I  have  met  with  an  instance  in 
which  the  coats  of  the  stomach  were  considerably  hardened  by  sul- 
phuric acid.  Softening  can  never  be  inferred  to  have  proceeded  from 
poison,  unless  other  well-marked  changes  are  present,  or  unless  the 
poison  is  discovered  in  the  softened  parts.  The  stomachs  of  infants 
have  been  frequently  found  softened  from  natural  causes :  such  cases 


PERFORATION    OF    THE    STOMACH.  85 

could  not  be  mistaken  for  poisoning,  since  the  history  of  them  during 
life,  the  want  of  other  appearances  indicative  of  poisoning,  and  the 
total  absence  of  poison  from  the  viscera,  would  prevent  such  a  sus- 
picion from  being  entertained. 

Perforation. — The  stomach  may  become  perforated,  either  as  a  result 
of  poisoning  or  disease. 

Perforation  from  Poisoning. — This  may  arise :  1,  from  corrosion  ; 
2,  from  ulceration.  The  perforation  by  corrosion  is  by  far  the  most 
common  variety  of  perforation  from  poisoning.  It  is  occasionally 
witnessed  when  the  strong  mineral  acids  have  been  taken,  especially 
sulphuric  acid ;  the  stomach,  in  such  cases,  is  blackened  and  exten- 
sively destroyed,  the  aperture  is  large,  the  edges  are  rough  and  irreg- 
ular, and  the  coats  are  easily  lacerated.  The  acid  escapes  into  the 
abdomen,  and  may  be  readily  detected  there  by  chemical  analysis. 
The  perforation  from  ulceration,  caused  by  irritant  poison  (arsenic), 
is  but  little  known.  There  are  but  few  instances  on  record.  In  a 
great  number  of  poisoned  subjects  examined  during  many  years  past 
at  Guy's  Hospital,  not  a  single  case  has  occurred.  It  must,  then,  be 
looked  upon  as  a  rare  appearance  in  cases  of  irritant  poisoning. 

Perforation  from.  Disease. — This  is  by  no  means  an  unusual  condi- 
tion. Many  cases  of  this  disease  will  be  found  reported  elsewhere. 
("  Guy's  Hosp.  Rep."  No.  8.)  It  is  invariably  fatal  when  it  proceeds 
so  far  that  the  contents  of  the  stomach  escape  into  the  abdomen ;  but 
sometimes  the  stomach  becomes  glued  to  the  pancreas  or  other  organs 
during  the  ulcerative  process,  and  then  the  person  may  recover. 
Several  instances  of  this  kind  of  adhesion  have  been  met  with  in 
inspections.  The  symptoms  from  perforation  commonly  attack  a 
person  suddenly,  while  apparently  enjoying  perfect  health.  Hence 
these  cases  may  be  easily  mistaken  for  those  of  irritant  poisoning. 
The  principal  facts  observed  with  regard  to  this  formidable  disease 
are  the  following:  1.  It  often  attacks  young  women  from  eighteen  to 
twenty-three  years  of  age.  2.  The  preceding  illness  is  extremely 
slight ;  sometimes  there  is  mere  loss  of  appetite,  or  a  capricious 
appetite  with  uneasiness  after  eating.  3.  The  attack  commences 
with  a  sudden  and  most  severe  pain  in  the  abdomen,  generally  soon 
after  a  meal.  In  irritant  poisoning  the  pain  usually  comes  on  grad- 
ually, and  slowly  increases  in  severity.  4.  Vomiting,  if  it  exist  at 
all,  is  commonly  slight,  and  is  chiefly  confined  to  what  is  swallowed. 
There  is  no  purging :  the  bowels  are  generally  constipated.  In  irri- 
tant poisoning  the  vomiting  is  usually  severe,  and  purging  seldom 
absent.  5.  The  person  dies  commonly  in  from  eighteen  to  thirty  six 
hours ;  this  is  also  the  average  period  of  death  in  the  most  common 
form  of  irritant  poisoning,  i.  e.  by  arsenic  ;  but  in  no  case  yet  recorded 
has  arsenic  caused  perforation  of  the  stomach  within  twenty-four 
hours ;  and  it  appears  probable  that  a  considerable  time  must  elapse 
before  such  an  effect  could  be  produced  by  this  or  any  irritant.  6. 
In  perforation  from  disease,  the  symptoms  and  death  are  clearly  refer- 
able to  peritonitis.  7.  In  the  perforation  from  disease  the  aperture 
is  commonly  of  an  oval  or  rounded  form,  about  half  an  inch  in 
diameter,  situated  in  or  near  the  lesser  curvature  of  the  stomach,  and 


86  SPONTANEOUS    OR    GELATINIZED    PERFORATION. 

the  edges  are  smooth.  The  outer  margin  of  the  aperture  is  often 
blackened,  and  the  aperture  itself  is  funnel-shaped  from  within  out- 
wards, i.  e.  the  mucous  coat  is  the  most  removed,  and  the  outer  or 
peritoneal  coat,  the  least.  The  coats  of  the  stomach,  round  the  edge 
of  the  aperture,  are  usually  thickened  for  some  distance ;  and  when 
cut  they  have  almost  a  cartilaginous  hardness.  These  characters  of 
the  aperture  will  not  alone  indicate  whether  it  is  the  result  of  poison- 
ing or  disease ;  but  the  absence  of  poison  from  the  stomach,  with  the 
want  of  other  characteristic  marks  of  irritant  poisoning,  would  enable 
us  to  say  that  disease  was  the  cause.  Besides,  the  history  of  the  case 
during  life  would  materially  assist  us  in  our  judgment.  The  great 
risk  in  all  these  cases  is,  that  the  effects  of  disease  may  be  mistaken 
for  those  of  poisoning ;  for  we  are  not  likely  to  mistake  a  perfora- 
tion caused  by  irritant  poison  for  the  result  of  disease.  Notwithstand- 
ing the  well-marked  differences  above  described,  it  is  common  to 
meet  with  cases  of  imputed  poisoning,  where  death  has  really  occurred 
from  peritonitis  following  perforation.  I  have  been  required  to  exa- 
mine several  cases  of  this  kind ;  one  of  them  will  be  found  else- 
where recorded.  ("Guy's  Hosp.  Eeports,"  Oct.  1850,  page  226.)  In 
another  the  body  was  exhumed  after  several  months'  burial,  and  the 
stomach  was  found  perforated  from  disease  in  the  usual  situation. 
[Intestinal  perforation  sometimes  occurs  from  sudden  strain  or  effort 
or  external  violence. — H.] 

Spontaneous  or  Gelatinized  Perforation. — The  stomach  is  occasion- 
ally subject  to  a  spontaneous  change,  by  which  its  coats  are  softened, 
and  give  way  generally  at  the  cardiac  or  greater  end.  As  the  effu- 
sion of  the  contents  of  the  organ  in  such  a  case  never  gives  rise  to 
peritoneal  inflammation,  and  no  symptoms  occur  prior  to  death  to 
indicate  the  existence  of  so  extensive  a  destruction  of  parts,  it  is 
presumed  to  be  a  change  in  the  dead  body,  and  the  coats  of  the 
stomach  are  supposed  to  undergo  a  process  of  solution  or  digestion. 
It  is  commonly  attributed  to  the  solvent  action  of  the  gastric  juice, 
the  spleen,  diaphragm,  and  other  viscera  being  sometimes  softened. 
My  colleague,  Dr.  Wilks,  who  has  for  many  years  conducted  the 
inspections  at  Guy's  Hospital,  informs  me  that  this  post-mortem  or 
cadaveric  perforation  of  the  stomach  is  so  rare  a  condition,  that  it  is 
not  met  with  once  in  five  hundred  cases.  In  the  last  two  cases  in 
which  it  was  observed,  one  patient  had  died  from  albuminuria  and 
the  other  from  head-affection ;  but  in  neither  of  these  could  there  be 
found  any  peculiarities  regarding  their  food,  the  time  of  the  last 
meal,  or  the  state  of  the  bodies  to  account  for  the  spontaneous  de- 
struction of  the  coats  of  the  stomach.  (For  remarks  on  this  subject 
by  Dr.  Budd,  see  "  Med.  Gaz."  vol.  39,  p.  895.)  In  January,  1845,  I 
met  with  an  instance  of  this  perforation  in  a  child  between  two  and 
three  years  of  age.  It  was  seized  with  convulsions,  became  insensi- 
ble, and  died  twenty-three  hours  afterwards.  After  death,  the  greater 
end  of  the  stomach  was  found  destroyed  to  the  extent  of  three  inches  ; 
and  the  edges  were  softened  and  blackened.  There  was  no  food  in 
the  stomach,  and  nothing  had  passed  into  the  organ  for  thirty-two 
hours  before  death !     It  was  therefore  impossible  to  ascribe  death  to 


SPONTANEOUS    OR    GELATINIZED    PERFORATION.  87 

the  perforation,  or  the  perforation  to  poison.  (For  a  full  account  of 
this  case,  see  "  Med.  Gaz."  vol.  36,  p.  32.)  An  inspection  of  the  body, 
with  a  general  history  of  the  case,  will  commonly  suffice  to  remove 
any  doubt  in  forming  an  opinion  whether  the  extensive  destruction 
so  commonly  met  with,  has  or  has  not  arisen  from  poison.  Thus,  in 
a  cadaveric  perforation,  the  aperture  is  generally  situated  in  that  part 
of  the  stomach  which  lies  to  the  left  of  the  cardia  ;  it  is  very  large, 
of  an  irregular  form,  and  ragged  and  pulpy  at  the  edges,  which  have 
the  appearance  of  being  scraped.  The  mucous  membrane  of  the 
stomach  is  not  found  inflamed.  There  is  occasionally  slight  redness, 
with  dark  brown  or  almost  black  lines  (strias)  in  and  near  the  dis- 
solved coats,  which  have  an  acid  reaction.  It  can  only  be  confounded 
with  perforation  by  the  action  of  corrosives ;  but  the  well-marked 
symptoms  during  life,  and  the  detection  of  the  poison  after  death, 
together  with  the  changes  in  the  throat  and  gullet,  will  at  once  indi- 
cate the  perforation  produced  by  corrosive  poison. 

[It  is  vitally  important  that  the  post-mortem  examiner  should  be 
qualified  by  practical  training  and  experience,  as  well  as  judgment, 
to  understand  fully  and  distinctly  the  appearances  referred  to  in  the 
foregoing  chapter.  We  fear,  however,  that  the  responsibility  is  too 
often  assumed  in  this  country  by  practitioners  who  have  no  right  or 
reason  to  pretend  to  the  indispensable  qualifications,  and  whose 
ignorance  and  indiscretion  might  easily  be  exposed  by  a  well  directed 
cross-examination.  The  case  of  John  Hendrickson,  Jr.,  convicted, 
on  altogether  insufficient  medical  testimony,  of  poisoning  his  wife 
with  aconite,  affords  a  lamentable  instance  of  this  kind  of  perversion 
of  medico-legal  investigation.  (See  "  Am.  Journ.  Med.  Sci.,"  October, 
1855,  p.  447,  for  an  able  and  justly  severe  review  of  the  medical  evi- 
dence in  this  trial  by  Dr.  0.  Lee.)  But  it  is  not  only  in  the  observa- 
tion of  the  anatomical  appearances,  even  when  fully  competent  to 
recognize  their  true  characters,  that  we  must  exercise  the  greatest 
caution.  The  evidence  afforded  by  the  sight  and  smell  of  matters 
in  the  alimentary  canal  or  other  portions  of  the  body,  although 
sometimes  very  significant,  should  always  be  subjected  to  the  closest 
scrutiny.  Odor  and  color  are  proverbially  uncertain ;  and  although 
the  recognition  of  peculiarities  of  form  is  less  liable  to  error,  yet 
when  these  are  so  minute  as  to  require  the  employment  of  the  micro- 
scope to  determine  them,  the  faculty  of  discriminating  is  at  present 
restricted  to  an  extremely  limited  circle  of  observers.  In  the  hands 
of  a  judicious  and  genuine  expert  in  this  mode  of  exploration,  the 
microscope  doubtless  may  be,  as  it  already  has  been,  resorted  to  with 
the  happiest  effect  in  corroboration  of  other  more  appreciable  signs ; 
still  our  inclination  is  to  look  with  particular  reserve  upon  all  results 
derived  from  such  a  source  alone.  We  fully  agree  nevertheless  with 
Dr.  M.  Stille"  in  his  indorsement  of  the  views  of  Dr.  Frazer,  that  the 
value  of  the  microscope  in  identifying  the  presence  of  some  vegeta- 
ble poisons  by  their  botanical  characters  has  not  received  the  atten- 
tion which  it  deserves.  (Wharton  and  Stille,  "  Med.  Jurisp.,"  2d  ed. 
p.  474.)  Dr.  Frazer,  in  his  interesting  paper  on  the  subject,  gives 
some  very  valuable  hints,  and  concludes  with  detailed  instructions, 


88  SPONTANEOUS    OR    GELATINIZED    PERFORATION. 

"which,  while  they  must  prove  in  the  highest  degree  useful  to  the 
accomplished  microscopist,  at  the  same  time  demonstrate  the  absolute 
necessity  of  a  special  training  on  the  part  of  any  one  who  may  desire 
to  avail  himself  of  such  difficult  tests. 

"In  such  cases  I  would  propose,"  says  Dr.  Frazer,  "that,  aided  by 
the  history  of  symptoms,  an  aid  of  which  we  always  avail  ourselves 
in  other  forms  of  poisoning,  the  microscope  be  employed  in  their 
investigation ;  and  the  most  certain  way,  I  believe,  to  accomplish 
this  result,  especially  for  those  not  very  intimately  acquainted  with 
the  peculiar  differential  characters  of  the  plants,  is  to  compare  what- 
ever vegetable  fragments  may  be  ejected  by  vomiting  during  life,  or 
found  in  the  body  after  death,  with  some  recent  specimens  of  those 
vegetables  which  are  most  suspected  to  have  been  the  cause  of  the 
accident.  I  have  satisfied  myself  in  this  manner  that  the  leaves 
especially  of  aconite,  henbane,  foxglove,  belladonna,  and  several 
other  of  our  indigenous  poisonous  plants,  can  be  easily  recognized, 
and  that  they  present  distinctive  characters  adequate  to  establish 
ample  ground  for  their  discrimination. 

"  The  point  in  such  an  investigation,  which  we  require  to  deter- 
mine in  the  first  instance,  is  identically  similar  to  the  first  step  in 
deciding  on  the  nature  of  a  botanical  specimen ;  if  the  specimen  con- 
sists altogether  of  cellular  tissue,  it  is  to  be  classed  as  one  of  the 
'  cellulares,'  and  possibly  may  prove  to  be  some  of  the  poisonous  fungi ; 
should  it,  however,  yield  us  distinct  evidence  of  vascular  tissue,  thus 
demonstrating  its  more  exalted  place  in  the  botanist's  systematic  ar- 
rangements, in  that  case  we  will  have  as  our  next  duty,  supposing  it 
is  a  fragment  of  leaf  which  we  are  examining,  to  decide  on  the  nature 
of  the  venation,  which  at  once  points  out  whether  it  constituted  a 
portion  of  an  exogenous  or  of  an  endogenous  plant,  the  latter  having 
the  well-known  parallel  venation,  and  the  former  presenting  an 
equalled  distinctive  reticulated  arrangement.  Having  advanced  so 
far,  we  then  have  four  other  points,  at  least,  for  aiding  our  further 
identification  of  its  source. 

"  1st.  The  presence  or  absence  of  hairs,  their  relative  abundance 
on  the  upper  or  under  surface  of  the  leaf,  and  their  shape,  composi- 
tion, and  arrangement. 

"  2d.  The  appearance  of  the  epiderm  on  the  upper  surface  of  the 
leaf,  the  form  of  the  cells  of  which  it  is  composed,  the  existence  or 
non-existence  of  stomata,  and  if  they  are  present,  their  shape,  size, 
and  disposition  in  the  epiderm. 

"  3d.  Similar  observations  on  the  epiderm  of  the  under  surface  of 
the  leaf. 

"  4th.  The  disposition  of  the  parenclryma  of  the  leaf,  and  the  de- 
velopment of  various  crystalline  matter  (raphides)  in  this  tissue,  and 
their  form  when  they  exist. 

"An  agreement  in  these  four  points,  with  corresponding  appear- 
ances in  a  recent  specimen,  would,  I  conceive,  afford  more  than  an 
equivalent  to  the  degree  of  moral  certainty  which  is  now  derived 
from  a  chemical  analysis  of  a  mineral  poison,  and  I  can  readily  under- 
stand, with  the  scientific  aids  now  at  our  disposal,  that  just  as  the 


SPONTANEOUS    OR    GELATINIZED    PERFORATION.  89 

chemist  is  able  to  place  securely  in  a  sealed  tube,  and  exhibit  before 
the  court  sublimates  of  arsenic  and  mercury  as  undoubted  evidence 
of  his  analytic  skill,  so  the  microscopic  observer  might  produce,  to 
corroborate  his  testimony,  accurate  drawings  of  the  fragments  of  a 
poisonous  plant,  printed  by  solar  light,  as  photographs,  or  more 
clearly  obtained  with  the  aid  of  a  pencil  or  camera."  (See  "Edinb. 
Monthly  Journ.  of  Med.,"  April,  1855,  from  "  Dublin  Hosp.  Gaz.") 
— H.1 


90  SULPHURIC    ACID.      SYMPTOMS 


IRRITANT  POISONS. 


CHAPTER    VII. 

Sulphuric  acid  or  oil  of  vitriol. — nitric  acid  or  aqua  fortis. 
— hydrochloric  acid. — symptoms. — appearances  and  analysis. 

Sulphuric  Acid,  or  Oil  of  Vitriol. 

Symptoms. — When  this  poison  is  swallowed  in  a  concentrated  form, 
the  symptoms  produced  come  on  either  immediately,  or  during  the  act 
of  swallowing.  There  is  violent  burning  pain,  extending  through 
the  throat  and  gullet  to  the  stomach,  and  the  pain  is  often  so  severe 
that  the  body  is  bent.  There  is  an  escape  of  gaseous  and  frothy 
matter,  followed  by  retching  and  vomiting,  the  latter  accompanied  by 
the  discharge  of  shreds  of  tough  mucus  and  of  a  liquid  of  a  dark 
coffee-ground  color,  mixed  with  blood.  The  mouth  is  excoriated, 
the  lining  membrane  and  surface  of  the  tongue  white,  or  resembling 
soaked  parchment ;  in  one  instance  the  appearance  of  the  mouth  was 
as  if  it  had  been  smeared  with  white  paint.  After  a  time,  the  mem- 
brane acquires  a  gray  or  brownish  color ;  the  mouth  is  filled  with  a 
thick  viscid  substance  consisting  of  saliva,  mucus,  and  the  corroded 
membrane :  this  renders  speaking  and  swallowing  difficult.  If  the 
poison  has  been  administered  by  a  spoon,  or  the  phial  containing  it 
has  been  passed  to  the  back  of  the  throat,  the  mouth  may  escape  the 
chemical  action  of  the  acid.  The  medical  witness  must  bear  this 
circumstance  in  mind,  when  he  is  called  to  examine  an  infant  sus- 
pected to  have  been  poisoned  by  sulphuric  acid.  Around  the  lips 
and  on  the  neck  may  be  found  spots  of  a  brown  color  from  the  spill- 
ing of  the  acid  and  its  action  on  the  skin.  There  is  great  difficulty  of 
breathing,  owing  to  the  swelling  and  excoriation  of  the  throat  and 
larynx,  and  the  countenance  has  from  this  cause,  a  bluish  or  livid 
appearance ;  the  least  motion  of  the  abdominal  muscles  is  attended 
with  increase  of  pain.  The  stomach  is  so  irritable,  that  whatever  is 
swallowed  is  immediately  ejected,  and  the  vomiting  is  commonly 
violent  and  incessant.  The  matters  first  vomited  generally  contain  the 
poison :  they  are  acid,  and  if  they  fall  on  a  limestone  pavement  there 
is  effervescence ;  if  on  colored  articles  of  dress,  the  color  is  some- 
times altered  to  a  red  or  yellow,  or  it  is  entirely  discharged  and  the 
texture  of  the  stuff  destroyed  ;  on  a  black  cloth  dress,  the  spots  pro- 
duced by  the  concentrated  acid  are  reddish-brown,  and  remain  moist 


AND    APPEARANCES.      FATAL    DOSE.  91 

for  a  considerable  time.  After  a  time  there  is  exhaustion,  accom- 
panied by  great  weakness ;  the  pulse  becomes  quick,  small,  and  feeble , 
the  skin  cold,  mottled,  and  covered  with  a  clammy  sweat.  There  is 
generally  great  thirst,  with  obstinate  constipation  of  the  bowels; 
should  any  evacuations  take  place,  they  are  commonly  either  of  a 
dark  brown  or  leaden  color,  in  some  instances  almost  black,  arising 
from  an  admixture  of  altered  blood.  There  are  sometimes  convul- 
sive motions  of  the  muscles,  especially  those  of  the  face  and  lips. 
The  countenance,  if  not  livid  from  obstructed  respiration,  is  pale, 
expressive  of  great  anxiety  and  intense  suffering.  The  intellectual 
faculties  are  quite  clear,  and  death  usually  takes  place  very  suddenly, 
in  from  eighteen  to  twenty-four  hours  after  the  poison  has  been  taken. 
Sulphate  of  Indigo  produces  similar  symptoms.  The  vomited  matters 
are  however  bluish  black. 

Appearances  after  Death. — The  appearances  met  with  in  the  body 
of  a  person  who  has  died  from  the  effects  of  this  acid  vary,  according 
to  whether  death  has  taken  place  rapidly  or  slowly.  Supposing  the 
case  to  have  proved  rapidly  fatal,  the  membrane  lining  the  mouth 
may  be  found  white,  softened,  and  corroded.  The  mucous  membrane 
of  the  throat  and  gullet  is  commonly  found  corroded,  having  a  brown- 
black,  or  ash-gray  color,  and  blood  is  effused  in  patches  beneath  it. 
The  corroded  membrane  of  the  gullet  is  occasionally  disposed  in 
longitudinal  folds,  portions  of  it  being  partly  detached.  The  stomach, 
if  not  perforated,  is  collapsed  and  contracted.  On  laying  it  open, 
the  contents  are  commonly  found  of  a  dark  brown  or  black  color 
and  of  a  tarry  consistency,  being  formed  in  great  part  of  mucus  and 
altered  blood.  The  contents  may  or  may  not  be  acid,  according  to 
the  time  the  patient  has  survived,  and  the  treatment  which  has  been 
adopted.  On  removing  them,  the  stomach  may  be  seen  traversed  by 
black  lines,  or  the  whole  of  the  mucous  membrane  may  be  stained 
black  or  of  a  dark  brown  color.  On  forcibly  stretching  the  coats, 
the  red  color  indicative  of  inflammation  may  be  sometimes  seen  in 
the  parts  beneath,  or  surrounding  the  blackened  portions.  When 
the  stomach  is  perforated,  the  coats  are  softened,  and  the  edge  of  the 
aperture  is  commonly  black  and  irregular.  In  removing  the  stomach, 
the  opening  is  liable  to  be  made  larger  by  the  mere  weight  of  the 
organ. 

Fatal  Dose. — The  dangerous  effects  of  sulphuric  acid  appear  to 
arise  rather  from  its  degree  of  concentration,  than  from  the  absolute 
quantity  taken.  The  quantity  actually  required  to  prove  fatal,  must 
depend  on  many  circumstances.  If  the  stomach  is  full  when  the 
poison  is  swallowed,  the  action  of  the  acid  may  be  spent  on  the  food 
and  not  on  the  stomach ;  and  a  larger  quantity  might  then  be  taken 
than  would  suffice  to  destroy  life  if  the  organ  were  empty.  The 
smallest  quantity  which  is  described  as  having  proved  fatal  was  in 
the  following  case :  Half  a  teaspoonful  of  concentrated  sulphuric 
acid  was  given  to  a  child  about  a  year  old  by  mistake  for  castor  oil. 
The  usual  symptoms  came  on,  with  great  disturbance  of  breathing ; 
and  the  child  died  in  twenty-four  hours.  The  quantity  here  taken 
could  not  have  exceeded  forty  drops.     ("Med.  Gaz.,"  vol.  29,  p.  1-A7.) 


92  SULPHURIC    ACID.      CHEMICAL    ANALYSIS. 

It  is,  however,  doubtful  whether  this  small  quantity  would  have 
proved  fatal  to  an  adult.  The  smallest  fatal  dose  which  Dr.  Christison 
states  he  has  found  recorded,  is  one  drachm;  it  was  taken  in  mistake 
by  a  young  man,  and  killed  him  in  seven  days.  (Op.  cit.,  162.) 
Even  when  diluted,  the  acid  will  destroy  life  rapidly.  A  man  swal- 
lowed, on  an  empty  stomach,  six  drachms  of  the  strongest  acid  diluted 
with  eighteen  drachms  of  water.  He  suffered  from  the  usual  symp- 
toms, and  died  in  two  hours  and  a  half.  ("  Med.  Times  and  Gaz." 
1863,  vol.  1,  p.  183.) 

The  average  period  at  which  death  takes  place  in  cases  of  acute 
poisoning  by  sulphuric  acid,  is  from  eighteen  to  twenty-four  hours. 
The  shortest  case  recorded,  occurred  to  M.  Eapp.  A  man,  get.  50, 
swallowed  three  ounces  and  a  half  of  concentrated  sulphuric  acid ; 
he  died  in  three-quarters  of  an  hour.  ("Gazette  Medicale,"  Dec.  28, 
1850.)  On  the  other  hand,  there  are  numerous  instances  reported  in 
which  the  poison  proved  fatal  from  secondary  causes,  at  periods 
varying  from  one  week  to  several  months. 

Chemical  Analysis. — If  the  acid  is  in  a  pure  state  and  concentrat>:d, 
it  possesses  these  properties:  1.  Wood,  sugar,  or  other  organic 
matter  plunged  into  it,  is  speedily  carbonized  or  charred,  either  with 
or  without  the  application  of  heat.  2.  When  boiled  with  wood, 
copper-cuttings,  or  mercury,  it  evolves  fumes  of  sulphurous  acid; 
this  is  immediately  known  by  the  odor,  as  well  as  by  the  acid  vapor 
first  rendering  blue,  and  then  bleaching,  starch-paper  dipped  in  a 
solution  of  iodic  acid.  3.  When  mixed  with  an  equal  bulk  of  water, 
great  heat  is  evolved — nearly  200°  F.,  in  a  cold  vessel. 

Sulphuric  acid  when  diluted  does  not  carbonize  organic  substances. 
One  test  only  is  required  for  its  detection,  namely,  a  solution  of  a 
salt  of  baryta— either  the  nitrate  of  baryta,  or  the  chloride  of  barium. 
Having  ascertained  by  test-paper  that  the  suspected  liquid  is  acid, 
we  add  to  a  portion  of  it  a  few  drops  of  nitric  acid,  and  then  a  solu- 
tion of  nitrate  of  baryta.  If  sulphuric  acid  is  present,  a  dense  white 
precipitate  of  sulphate  of  baryta  will  fall  down ;  this  is  insoluble  in 
all  acids  and  alkalies.  If  the  precipitate  is  collected,  dried,  and 
heated  to  redness  in  a  small  platinum  crucible,  or  in  a  folded  piece 
of  platinum  foil,  with  five  or  six  parts  of  charcoal  powder,  it  will,  if 
a  sulphate,  be  converted  into  sulphide  of  barium.  To  prove  this,  we 
add  to  the  calcined  residue,  hydrochloric  acid,  at  the  same  time  sus- 
pending over  it  a  slip  of  filtering  paper  moistened  with  a  solution  of 
acetate  of  lead.  If  the  precipitate  obtained  is  a  sulphate,  the  gas 
evolved  will  be  sulphuretted  hydrogen,  known  by  its  odor,  and  by 
its  turning  a  salt  of  lead  of  a  brown  color.  The  cyanide  or  ferro- 
cyanide  of  potassium  may  be  used  as  a  reducing  agent  in  place  of 
charcoal,  in  a  proportion  about  equal  to  that  of  the  sulphate  of  baryta. 
The  experiment  may  then  be  performed  in  a  reduction-tube  in  the 
flame  of  a  spirit-lamp.  On  breaking  the  glass  and  laving  the  in- 
cinerated residue  on  paper  or  card  wetted  with  a  salt  of  lead,  a  brown 
stain  indicative  of  sulphide  of  lead  is  produced. 

In  liquids  containing  organic  matter. — If  sulphuric  acid  is  mixed 
with  such  liquids  as  porter,  coffee,  or  tea,  the  process  for  its  detection 


DETECTION    IN    ORGANIC    LIQUIDS.  93 

is  substantially  the  same,  the  liquid  being  first  rendered  clear  by 
filtration.  The  precipitated  sulphate  of  baryta,  if  mixed  with  organic 
matter,  may  be  purified  by  boiling  it  in  strong  nitric  acid ;  but  this 
is  not  commonly  necessary,  as  the  reduction  of  the  dried  precipitate 
may  be  equally  well  performed  with  the  impure,  as  with  the  pure 
sulphate.  Some  liquids,  such  as  vinegar,  porter,  and  most  wines, 
generally  contain  sulphuric  acid  or  a  sulphate,  but  the  acid  is  in 
small  proportion  ;  therefore,  if  there  is  an  abundant  precipitate,  there 
can  be  no  doubt,  cseteris  paribus,  that  free  sulphuric  acid  has  been 
added  to  them.  Should  the  liquid  be  thick  and  viscid,  like  gruel, 
it  may  be  diluted  with  water,  and  then  boiled  with  the  addition  of  a 
little  acetic  acid.  For  the  action  of  the  barytic  test,  it  is  not  neces- 
sary that  the  liquid  should  be  absolutely  clear,  provided  it  is  not  so 
thick  as  to  interfere  mechanically  with  the  precipitation  of  the  sul- 
phate of  baryta.  So  far  with  regard  to  articles  administered,  or  of 
which  the  administration  has  been  attempted.  This  process  may  be 
applied  to  the  examination  of  matters  vomited  and  of  the  contents  of 
the  stomach,  care  being  taken  to  separate  the  insoluble  parts  by  filtra- 
tion, before  adding  the  test.  The  coats  of  the  stomach  should  be 
cut  up  and  then  boiled  in  distilled  water.  Sulphuric  acid  may  be 
detected  on  articles  of  clothing  by  a  similar  process.  The  concentrated 
acid  produces  brown  stains  on  black  cloth — the  spots  remain  damp 
and  the  fibre  of  the  stuff  is  gradually  softened  and  corroded.  The 
stained  portion  of  cloth  should  be  boiled  in  water  and  the  solution 
filtered  and  tested  with  a  salt  of  barium.  If  any  free  acid  is  present, 
the  stained  stuff  and  the  solution  obtained  from  it,  will  redden  litmus 
paper. 

Nitric  Acid.    Aqua  Fortis. 

Symptoms. — When  nitric  acid  is  taken  in  a  concentrated  state,  the 
symptoms  bear  a  close  resemblance  to  those  produced  by  sulphuric 
acid.  They  come  on  immediately,  and  the  swallowing  of  the  acid  is 
accompanied  by  intense  burning  pain  in  the  throat  and  gullet  ex- 
tending downwards  to  the  stomach :  there  are  gaseous  eructations, 
from  the  chemical  action  of  the  poison,  swelling  of  the  abdomen, 
violent  vomiting  of  liquid  or  solid  matters,  mixed  with  altered  blood 
of  a  dark  brown  color,  and  shreds  of  yellowish-colored  mucus,  having 
a  strong  acid  reaction.  The  abdomen  is  generally  exquisitely 
tender :  but  in  one  well-marked  case  of  poisoning  by  the  acid,  the 
pain  was  chiefly  confined  to  the  throat :  probably  the  poison  had  not 
reached  the  stomach.  The  mucous  membrane  of  the  mouth  is 
commonly  soft  and  white,  after  a  time  becoming  yellow,  or  even 
brown  ;  the  teeth  are  also  white,  and  the  enamel  is  partially  destroyed 
by  the  chemical  action  of  the  acid.  There  is  great  difficulty  of  speak- 
ing and  swallowing,  the  mouth  being  filled  with  viscid  mucus :  the 
power  of  swallowing  is,  indeed,  sometimes  entirely  lost.  On  opening 
the  mouth,  the  tongue  may  be  found  swollen,  and  of  a  citron  color ; 
the  tonsils  are  also  swollen  and  enlarged ;  the  teeth  are  yellow  and 
corroded.     As   the  symptoms   progress,  the   pulse   becomes  small, 


94:  APPEARANCES    AFTER    DEATH. 

frequent,  and  irregular — the  surface  of  the  body  extremely  cold,  and 
there  are  frequent  rigors  (shivering).  The  swallowing  of  liquids 
increases  the  severity  of  the  pain  and  occasions  vomiting.  There  is 
obstinate  constipation.  Death  takes  place  in  from  eighteen  to  twenty- 
four  hours,  and  is  sometimes  preceded  by  a  kind  of  stupor,  from 
which  the  patient  is  easily  roused.  The  intellectual  faculties  com- 
monly remain  clear  until  the  last. 

The  vapor  of  this  acid  is  destructive  to  life.  In  March,  1854,  Mr. 
Haywood^  a  chemist  of  Sheffield,  lost  his  life  under  the  following 
circumstances:  He  was  pouring  a  mixture  of  nitric  and  sulphuric 
acids  from  a  carboy  containing  about  sixty  pounds,  when  by  some 
accident  the  vessel  was  broken.  For  a  few  minutes  he  inhaled  the 
fumes  of  the  mixed  acids,  but  it  does  not  appear  that  any  of  the 
liquid  fell  over  him.  Three  hours  after  the  accident,  he  was  sitting 
up  and  appeared  to  be  in  moderately  good  health.  He  was  then 
seen  by  a  medical  man,  and  complained  merely  of  some  cuts  about 
his  hands.  He  coughed  violently.  In  three  hours  more  there  was 
difficulty  of  breathing,  with  increase  of  the  cough.  There  was  a 
sense  of  tightness  at  the  lower  part  of  the  throat,  and  the  pulse  was 
hard.  At  times  he  said  he  could  scarcely  breathe.  He  died  eleven 
hours  after  the  accident.  On  inspection,  there  was  congestion  of  the 
windpipe  and  bronchial  tubes,  with  effusion  of  blood  in  the  latter. 
The  heart  was  flaccid,  and  contained  but  little  blood ;  and  the  lining 
membrane  of  the  heart  and  aorta  was  inflamed.  The  blood  gave  a 
slightly  acid  reaction  with  test  paper.  The  windpipe  was  not  exa- 
mined. It  is  very  probable  the  seat  of  mischief  was  in  this  organ, 
and  that  the  deceased  died  from  inflammatory  effusion  and  enlarge- 
ment of  the  parts  about  the  opening  of  the  windpipe.  ("  Lancet," 
April  15,  1854,  p.  430.)  A  similar  accident  occurred  to  Mr.  Stewart 
and  one  of  the  janitors  of  an  educational  institution  in  Edinburgh 
in  March,  1863.     They  both  died  from  the  effects  of  the  acid  vapor. 

Appearances  after  death. — Supposing  death  to  have  taken  place 
rapidly  from  the  liquid  acid,  the  following  appearances  may  be  met 
with.  The  skin  of  the  mouth  and  lips  will  present  various  shades  of 
color,  from  an  orange  yellow  to  a  brown.  Yellow  spots  produced 
by  the  spilling  of  the  acid  may  be  found  about  the  hands  and  neck. 
The  membrane  lining  the  mouth  is  sometimes  white,  at  others  of  a 
citron  color ;  the  teeth  are  white,  but  present  sometimes  a  yellowish 
color.  The  throat  and  windpipe  are  much  inflamed.  The  lining 
membrane  of  the  gullet  is  softened,  and  of  a  yellow  or  brown  color, 
easily  detached,  often  in  long  shreds.  The  windpipe  is  more  vascular 
than  usual,  and  the  lungs  are  congested.  The  most  strongly  marked 
changes  are,  however,  seen  in  the  stomach.  When  not  perforated, 
this  organ  may  be  found  distended  with  gas,  its  mucous  membrane 
partially  inflamed  and  covered  by  patches  of  a  yellow,  brown,  or 
green  color,  or  it  may  be  even  black.  Its  coats  may  be  so  much 
softened,  as  to  break  down  under  the  slightest  pressure.  In  the 
duodenum  similar  changes  are  found ;  but  in  some  cases  the  small 
intestines  have  presented  no  other  appearance  than  that  o\'  slight 
redness.     It  might  be  supposed  that  the  stomach  would  be  in  general 


CHEMICAL    ANALYSIS.  95 

perforated  by  this  corrosive  liquid ;  but  perforation  has  not  been 
often  observed.  In  a  case  which  proved  fatal  after  the  long  period 
of  six  months,  there  was,  at  the  intestinal  end  of  the  stomach,  a  dis- 
tinct cicatrix  with  puckering  and  hardening  of  the  surrounding 
mucous  membrane,  causing  a  slight  contraction  of  the  intestinal  ori- 
fice. The  only  other  appearance  consisted  in  some  dark  longitudinal 
lines  on  the  posterior  surface  of  the  lining  membrane  of  the  gullet. 
This  had  probably  been  caused  by  the  acid.  ("  Lancet,"  Nov.  24, 
1860,  p.  510.) 

The  smallest  quantity  of  this  acid  which  I  find  reported  to  have 
destroyed  life,  is  about  two  drachms.  It  was  in  the  case  of  a  boy, 
aged  thirteen :  he  died  in  thirty-six  hours.  Death  commonly  takes 
place  within  twenty-four  hours.  Sobernheim  relates  a  case  of  poi- 
soning by  nitric  acid,  which  proved  fatal  in  one  hour  and  three  quarters. 
(Op.  cit.,  402.)  This  I  believe  to  be  the  most  rapidly  fatal  instance 
on  record,  where  the  acid  acted  as  a  poison.  The  usual  well-marked 
effects  were  found  in  the  gullet,  stomach,  and  small  intestines.  In 
infants,  life  may  be  destroyed  by  this  poison  in  a  few  minutes,  should 
it  happen  to  affect  the  larynx.  The  longest  case  is,  perhaps,  that 
recorded  by  Tartra,  where  a  woman  died  from  exhaustion,  produced 
by  the  secondary  effects  of  the  acid,  eight  months  after  having  swal- 
lowed it. 

Chemical  Analysis.  In  the  simple  state. — This  acid  may  be  met 
with  either  concentrated  or  diluted.  The  concentrated  acid  varies  in 
color  from  a  deep  orange  red  to  a  light  straw  yellow.  It  may  be 
recognized,  1.  By  evolving  acid  fumes  when  exposed  to  the  air  or 
when  heated.  2.  By  its  staining  organic  matter  yellow  or  brown, 
the  color  being  .heightened  and  turned  to  a  reddish  tint  by  contact 
with  caustic  alkalies.  3.  When  mixed  with  a  few  copper  cuttings, 
it  is  rapidly  decomposed,  a  deep  red  acid  vapor  is  given  off,  and  a 
greenish  colored  solution  of  nitrate  of  copper  is  formed.  Tin  or 
mercury  may  be  substituted  for  copper  in  this  experiment.  4.  The 
addition  of  gold-leaf  and  a  few  drops  of  hydrochloric  acid :  if  nitric 
acid  is  present,  the  gold  will  be  dissolved  on  warming  the  mixture. 
Common  aqua  fortis  (nitric  acid)  sometimes  contains  as  impurity,  a 
sufficiency  of  hydrochloric  acid  to  dissolve  gold-leaf  by  heat.  In 
the  diluted  state. — This  acid  is  not  precipitated  like  the  sulphuric,  by 
any  common  reagent,  since  all  its  alkaline  combinations  are  soluble 
in  water.  1.  The  liquid  has  a  highly  acid  reaction,  and  (if  not  too 
diluted)  on  boiling  it  with  some  copper  turnings,  red  fumes  of  ni- 
trous acid  vapor  are  given  off,  the  liquid  acquiring  a  blue  color  at 
the  same  time.  2.  A  streak  made  on  white  paper  with  the  diluted 
acid  does  not  carbonize  it  when  heated  ;  but  a  scarcely  visible  yellow 
stain  is  left.  3.  The  liquid  is  neither  precipitated  by  nitrate  of 
baryta  nor  by  nitrate  of  silver.  These  two  last  experiments  give 
merely  negative  results :  they  serve  to  show  that  the  sulphuric  and 
hydrochloric  acids  are  absent. 

In  order  to  detect  nitric  acid  when  mixed  with  water  or  other 
liquids  the  liquid  should  be  carefully  neutralized  by  potash,  and 
then  evaporated  slowly  to  obtain  crystals.     If  the  liquid  contain 


Dti  NITRIC    ACID.      CHEMICAL    ANALYSIS. 

nitric  acid,  these  crystals  will  possess  the  following '  characters :  1. 
They  appear  in  the  form  of  lengthened  fluted  prisms,  which  neither 
effloresce  nor  deliquesce  on  exposure.  One  drop  of  the  solution,  evapo- 
rated spontaneously  on  glass,  will  suffice  to  yield  distinct  and  well- 
formed  prismatic  crystals.  This  character  distinguishes  the  nitrate  of 
potash  from  a  large  number  of  salts.  2.  When  moistened  with  strong 
sulphuric  acid,  the  powdered  crystals  slowly  evolve  a  colorless  acid 
vapor.  By  this  test,  the  nitrate  is  known  from  every  other  deflagrat- 
ing salt.  3.  A  portion  of  the  powdered  crystals  should  be  placed 
in  a  small  tube  and  mixed  with  their  bulk  of  fine  copper  filings.  The 
mass  is  then  to  be  moistened  with  watert  and  a  few  drops  of  strong 
sulphuric  acid  added.  Either  with  or  without  the  application  of  a 
gentle  heat,  a  decomposition  immediately  ensues,  by  which  red  fumes 
of  nitrous  acid  are  evolved,  recognizable  by  their  color,  odor,  and 
acid  reaction.  In  operating  on  a  small  quantity  of  nitrate  free  from 
chloride,  the  crystals  may  be  placed  in  a  watch-glass  and  mixed  with 
one  or  two  drops  of  concentrated  sulphuric  acid  and  a  few  copper 
filings.  Invert  over  this  another  watch-glass  containing  a  small  slip 
of  blue  litmus-paper  wetted,  and  a  slip  of  starch-paper  moistened 
with  a  solution  of  iodide  of  potassium.  After  a  longer  or  shorter 
interval  the  litmus  will  be  reddened,  and  the  starch-paper  will  as- 
sume a  blue-black  color.  If  the  nitrate  should  be  mixed  with  much 
chloride,  then  the  power  of  dissolving  leaf  gold  on  boiling  the  dry 
salt  with  strong  hydrochloric  acid,  furnishes  the  best  means  of  de- 
tection. 4.  We  add  to  the  crystals  a  small  portion  of  gold-leaf  and 
hydrochloric  acid;  then  boil  for  a  few  minutes.  The  gold  will  either 
wholly  or  entirely  disappear  if  nitric  acid  or  a  nitrate  is  present.  Its 
partial  solution  will  be  indicated  by  a  dark  purple  or  brown  color 
on  the  addition  of  chloride  of  tin  to  the  liquid  after  boiling. 

In  liquids  containing  organic  matter. — Nitric  acid  may  be  adminis- 
tered in  such  liquids  as  tea,  vinegar,  or  porter.  In  this  case,  besides 
the  acid  reaction,  there  will  be  a  peculiar  smell  produced  by  the 
strong  acid,  when  mixed  with  substances  of  an  organic  nature.  The 
application  of  the  usual  tests  may  be  here  counteracted  ;  thus,  unless 
the  quantity  of  nitric  acid  in  the  liquid  is  considerable,  the  orange- 
red  fumes  of  nitrous  acid  are  not  evolved  on  boiling  it  with  copper 
cuttings.  If  the  liquid  is  viscid,  this  viscidity  must  be  destroyed  by 
dilution  with  water;  and  in  all  cases,  if  any  solid  or  insoluble  sub- 
stances are  present  as  in  the  matters  vomited  or  contents  of  the  stomach, 
it  must  be  filtered,  in  order  to  separate  the  insoluble  portions.  If 
we  succeed  in  procuring  a  clear  acid  liquor,  the  color  may  be  disre- 
garded. After  warming  the  acid,  we  should  carefully  neutralize  it 
with  a  weak  solution  of  carbonate  of  potash ;  it  may  then  be  concen- 
trated by  evaporation.  Paper  dipped  into  this  liquid  and  dried,  burns 
with  deflagration,  and  a  few  drops  on  a  glass  slicle  will  yield  crystals 
possessing  those  properties  which  have  been  described  as  character- 
istic of  the  compound  of  potash  with  nitric  acid.  The  crystals  so 
obtained  may  be  colored  and  impure ;  but  this  does  not  interfere  with 
the  action  of  the  most  important  test  for  nitric  acid,  namely,  the  mix- 
ture of  copper  filings  and  sulphuric  acid.    The  crystals  may,  however, 


HYDROCHLORIC    ACID.      SYMPTOMS.  97 

if  necessary,  be  purified  by  washing  them  with,  ether  or  alcohol. 
These  liquids  do  not  dissolve  the  nitrate  of  potash,  but  will  often 
serve  to  remove  from  it  the  organic  matters  by  which  it  is  colored. 
When  either  the  nitric  acid,  or  the  nitrate  into  which  it  has  been  con- 
verted, is  mixed  with  common  salt,  the  copper  test  cannot  be  employed. 
In  such  a  case  the  gold  test  will  furnish  the  best  evidence.  Hydro- 
chloric acid  with  a  small  portion  of  gold-leaf  may  be  added  to  the 
dried  residue,  and  the  mixture  boiled.  If  nitric  acid  or  a  nitrate  is 
present,  ev^n  in  minute  proportion,  some  portion  of  the  gold  will  be 
dissolved,  a  fact  demonstrable  by  the  addition  of  chloride  of  tin. 

Nitric  acid  may  be  detected  in  stains  on  clothing,  if  recent,  by 
simply  boiling  the  stained  cloth  in  water,  with  or  without  the  addi- 
tion of  a  small  quantity  of  carbonate  of  potash.  The  carbonate 
must  be  used  when  an  acid  liquid  is  not  obtained  by  boiling  the 
stained  cloth  in  distilled  water. 

Hydrochloric  Acid.    Muriatic  Acid. 

This  acid,  which  is  also  called  Muriatic  acid,  and  is  popularly 
known  under  the  name  of  Spirit  of  salt,  is  but  seldom  taken  as  a 
poison.  In  the  few  cases  which  have  been  hitherto  observed,  the 
symptoms  and  appearances  have  been  similar  to  those  caused  by  nitric 
acid.  The  following  case  will  show  the  nature  of  the  symptoms.  A 
woman  swallowed  half  an  ounce  of  concentrated  hydrochloric  acid, 
and  in  three  quarters  of  an  hour,  the  prominent  symptoms  were 
burning  pain  in  the  throat  and  stomach,  feeble  pulse,  cold  and  clammy 
skin,  retching  and  vomiting  of  a  brown  matter  streaked  with  blood 
and  containing  shreds  of  membrane.  There  was  great  exhaustion. 
The  throat  became  swollen,  the  patient  lost  the  power  of  swallowing, 
and  died  in  eighteen  hours.  She  retained  her  senses  until  the  last. 
The  appearances  in  the  body  were  as  follows :  the  mucous  membrane 
of  the  mouth  and  throat  was  white,  softened,  and  destroyed  in  many 
places  by  the  corrosive  action  of  the  acid.  The  membrane  of  the 
gullet  was  red  and  inflamed.  The  back  part  of  the  stomach  near  the 
pylorus  was  black,  stripped  of  its  mucous  membrane  (which  was 
generally  softened),  and  marked  with  black  lines.  It  was  not  perfo- 
rated. ("  Lancet,"  July  16,  1859,  p.  59.)  For  a  more  detailed  ac- 
count of  poisoning  by  this  acid,  see  "  On  Poisons,"  second  edition, 
p.  289. 

Chemical  Analysis. — In  a  concentrated state,  hydrochloric  acid  evolves 
copious  fumes.  The  pure  acid  is  nearly  colorless ;  the  commercial 
acid  is  of  a  lemon  yellow  color,  and  frequently  contains  iron,  arsenic, 
common  salt,  and  other  impurities.  When  boiled  with  a  small  quan- 
tity of  peroxide  of  manganese,  chlorine  is  evolved.  It  does  not 
dissolve  gold-leaf  until  a  few  drops  of  nitric  acid  have  been  added 
to  it,  and  the  mixture  heated.  In  the  diluted  state,  these  properties 
are  lost.  It  may  then  be  recognized  by  the  dense  white  precipitate 
which  it  gives  when  a  solution  of  nitrate  of  silver  is  added  to  it.. 
This  precipitate  is  insoluble  in  nitric  acid ;  it  acquires  a  purple  and 
7 


98  OXALIC    ACID.      SYMPTOMS. 

black  color  if  exposed  to  light,  and  when  heated,  it  melts  without 
decomposition,  forming  a  yellowish-colored  substance  on  cooling. 

Hydrochloric  acid,  as  well  as  alkaline  chlorides,  are  natural  con- 
stituents of  the  fluids  of  the  alimentary  canal.  The  presence  of  local 
chemical  changes  in  the  throat  and  stomach,  would  show  whether  the 
acid  had  been  taken  as  a  poison.  If  the  acid  is  found  only  in  small 
quantity,  no  inference  of  poisoning  can  be  drawn  unless  there  are 
distinct  marks  of  its  chemical  action  upon  the  throat  and  stomach. 
It  darkens  the  blood  like  sulphuric  acid,  although  it  has  not  the  same 
degree  of  carbonating  action  on  organic  matter. 


CHAPTEE    VIII. 

Poisoning  by  vegetable  acids. — oxalic  acid. — symptoms  and 
appearances. — chemical  analysis. — acid  oxalate  of  potash 
or  salt  of  sorrel. tartaric  and  acetic  acids. — [aromatic 

VINEGAR.] 

Oxalic  Acid. 

Symptoms. — If  this  poison  is  taken  in  a  large  dose,  i.  e.  from  half 
an  ounce  to  an  ounce  of  the  crystals  dissolved  in  water,  a  hot  burn- 
ing acid  taste  is  experienced  during  the  act  of  swallowing  it.  This 
is  accompanied  by  a  similar  sensation  extending  through  the  gullet 
to  the  stomach.  There  is  sometimes  a  sense  of  constriction  or  suffo- 
cation ;  the  countenance  is  livid  and  the  surface  of  the  skin  soon 
becomes  cold  and  clammy.  Vomiting  occurs  either  immediately  or 
within  a  few  minutes.  Should  the  poison  be  diluted,  there  is  merely 
a  sensation  of  strong  acidity,  and  vomiting  may  not  occur  until  after 
a  quarter  of  an  hour  or  twenty  minutes.  In  some  cases  there  has 
been  little  or  no  vomiting;  while  in  others,  this  symptom  has  been 
incessant  until  death.  In  one  case,  in  which  an  ounce  of  the  acid 
was  swallowed,  the  vomiting  with  pain  in  the  stomach  continued  until 
the  fifth  da}T,  when  the  man  died  suddenly  ("  Lancet,"  Nov.  24, 1860, 
p.  509),  and  in  another  in  which  the  poison  was  much  diluted,  vomit- 
ing did  not  occur  for  seven  hours.  ("  Christison,"  221.)  The  vomited 
matters  are  highly  acid,  and  have  a  greenish-brown  or  almost  black 
color ;  they  consist  chiefly  of  mucus  and  altered  blood.  The  patient 
complains  of  great  pain  and  tenderness  in  the  abdomen,  with  a  burn- 
ing sensation  in  the  stomach.  There  are  cold  clammy  perspirations 
and  convulsions.  There  is  in  general  an  entire  prostration  of  strength, 
so  that  if  the  person  is  in  the  erect  position,  he  falls  ;  there  is  like- 
wise unconsciousness  of  surrounding  objects,  and  a  kind  of  stupor 
from  which,  however,  the  patient  may  be  without  difficulty  roused. 
Owing  to  the  severity  of  the  pain,  the  legs  are  sometimes  drawn  up 
towards  the  abdomen,  or  the  patient  rolls  about  on  the  floor  or  bed. 
The  pulse  is  small,  irregular,  and  scarcely  perceptible;  the  skin  cold 


APPEAEANCES    AFTEE    DEATH.  99 

and  clammy  ;  and  there  is  a  sensation  of  numbness  in  the  limbs  with 
spasmodic  breathing.  The  inspirations  are  deep,  and  a  long  interval 
elapses  between  them.  Should  the  patient  survive  the  first  effects  of 
the  poison,  the  following  symptoms  may  appear :  soreness  of  the 
mouth,  constriction  and  burning  pain  in  the  throat  with  pain  in  swal- 
lowing, tenderness  in  the  abdomen,  and  irritability  of  the  stomach, 
so  that  there  is  frequent  vomiting,  accompanied  by  purging.  The 
tongue  is  swollen,  and  there  is  great  thirst. 

Appearances  after  Death. — The  mucous  membrane  of  the  tongue, 
mouth,  throat,  and  gullet,  is  softened  and  commonly  white,  as  if 
bleached,  but  it  is  sometimes  coated  with  a  portion  of  the  brown 
mucous  matter  discharged  from  the  stomach.  This  latter  organ  con- 
tains a  dark  brown  mucous  liquid,  often  acid,  and  having  almost  a 
gelatinous  consistency.  On  removing  the  contents,  the  mucous  mem- 
brane will  be  seen  pale  and  softened,  without  always  presenting  marks 
of  inflammation  or  abrasion,  if  death  has  taken  place  rapidly.  This 
membrane  is  white,  soft,  and  brittle,  easily  raised  by  the  scalpel,  and 
presents  the  appearance  which  we  might  suppose  it  would  assume 
after  having  been  for  some  time  boiled  in  water.  The  small  vessels 
are  seen  ramifying  over  the  surface,  filled  with  dark-colored  blood, 
apparently  solidified  within  them.  The  lining  membrane  of  the  gul- 
let presents  the  same  characters.  It  is  pale,  and  appears  as  if  it  had 
been  boiled  in  water,  or  digested  in  alcohol;  it  has  been  found 
strongly  raised  in  longitudinal  folds,  interrupted  by  patches  where 
the  membrane  has  become  abraded.  In  a  case  which  was  fatal  in 
eight  hours,  the  tongue  was  covered  with  white  specks ;  the  gullet 
was  not  inflamed,  but  the  stomach  was  extensively  destroyed,  and 
had  a  gangrenous  appearance.  Portions  of  the  mucous  membrane 
were  detached,  exposing  the  muscular  coat.  With  respect  to  the  in- 
testines, the  upper  portion  may  be  found  inflamed ;  but,  unless  the 
case  is  protracted,  the  appearances  in  the  bowels  are  not  strongly 
marked. 

It  is  worthy  of  observation  that  the  glairy  contents  of  the  stomach 
do  not  always  indicate  strong  acidity  until  after  they  have  been  boiled 
in  water.  Oxalic  acid  does  not  appear  to  have  a  strongly  corrosive 
action  on  the  stomach,  like  that  possessed  by  the  mineral  acids.  It 
is  therefore  rare  to  hear  of  the  coats  of  the  organ  being  perforated 
by  it.  The  acid,  when  in  a  concentrated  state,  renders  the  mucous 
coat  soft  and  brittle,  and  perforation  of  the  coats  may  occur  either 
during  life  or  after  death  as  a  result  of  its  chemical  action.  Dr. 
Wood  has  recorded  the  case  of  a  female,  set.  27,  found  dead,  whose 
death  had  been  obviously  caused  by  oxalic  acid,  but  the  quantity 
taken,  and  the  duration  of  the  case,  were  unknown.  The  stomach 
presented,  at  its  upper  and  fore  part  near  the  cardiac  opening,  an 
irregular  aperture  of  a  size  to  admit  the  point  of  the  finger. 

The  smallest  quantity  of  this  poison  which  has  been  known  to 
destroy  life  is  one  drachm  (sixty  grains).  The  boy,  set.  16,  took  the 
poison  in  a  solid  form,  and  was  found  in  about  an  hour  insensible, 
pulseless,  and  his  jaws  spasmodically  closed.  He  had  vomited  some 
bloody  matter ;  his  tongue  and  lips  were  unusually  pale,  but  there 


100  CHEMICAL    ANALYSIS. 

was  no  excoriation.  He  died  in  eight  hours.  ("Lancet,"  Dec.  1, 
1855.)  Two  cases  occurred  at  Guy's  Hospital,  in  each  of  which  half 
an  ounce  of  oxalic  acid  had  been  swallowed.  Active  treatment  was 
adopted,  and  both  patients  recovered.  When  the  dose  of  oxalic  acid 
is  half  an  ounce  and  upwards,  death  commonly  takes  place  within 
an  hour ;  but  there  are  numerous  exceptions  to  this  rapidity  of  action. 
Dr.  Christison  mentions  an  instance  in  which  an  ounce  of  oxalic 
acid  killed  a  girl  in  thirty  minutes ;  and  another  in  which  the  same 
quantity  destroyed  life  in  ten  minutes  ;  but  in  a  third  case  death  did 
not  occur  until  the  fifth  day.  The  late  Dr.  Ogilvy,  of  Coventry,  has 
reported  a  case  of  poisoning  by  oxalic  acid,  in  which  it  is  probable 
that  death  took  place  within  three  minutes  after  the  poison  had  been 
swallowed.  The  quantity  of  the  acid  taken  could  not  be  deter- 
mined. 

Chemical  Analysis.  In  the  simple  state. — This  acid  may  be  met 
with,  either  as  a  solid,  or  in  solution  in  water.  Solid  oxalic  acid:  It 
crystallizes  in  long  slender  prisms,  which,  when  perfect,  are  four- 
sided.     In  this  respect,  it  differs  from  other  common  acids,  mineral 

and  vegetable.  The  crystals  are  unchange- 
able in  air ;  they  are  soluble  in  water  and 
alcohol,  forming  strongly  acid  solutions. 
"When  heated  on  platinum  foil  they  melt, 
and  are  entirely  dissipated  in  vapor  with- 
out combustion  and  without  being  carbon- 
ized. Heated  in  a  close  tube,  they  melt, 
and  the  vapor  is  condensed  in  a  white 
crystalline  sublimate  in  a  cold  part  of  the 
tube.  There  should  be  no  residue  what- 
ever if  the  acid  is  pure ;  but  the  commer- 
cial acid  generally  leaves  a  slight  residue 
of  fixed  impurity.  By  this  effect  of  heat, 
WJr°»»  m^-^-~~,  '  oxalic  acid  is  easily  distinguished  from 

those  crystalline  salts  for  which  it  has  been 
sometimes  fatally  mistaken,  namely,  the  sulphates  of  magnesia  and 
zinc.     These  leave  white  residues  in  the  form  of  anhydrous  salts. 

Tests.  1.  Nitrate  of  silver. — When  added  to  a  solution  of  oxalic 
acid,  it  produces  an  abundant  white  precipitate  of  oxalate  of  silver. 
A  solution  containing  so  small  a  quantity  of  oxalic  acid  as  not  to 
redden  litmus-paper,  is  affected  by  this  test ;  but  when  the  quantity 
of  poison  is  small,  it  would  be  always  advisable  to  concentrate  the 
liquid  by  evaporation  before  applying  it.  The  oxalate  of  silver  is 
identified  by  the  following  properties :  1.  It  is  completely  dissolved 
by  cold  nitric  acid.  If  collected  on  a  filter,  thoroughly  dried,  and 
heated  on  thin  platinum  foil,  it  is  entirely  dissipated  in  a  white  vapor 
with  a  slight  detonation.  When  the  oxalate  is  in  small  quantity, 
this  detonation  may  be  observed  in  detached  particles  on  burning 
the  filter  previously  well  dried.  2.  Sulphate  of  lime. — A  solution  of 
oxalic  acid  is  precipitated  white  by  lime  water  and  all  the  salts  of 
lime.  Lime  water  is  itself  objectionable  as  a  test,  because  it  is  pre- 
cipitated white  by  several  other  acids.     The  salt  of  lime,  which,  as 


CHEMICAL    ANALYSIS.  101 

a  test,  is  open  to  the  least  objection,  is  the  sulphate.  As  this  is  not  a 
very  soluble  salt,  its  solution  must  be  added  in  rather  large  quantity 
to  the  suspected  acid  poisonous  liquid  previously  concentrated.  A 
white  precipitate  of  oxalate  of  lime  is  slowly  formed.  This  precipi- 
tate should  possess  the  following  properties :  1.  It  ought  to  be 
immediately  dissolved  by  nitric  or  hydrochloric  acid.  2.  It  ought 
not  to  be  dissolved  by  the  tartaric,  acetic,  or  any  vegetable  acid. 

In  organic  liquids. — The  process  is  the  same,  whether  it  is  applied 
to  liquids  in  which  the  poison  is  administered,  or  to  the  matters 
vomited,  or,  lastly,  to  the  contents  of  the  stomach.  Should  the  liquid 
be  very  acid,  we  must  filter  it  to  separate  any  insoluble  matters ; 
should  it  not  be  very  acid,  the  whole  may  be  boiled,  if  necessary, 
with  distilled  water  filtered,  and  concentrated  by  evaporation.  To 
the  filtered  liquid,  acidulated  with  acetic  acid,  acetate  of  lead  should 
be  added  until  there  is  no  further  precipitation ;  and  the  white  preci- 
pitate formed,  collected,  and  washed.  If  any  oxalic  acid  was  present 
in  the  liquid,  it  would  exist  in  this  precipitate  under  the  form  of 
oxalate  of  lead.  Diffuse  the  precipitate  in  water,  and  pass  into  the 
liquid,  for  about  half  an  hour,  a  current  of  sulphuretted  hydrogen 
gas,  taking  care  that  the  gas  comes  in  contact  with  every  portion  of 
the  precipitate.  Black  sulphide  of  lead  will  be  thrown  down ;  and 
with  it  commonly  the  greater  part  of  the  organic  matter  mixed  with 
the  oxalate  of  lead.  Filter,  to  separate  the  sulphide  of  lead ;  the 
filtered  liquid  may  be  clear  and  slightly  acid.  Concentrate  by  eva- 
poration ;  the  sulphuretted  hydrogen  dissolved  in  the  liquid  is  thereby 
expelled,  and  oxalic  acid  may  be  ultimately  obtained  crystallized  by 
slow  evaporation  in  a  watch-glass  or  on  a  glass-slide,  for  microsco- 
pical observation.  If  there  was  no  oxalic  acid  in  the  precipitate,  no 
crystals  will  be  procured  by  evaporation.  If  crystals  are  obtained, 
they  must  be  dissolved  in  water,  and  tested  in  the  manner  above 
directed.  Should  the  organic  liquid  contain  sulphuric  acid  or  sul- 
phates, these  should  be  separated  before  precipitation  by  lead  is 
resorted  to.  As  oxalic  acid  is  very  soluble  in  alcohol,  this  liquid 
may  be  occasionally  employed  for  separating  it  from  the  contents  of 
the  stomach  and  from  many  organic  compounds.  Crystals  may  be 
obtained  from  the  alcoholic  solution,  and  these  may  be  purified  and 
tested  by  the  methods  already  described.  In  cases  in  which  the  acid 
is  mixed  with  blood,  mucous  or  farinaceous  matters  which  do  not  admit 
readily  of  filtration,  I  have  found  the  following  method  serviceable 
for  the  detection  of  the  poison.  The  acid  liquid  should  be  placed  in 
a  tube  open  at  one  end  and  closed  at  the  other  by  wet  bladder.  This 
should  be  immersed  in  a  glass  containing  distilled  water.  After 
some  hours  the  oxalic  acid  will  traverse  the  bladder  and  may  be 
found  by  the  use  of  the  appropriate  test  (nitrate  of  silver)  in  the 
watery  liquid,  free  from  the  mucus  and  other  matters  associated 
with  it  in  the  stomach.  The  precipitate  obtained  with  the  nitrate  of 
silver  may  be  further  tested  in  the  manner  above  described. 


102  ACID    OXALATE    OF    POTASH. 


Acid  Oxalate  of  Potash,  or  Salt  of  Sorrel. 

Symptoms  and  Effects. — The  poisonous  effects  of  this  salt  entirely 
depend  on  the  oxalic  acid  which  it  contains.  It  is  much  used  for  the 
purpose  of  bleaching  straw  and  removing  ink-stains,  and  is  sold  for 
this  purpose  under  the  name  of  essential  salt  of  lemons.  Its  poison- 
ous properties  are  not  generally  known,  or  no  doubt  it  would  be 
frequently  substituted  for  oxalic  acid.  Out  of  three  cases  of  poison- 
ing by  this  substance,  two  proved  fatal,  while  in  the  other  the  patient 
recovered.  In  the  case  of  recovery,  a  young  lady,  aged  twenty, 
swallowed  an  ounce  of  the  salt  dissolved  in  warm  water.  She  was 
not  seen  by  any  one  for  an  hour  and  a  half;  she  was  then  found  on 
the  floor,  faint  and  exhausted,  having  previously  vomited  consider- 
ably. There  was  great,  depression,  the  skin  cold  and  clammy,  the 
pulse  feeble,  and  there  was  a  scalding  sensation  in  the  throat  and 
stomach.  There  was  also  continued  shivering.  Proper  medical 
treatment  was  adopted,  and  she  recovered  in  two  days,  still  suffering 
from  debility  and  great  irritation  of  the  stomach.  During  the  state 
of  depression,  it  was  remarked  that  the  membranes  of  the  eyes  were 
much  injected,  and  the  pupils  dilated.  There  was  also  great  dimness 
of  vision.     ("  Med.  Gaz."  vol.  27,  p.  480.) 

This  salt  destroys  life  almost  as  rapidly  as  oxalic  acid  itself;  and 
in  the  symptoms  which  it  produces,  it  closely  resembles  that  poison. 
In  one  case,  half  an  ounce  killed  an  adult  in  so  short  a  time  as  eight 
minutes ;  but  probably  the  fatal  effects  were  in  this  instance  acceler- 
ated by  the  debilitated  state  of  the  person  who  took  it.  In  another 
case,  reported  by  M.  Chevallier,  death  took  place  in  ten  minutes. 
("Ann.  d'Hyg."  1850,  vol.  1,  p.  162.)  In  some  instances  this  poison- 
ous substance  has  been  supplied  by  mistake  for  cream  of  tartar,  and 
has  thus  caused  death. 

Chemical  Analysis. — It  is  not  very  soluble  in  cold  water,  but  its 
solution  may  be  readily  mistaken  for  that  of  oxalic  acid.  The  tests 
for  oxalic  acid  may  be  applied  for  the  detection  of  this  salt. 

Tartaric  Acid. 

Symptoms  and  Appearances. — Tartaric  acid  has  not  been  considered 
to  possess  any  poisonous  properties ;  but  one  case  has  occurred,  in 
which  there  was  no  doubt  that  it  acted  as  an  irritant,  and  destroyed 
life.  The  case  referred  to  was  the  subject  of  a  trial  for  manslaughter 
at  the  Central  Criminal  Court  {Reg.  v.  Watkins),  in  January,  1845. 
The  accused  gave  the  deceased,  a  man  aged  twenty-four,  by  mistake, 
one  ounce  of  tartaric  acid  instead  of  aperient  salts.  The  deceased 
swallowed  the  whole  dissolved  in  half  a  pint  of  warm  water  at  a 
dose :  he  immediately  exclaimed  that  he  was  poisoned ;  he  complained 
of  having  a  burning  sensation  in  his  throat  and  stomach,  as  though 
he  had  drunk  oil  of  vitriol,  and  that  he  could  compare  it  to  nothing 
but  being  all  on  fire.  Soda  and  magnesia  were  administered  with 
diluent  drinks.  Vomiting  set  in,  and  continued  until  death.,  which 
took  place  nine  days  afterwards.    On  inspection,  nearly  the  whole  of 


ACETIC    ACID.  103 

the  alimentary  canal  was  found  highly  inflamed.  The  accused  ad- 
•  mitted  that  he  had  made  a  mistake,  and  tartaric  acid  was  found  in 
the  dregs  of  the  cup.  The  jury  acquitted  the  prisoner.  Another 
case  of  poisoning  by  this  acid,  with  a  report  of  the  results  of  analysis, 
has  been  published  by  M.  Devergie.  ("Ann.  d'Hyg.,"  1851,  vol.  ii. 
p.  432.)  This  case  gave  rise  to  a  controversy  between  the  late  M. 
Orfila  and  M.  Devergie,  the  points  in  dispute  relating  chiefly  to  the 
processes  for  the  detection  of  the  acid  in  the  stomach  and  tissues. 
(See  "Ann.  d'Hyg.,"  1852,  vol.  i.  pp.  199,  382,  and  vol.  ii.  p.  230.) 

Acetic  Acid. 

This  acid  has  been  generally  excluded  from  the  class  of  poisons. 
Common  vinegar,  which  contains  only  five  per  cent,  of  acetic  acid, 
has  often  been  taken  in  large  doses  without  injurious  consequences. 
From  the  experiments  performed  by  Orfila  on  dogs,  and  from  one 
case  which  he  reports  as  having  occurred  in  the  human  subject,  acetic 
acid,  when  concentrated,  appears  to  exert  an  irritant  action  on  the 
body.  ("Annalesd'Hygiene,"  1831,  vol.ii.  p.  159  ;  also  "Toxicologic," 
vol.  ii.  p.  198.)  This  is  not  more  than  we  might  have  expected, 
seeing  that  the  concentrated  acid  is  highly  corrosive.  In  the  case 
referred  to,  the  deceased,  a  young  female  aged  nineteen,  was  found 
dying  on  the  highway.  She  suffered  from  convulsions — complained 
of  pain  in  the  stomach,  and  died  in  a  very  short  time.  On  inspection, 
the  stomach  was  found  neither  softened  nor  corroded,  but  its  mucous 
membrane  near  the  pylorus  was  almost  black.  The  mucous  glands 
were  prominent,  and  the  vessels  were  filled  with  black  coagulated 
blood. 

Vinegar,  which  may  be  regarded  as  an  organic  mixture  containing 
but  a  very  small  proportion  of  acetic  acid  (five  per  cent.),  may  be 
examined  by  distilling  a  portion,  and  testing  the  distilled  liquid  for 
the  acid.  Vinegar,  as  it  exists  in  commerce,  always  contains  a  small 
quantity  of  sulphuric  acid,  and  occasionally  traces  of  arsenic  and 
lead.  In  general  it  is  easily  recognized  by  its  odor.  Pelletan  ob- 
served in  the  case  of  a  child  that  the  abuse  of  vinegar  led  to  a 
thinning  of  the  mucous  membrane  of  the  stomach ;  and  Landerer 
remarked  that  the  milk  of  a  wet-nurse  who  had  been  in  the  habit  of 
taking  large  quantities  of  the  Vinegar  of  Roses,  became  thin,  very 
acid,  and  deficient  in  casein  and  oil.  The  infant  which  she  was 
suckling  gradually  wasted  and  died,  and  the  woman  herself  suffered 
severely.     ("Heller's  Archiv.,"  1847,  2  H.  S.  185.) 

[Aromatic  Vinegar,  which  is  a  stronger  preparation  (containing 
at  least  ninety  per  cent,  of  acetic  acid),  rendered  still  more  irritating 
by  the  aromatic  oils  dissolved  in  it,  may  be  unintentionally  used  in 
such  a  manner  as  to  produce  very  serious,  if  not  fatal  injury.  We 
have  attended  a  lady  whose  husband,  in  his  anxiety  to  restore  her 
from  a  fainting  fit,  had  poured  a  quantity  of  aromatic  vinegar  into 
her  nostrils.  The  result  of  this  accident  was  the  corrosion  and  sub- 
sequent violent  inflammation  of  the  lining  membrane  of  the  nostrils 


104  POISONING    BY    POTASH    AND    SODA. 

and  of  the  posterior  surface  of  the  soft  palate.  The  same  amount  of 
irritation,  extending  into  either  the  larynx  or  oesophagus,  would 
probably  have  destroyed  her  life. — H.] 


CHAPTER   IX. 

Poisoning  by  alkalies  and  alkaline  salts. — potash,  soda,  and 
ammonia. — nitrate  and  sulphate   of  potash. chloeide  of 

BARIUM. 

Potash  and  Soda. 

Symptoms. — The  symptoms  produced  by  potash  and  soda,  when 
taken  in  large  doses,  are  similar,  so  that  one  description  will  serve 
for  both.  The  most  common  form  in  which  these  poisons  are  met 
with,  is  in  the  state  of  pearlash  (carbonate  of  potash)  and  soap-lees 
(carbonate  of  soda).  The  person  experiences,  during  the  act  of 
swallowing,  an  acrid  caustic  taste,  owing  to  the  alkaline  liquid,  if 
sufficiently  concentrated,  excoriating  the  mucous  membrane.  There 
is  a  persistent  sensation  of  burning  heat  in  the  throat,  extending 
down  the  gullet  to  the  stomach.  Vomiting  is  not  always  observed ; 
but  when  it  does  occur,  the  vomited  matters  are  sometimes  mixed 
with  blood  of  a  dark  brown  color,  and  with  detached  portions  or 
flakes  of  mucous  membrane;  this  effect  depending  on  the  degree  of 
causticity  in  the  liquid  swallowed.  The  surface  is  cold  and  clammy ; 
there  is  purging,  with  severe  pain  in  the  abdomen,  resembling  colic. 
The  pulse  is  quick  and  feeble.  In  the  course  of  a  short  time,  the 
lips,  tongue,  and  throat  become  swollen,  soft,  and  red.  The  most 
rapidly  fatal  case  of  poisoning  by  alkalies  which  I  have  found  re- 
ported is  that  of  a  boy,  who  died  in  three  hours  after  swallowing  three 
ounces  of  a  strong  solution  of  carbonate  of  potash. 

Appearances  after  Death. — In  recent  cases  there  are  marks  of  the 
local  action  of  the  poison  on  the  mucous  membrane  of  the  mouth, 
throat,  and  gullet.  This  membrane  has  been  found  softened,  detached, 
and  inflamed  in  patches  of  a  deep  chocolate  color,  sometimes  almost 
black.  A  similar  appearance  has  been  met  with  in  the  mucous 
membrane  of  the  larynx  and  windpipe.  The  stomach  has  had  its 
mucous  surface  destroyed  in  patches,  and  there  has  been  partial  in- 
flammation. In  one  instance,  as  a  result  of  the  action  of  soda,  I 
found  it  puckered  and  blackened.  The  quantity  of  these  alkaline 
poisons  required  to  destroy  life  is  unknown.  The  fatal  effects  depend 
rather  on  the  degree  of  concentration  of  the  liquid,  than  on  the 
absolute  quantity  of  alkali  present. 

Chemical  Analysis. — When  potash  or  soda  or  the  carbonate  of 
either  alkali  is  contained  in  a  poisonous  proportion  in  any  organic 
liquid — it  will  be  observed  that  the  liquid  has  not  only  a  strong 


POISONING    BY    AMMONIA.  105 

alkaline  reaction — but  it  is  soapy  to  the  feel,  frothy  when  shaken, 
and  has  a  peculiar  odor.  The  alkali  may  be  obtained  in  the  state  of 
carbonate  or  otherwise  by  simply  evaporating  the  suspected  liquid 
and  incinerating  the  residue  in  a  silver  or  porcelain  vessel.  The 
presence  of  potash  or  soda  may  be  easily  determined  by  the  appro- 
priate tests  for  these  two  alkalies.  Potash  gives  a  violet,  and  soda 
an  intense  yellow  color  to  the  smokeless  flame  of  gas  or  spirit. 

Ammonia.    Spirit  of  Hartshorn. 

Symptoms  and  Appearances. — The  strong  solution  of  ammonia  pro- 
duces symptoms  similar  to  those  described  in  speaking  of  potash,  but 
as  it  is  much  more  irritating  it  produces  a  choking  sensation  followed 
by  intense  heat  and  burning  pain  in  the  throat,  gullet,  and  stomach. 

Serious  injury  to  the  organs  of  respiration  is  one  of  the  results  of 
the  action  of  this  poison.  A  gentleman  liable  to  attacks  of  fainting 
died  in  three  days,  after  swallowing  a  quantity  of  a  liquid  adminis- 
tered to  him  by  his  son.  This  liquid,  which  was  at  the  time  believed 
to  be  sal  volatile,  was,  in  fact,  a  strong  solution  of  ammonia.  The 
deceased  complained  immediately  of  a  sensation  of  choking  and 
strangling  in  the  act  of  vomiting.  Symptoms  of  difficulty  of  breath- 
ing set  in,  with  other  signs  of  irritation  in  the  throat  and  stomach. 
The  mucous  membrane  of  the  mouth  and  throat  was  corroded  and 
dissolved,  and  it  was  evident  that  the  liquid  had  caused  great  local 
irritation.  The  difficulty  of  breathing  was  such  as  to  threaten  suffo- 
cation, and  at  one  time  it  was  thought  that  an  operation  must  be 
resorted  to.  The  state  of  the  patient,  however,  precluded  its  per- 
formance, and  he  died  on  the  third  day.  On  inspection,  the  viscera 
presented  strong  marks  of  corrosion.  The  covering  of  the  tongue  was 
softened,  and  had  peeled  off;  the  lining  membrane  of  the  air-passages 
was  softened  and  covered  with  layers  of  false  membrane,  the  result 
of  inflammation;  and  the  larger  bronchial  tubes  were  completely 
obstructed  by  casts  or  cylinders  of  this  membrane.  The  lining 
membrane  of  the  gullet  was  softened,  and  at  the  lower  part,  near  its 
junction  with  the  stomach,  the  tube  was  completely  dissolved  and 
destroyed.  There  was  an  aperture  in  the  stomach  in  its  anterior 
wall,  about  one  inch  and  a  half  in  diameter ;  the  edges  were  soft, 
ragged,  and  blackened,  presenting  an  appearance  of  solution.  The 
contents  of  the  stomach  had  escaped.  On  the  inside,  the  vessels  were 
injected  with  dark-colored  blood,  and  there  were  numerous  small 
effusions  of  blood  in  various  parts  of  the  mucous  membrane.  The 
coats  were  thinned  and  softened  at  the  seat  of  the  aperture.  The 
blackened  and  congested  appearance  of  the  lining  membrane  some- 
what resembled  that  which  is  seen  in  poisoning  by  sulphuric  or 
oxalic  acid.  The  mucous  matter  on  the  coats  of  the  stomach  was 
feebly  acid.  No  poison  of  any  kind  was  found  in  the  layer  of  mucus 
or  in  the  coats.  There  was  not  in  any  part  the  slightest  trace  of 
ammonia,  the  poison  which  had  caused  the  mischief.  The  deceased 
had  lived  three  days;  remedies  had  been  used,  and  every  trace  of 
ammonia  had  disappeared.     The  immediate  cause  of  death  was  an 


106  POISONING    BY    SALTS    OF    POTASH. 

obstruction  of  the  air  tubes,  as  a  result  of  inflammation,  caused  by 
the  local  irritant  action  of  the  liquid ;  it  was  quite  obvious  that  a 
quantity  had  entered  the  windpipe.  The  perforation  of  the  stomach 
had  probably  taken  place  shortly  before  death,  or  there  would  have 
been  marks  of  peritonitis.  The  injury  to  the  stomach  and  gullet 
would  have  been  sufficient  to  cause  death,  even  supposing  that  the 
liquid  had  not  penetrated  into  the  lungs. 

Carbonate  of  Ammonia. — The  concentrated  solution  of  this  salt  (sal 
volatile)  is  probably  more  active  as  a  poison  than  is  commonly  sup- 
posed. A  man,  in  a  fit  of  passion,  swallowed  about  five  fluidrachms 
of  a  solution  of  sal  volatile.  In  ten  minutes,  he  was  seized  with 
stupor  and  insensibility ;  but  upon  the  application  of  stimulant  rem- 
edies he  recovered.  He  suffered  for  some  time  afterwards,  from 
severe  irritation  about  the  throat  and  gullet. 

A  female,  set.  19,  while  in  a  state  of  unconsciousness,  was  made  to 
swallow  a  quantity  of  hartshorn.  She  felt  a  severe  pain  in  the  sto- 
mach immediately,  and  in  about  an  hour  afterwards  she  vomited 
some  blood.  This  vomiting  of  blood  continued  for  several  days. 
These  symptoms  were  followed  by  great  irritability  of  the  stomach, 
and  the  constant  rejection  of  food.  There  was  obstinate  constipation 
of  the  bowels,  with  emaciation  and  loss  of  strength.  She  died  in  about 
three  months  from  the  time  at  which  she  had  swallowed  the  alkaline 
poison.  On  inspection,  the  gullet  was  found  healthy ;  the  orifice,  at 
its  junction  with  the  stomach,  was  slightly  contracted.  The  intes- 
tinal opening  (pylorus)  was  contracted  to  the  size  of  a  crowquill,  and 
the  coats  were  thickened.  On  the  posterior  wall  of  the  stomach  there 
was  a  dense  cicatrix  of  the  size  of  half  a  crown,  and  from  this  point 
fibrous  bands  ramified  in  various  directions.  The  duodenum  and 
other  parts  of  the  intestinal  canal  were  healthy.  ("  Med.  Times  and 
Gazette,"  Nov.  26,  1853,  p.  554.) 

Chemical  Analysis. — Ammonia  is  distinguished  from  potash  and 
soda  by  its  pungent  odor  and  entire  volatility.  The  Carbonate  of 
Ammonia  may  be  known  from  other  salts  by  its  alkaline  reaction,  its 
odor,  and  its  volatility  as  a  solid,  and  from  pure  ammonia  by  its 
effervescing  on  the  addition  of  an  acid. 

Nitrate  of  Potash,  Nitre,  Saltpetre. 

Symptoms  and  Appearances. — This  well-known  salt  has  on  several 
occasions  destroyed  life,  when  taken  in  large  doses ;  but  there  appears 
to  be  some  uncertainty  in  its  action  both  as  to  the  symptoms  and  the 
fatal  effects  on  the  body.  In  December,  1863,  a  man  swallowed  an 
ounce  of  nitre,  mixed  with  water,  by  mistake  for  Epsom  salts,  about 
nine  o'clock  in  the  morning.  It  produced  vomiting  with  severe  pain, 
but  no  purging.  There  was  coldness  of  the  surface  and  lividity  of 
the  face.  Death  took  place  in  three  hours.  On  inspection  the  mucous 
membrane  of  the  stomach  was  found  highly  inflamed,  especially 
towards  the  middle  of  the  greater  curvature,  where,  for  several  inches, 
it  resembled  scarlet  cloth.  The  pylorus  and  duodenum  were  of  a  deep 
crimson  color.     The  peritoneal  surface  was  reddened,  especially  over 


SULPHATE    OF    POTASII.  107 

the  stomach,  the  vessels  having  a  vermilion  red  color,  as  if  they  had 
been  injected.  The  heart  and  lungs  were  healthy,  the  blood  was  fluid 
and  more  florid  than  natural.  The  other  organs  presented  no  unusual 
appearance.  No  analysis  was  made  of  the  contents  of  the  stomach, 
but  that  the  nitre  was  the  cause  of  death  no  doubt  could  be  enter- 
tained, and  a  verdict  was  returned  accordingly  at  the  coroner's  in- 
quest. 

Analysis. — For  the  chemical  properties  and  method  of  detecting 
this  salt,  see  page  96. 

Sulphate  of  Potash. 

Symptoms  and  Appearances. — The  question  whether  this  should  be 
regarded  as  an  irritant  poisonous  salt  or  not,  was  much  debated 
among  members  of  the  profession,  in  reference  to  a  case  which  was 
tried  at  the  Central  Criminal  Court  in  October,  1843.  (The  Queen  v. 
Haynes)  The  accused  had  given  to  the  deceased,  the  night  before 
her  death,  two  ounces  of  sulphate  of  potash,  dissolved  in  water;  and 
it  was  alleged  that  a  fortnight  previously  to  this,  she  had  taken  in 
divided  doses,  as  much  as  a  quarter  of  a  pound  of  the  salt.  The 
woman  thought  that  she  was  pregnant,  but  this  was  disproved  by  an 
examination  of  the  body ;  and  it  was  charged  that  the  prisoner  had 
given  her  the  salt  with  the  intention  of  causing  a  miscarriage.  After 
the  last  dose,  she  was  seized  with  sickness,  and  died  within  a  very 
short  time.  The  stomach  was  found  empty,  but  highly  inflamed; 
and  there  was  blood  effused  on  the  brain.  One  medical  witness 
referred  death  to  the  action  of  the  sulphate  as  an  irritant  poison ;  the 
other  to  apoplexy,  as  an  indirect  result  of  the  violent  vomiting 
caused  by  it.  The  prisoner  was  acquitted  of  the  charge  of  murder, 
but  subsequently  found  guilty  of  administering  the  substance  with 
intent  to  procure  abortion.  Both  of  the  witnesses  admitted  that,  in 
small  doses,  the  salt  was  innocent ;  but  that  in  the  dose  of  two  ounces, 
it'  might  produce  dangerous  effects.  Several  other  fatal  cases  are 
recorded.     (See  "  Ann.  d'Hygiene,"  Avril,  1842.) 

There  is  no  doubt  that  the  most  simple  purgative  salts  may,  under 
certain  circumstances,  and  when  given  in  large  doses,  destroy  life. 
A  case  is  elsewhere  related,  in  which  sulphate  of  magnesia  caused 
death,  and  gave  rise  to  a  criminal  charge  in  this  country.  ("  Ox 
Poisons,"  2d  ed.  p.  4.)  It  is  said  that  sulphate  of  potash  has  in  some 
cases  caused  vomiting  and  other  serious  symptoms,  from  its  contain- 
ing as  impurity  sulphate  of  zinc.  This,  if  present,  would  be  easily 
discovered  by  the  appropriate  tests. 

Sulphate  of  potash  may  be  easily  identified.  It  is  in  hard  dry 
crystals,  soluble  in  water,  forming  a  neutral  solution  in  which  potash 
and  sulphuric  acid  may  be  discovered  by  the  appropriate  tests. 

Salts  of  Baryta. 

Chloride  of  Barium.  Symptoms. — A  woman,  aat.  23,  took  by  mis- 
take for  Epsom  salts   less  than  a  teaspoonful  (100  grains)  of  the 


108  SALTS    OF    BAETTA. 

chloride.  This  was  at  12.30,  1st  October,  1858.  In  half-an-hour 
there  was  a  feeling  of  deadly  sickness,  with  sharp  burning  pains  in 
the  stomach  and  bowels.  Vomiting  and  purging  set  in  violently, 
the  purging  being  attended  with  straining.  An  hour  and  a  half  after 
she  had  taken  the  poison  the  following  symptoms  were  observed  by 
Mr.  Walsh.  Face  pale  and  anxious,  eyes  deeply  sunk,  surface  cold, 
heart's  action  feeble,  pulse  scarcely  perceptible,  tongue  natural  and 
warm,  loss  of  muscular  power,  sensation  and  intelligence  not  affected, 
pupils  natural.  Fluids  taken  were  instantly  rejected  with  a  ropy 
mucus.  There  was  pain  in  the  stomach,  singing  in  the  ears,  twitching 
of  the  face,  and  twisting  of  the  legs  and  arms.  At  9  P.  M.  the  symp- 
toms had  abated,  but  at  2  A.  M.  (i.  e.  in  about  fourteen  hours)  the 
purging  had  returned,  and  the  symptoms  were  much  worse.  There 
was  a  loss  of  voluntary  muscular  power.  The  breathing  was  slow 
and  labored,  and  indicated  effusion  in  the  bronchial  tubes,  but  the 
woman  was  sensible.  Soon  after  3  A.  M.  she  was  convulsed,  and 
these  convulsions  continued  in  paroxysms  for  two  hours,  when  she 
died,  seventeen  hours  after  taking  the  poison.  During  the  fits  she 
had  several  watery  evacuations,  and  consciousness  was  lost.  There 
was  no  post-mortem  examination.     ("Lancet,"  1859,  vol.  1,  p.  211.) 

The  Carbonate  of  baryta  is  said  to  have  destroyed  life  in  two  cases, 
in  each  of  which  only  one  drachm  was  taken ;  but  the  following  case, 
which  occurred  to  Dr.  Wilson,  shows  that  this  compound  is  not  so 
poisonous  as  the  chloride.  A  young  woman  swallowed  half  a  tea- 
cupful  of  the  powdered  carbonate,  mixed  with  water,  at  a  time  when 
she  had  been  fasting  twenty-four  hours.  There  was  no  particular 
taste.  In  two  hours  she  experienced  dimness  of  sight,  double  vision, 
ringing  in  the  ears,  pain  in  the  head,  and  throbbing  in  the  temples, 
with  a  sensation  of  distension  and  weight  at  the  pit  of  the  stomach. 
There  was  also  palpitation  of  the  heart.  After  a  time  she  complained 
of  pain  in  the  legs  and  knees,  and  cramps  in  the  calves.  She 
vomited  twice  a  fluid  like  chalk  and  water.  The  skin  was  hot  and 
dry,  the  pulse  frequent,  full,  and  hard.  The  symptoms  gradually 
abated,  and  she  recovered,  although  the  pain  in  the  head  and  stomach 
continued  for  a  long  time.  ("  Med.  Gaz."  xiv.  4-18.)  The  carbonate 
is  used  as  a  poison  for  rats  and  mice. 

Analysis. —  Chloride  of  barium  crystallizes  in  plates:  it  is  soluble 
in  water.  1.  The  solution  yields  an  insoluble  white  precipitate  with 
sulphuric  acid  or  an  alkaline  sulphate.  This  precipitate  is  nearly 
insoluble  in  nitric  acid.  2.  The  powdered  salt,  burnt  on  platinum 
wire  in  a  smokeless  flame,  imparts  to  it  a  greenish  yellow  color.  3. 
Chlorine  may  be  detected  by  a  solution  of  nitrate  of  silver. 

Carbonate  of  baryta  is  a  white  insoluble  powder.  It  is  entirely 
dissolved  with  effervescence  (carbonic  acid)  by  diluted  hydrochloric 
acid.  On  evaporation,  it  yields  crystalline  plates  of  the  chloride  of 
barium,  which  may  be  tested  by  the  processes  above  mentioned. 


PHOSPHORUS.      SYMPTOMS    AND    APPEARANCES.         109 


CHAPTER  X. 

Phosphorus. — symptoms  and  appearances. — chronic  poisoning. 
— chemical  analysis. 

Symptoms. — Phosphorus  acts  as  an  irritant  poison,  but  its  operation 
is  attended  with  some  uncertainty,  according  to  the  state  in  which  it 
is  taken.  The  symptoms  are  frequently  slow  in  appearing :  it  is  only 
after  some  hours,  and  sometimes  even  one  or  two  days,  that  signs  of 
irritation  with  convulsions  and  spasms  appear ;  but  when  these  once 
come  on,  the  case  proceeds  rapidly  to  a  fatal  termination.  In  the 
first  instance  the  patient  experiences  a  disagreeable  taste  resembling 
that  of  garlic,  which  is  peculiar  to  this  poison.  An  alliaceous  or 
garlic  odor  may  be  perceived  in  the  breath.  There  is  an  acrid  burn- 
ing sensation  in  the  throat,  with  intense  thirst,  nausea,  severe  pain 
and  heat  with  tenderness  and  a  pricking  sensation  in  the  stomach, 
followed  by  distension  of  the  abdomen  and  frequent  vomiting. 
The  vomited  matters  are  black  or  of  a  dark  green  or  coffee-ground 
color,  and  have  the  odor  of  garlic:  white  vapors  may  be  seen  to 
proceed  from  them,  and  in  the  dark,  they  may  even  appear  phospho- 
rescent. Purging  has  been  noticed  among  the  symptoms,  and  the 
motions  have  been  observed  to  be  luminous  in  the  dark.  The  pulse 
is  small,  frequent,  and  scarcely  perceptible.  There  is  great  prostra- 
tion of  strength,  and  coldness  of  the  skin  with  other  symptoms  of 
collapse.  The  patient  may  die  quietly  in  a  comatose  state,  or  be 
convulsed  before  death. 

Chronic  Poisoning. — Chronic  poisoning  by  phosphorus  is  accom- 
panied by  nauseous  eructation,  frequent  vomiting,  a  sense  of  heat  in 
the  stomach,  purging,  straining,  pains  in  the  joints,  wasting,  hectic 
fever,  and  disease  of  the  stomach,  under  which  the  patient  slowly 
sinks.  Some  interest  is  attached  to  the  chronic  form  of  poisoning 
by  phosphorus  from  the  researches  of  Dr.  Strohl  and  others,  on  the 
effects  of  the  vapor  upon  persons  engaged  in  the  manufacture  of 
phosphorus  or  lucifer  matches.  It  has  been  remarked  that  such 
persons  have  suffered  from  necrosis  of  the  jaw,  carious  teeth,  and 
abscesses.  There  has  been  also  great  irritation  of  the  respiratory 
organs,  and  bronchitis  has  frequently  shown  itself  among  them.  (See 
"On  Poisons,"  2d  edit.  p.  345.) 

Appearances. — Among  the  appearances  produced  by  phosphorus 
are  marks  of  irritation  and  inflammation  in  the  stomach  and  intes- 
tines. The  stomach  has  been  found  much  contracted,  and  its  mucous 
membrane  inflamed,  occasionally  softened  and  presenting  purple  or 
violet-colored  spots.  Mr.  Worbe  found  the  stomach  perforated  in 
three  places  in  a  dog  which  had  been  poisoned  by  a  solution  of  phos- 


110  PHOSPHORUS.      ANALYSIS. 

phorus  in  oil.  In  one  fatal  case  the  body  was  found  in  a  state  of 
great  muscular  rigidity.  The  membranes  of  the  brain  were  con- 
gested, and  there  was  serious  effusion  between  them.  The  substance 
of  the  brain  was  also  congested.  The  heart  was  flaccid  and  nearly 
empty.  The  mucous  membrane  of  the  stomach,  gullet,  and  small 
intestines  was  very  red,  and  there  were  patches  in  which  the  mem- 
brane was  destroyed.  When  the  stomach  was  opened  a  white  vapor 
escaped,  accompanied  by  a  strong  smell  of  phosphorus.  This  organ 
contained  a  tablespoonful  of  a  viscid  greenish  matter,  from  which 
particles  of  phosphorus  with  some  Prussian  blue  (used  as  a  coloring 
for  the  phosphorus  paste),  subsided  on  standing.  ("Lancet,"  June 
13,  1857,  p.  600.)  The  mucous  membrane  has  been  found  raised  in 
small  bladders  or  vesications,  but  this  appearance  was  probably 
owing  to  putrefaction,  as  the  body  was  not  examined  until  twenty- 
three  days  after  death.  Schuchardt  describes  the  blood  as  dark  and 
fluid,  and  it  does  not  become  red  on  exposure  to  the  air.  Ecchymoses 
are  sometimes  found  on  the  skin  and  on  the  surfaces  of  various  organs. 
("  Brit,  and  For.  Med.  Kev."  1857,  vol.  19,  p.  506.  "  Journal  de  Chimie 
Medicale,"  1857,  p.  84.)  Among  the  appearances  met  with  in  the 
acute  form  of  poisoning  is  a  fatty  degeneration  of  the  voluntary 
muscles  as  well  as  of  the  liver,  heart,  and  kidneys.  (See  a  paper  on 
this  subject  by  Dr.  Moore,  "Dublin  Medical  Press,"  Nov.  15,  1865.) 

The  viscera,  and  even  the  flesh  of  animals  recently  poisoned  by 
phosphorus,  have  the  peculiar  odor  of  this  substance,  and  they  are 
frequently  luminous  in  the  dark.  (Galtier,  "  Toxicologic,"  vol.  1,  p. 
184.)  Mr.  Clowes  informed  me,  that  in  examining  some  fowls  which 
had  been  poisoned  with  phosphorus,  he  was  struck  with  the  strong 
odor  of  this  substance  on  opening  the  gizzards,  and  with  the  appear- 
ance of  a  fine  white  fume,  which  was  luminous  when  observed  in  a 
dark  room.  In  the  case  of  a  woman  who  died  while  taking  phos- 
phorus medicinally,  it  was  remarked  that  the  whole  of  the  organs 
were  luminous ;  thus  indicating  the  universal  diffusion  of  this  poison 
by  absorption.  (Casper's  "  Wochenschrift,"  21  and  28  Feb.  1846, 
115,  135.) 

That  phosphorus  is  a  powerful  poison,  is  proved  by  two  cases 
quoted  by  Dr.  Christison.  In  one,  death  was  caused  by  a  grain  and 
a  half  in  twelve  days;  in  the  other,  by  two  grains  in  about  eight 
days. 

The  earliest  period  at  which  death  has  been  observed  to  take  place 
was  four  hours.     This  was  in  a  case  related  by  Orfila. 

Chemical  Analysis. — Phosphorus  is  a  solid  of  waxy  consistency, 
having  a  peculiar  odor  and  taste  resembling  garlic.  It  is  the  odor 
and  taste  which  prevent  it  from  being  criminally  employed  as  a 
poison,  and  render  it  easy  of  detection  in  articles  of  food.  It  evolves 
a  white  vapor  in  daylight,  and  a  faint  bluish  luminosity  in  the  dark. 
It  melts  and  takes  fire  at  a  temperature  of  113°,  burning  with  a 
bright  yellow  flame,  and  producing  thick  white  acid  vapors  by  com- 
bustion. It  is  not  soluble  in  water,  but  it  is  dissolved  by  alcohol, 
ether,  chloroform,  and  the  oils.  Its  most  perfect  solvent  is  the  sul- 
phide of  carbon. 


PHOSPHORUS.      ANALYSIS.  Ill 

The  smell  which  phosphorus  imparts  to  solids  and  liquids  is  re- 
markably characteristic.  When  it  has  been  taken  in  a  solid  form 
the  particles  may  be  separated  as  a  sediment,  by  washing  the  con- 
tents of  the  stomach  in  water.  These  may  be  melted  under  water 
into  one  mass,  either  by  plunging  the  tube  containing  them  into  hot 
water,  or  by  pouring  hot  water  upon  them  in  a  glass.  If  a  portion 
of  the  organic  liquid  is  exposed  in  the  dark,  the  particles  of  phos- 
phorus will  be  easily  recognized  by  their  luminosity,  as  well  as  by 
their  combustion  when  the  surface  on  which  the  material  is  spread 
is  heated.  Owing  to  its  great  solubility  in  sulphide  of  carbon,  phos- 
phorus may  be  separated  from  many  organic  matters  by  digestion 
with  this  liquid.  It  is  thus  procured  from  flour  and  phosphorus- 
paste,  or  from  the  residue  of  the  contents  of  the  stomach  after  wash- 
ing and  decantation.  On  the  spontaneous  evaporation  of  the  sulphide, 
decanted  from  the  organic  liquid  or  solid,  the  phosphorus  may  be 
procured  in  small  globules  or  beads.  These  are  ignited  when  touched 
with  a  hot  wire,  and  burn  with  the  bright  flame  of  phosphorus. 

The  remarkable  substance,  known  under  the  name  of  allotropic 
phosphorus,  is  not  possessed  of  poisonous  properties.  This  fact,  long 
since  announced  by  Liebig  ("Letters  on  Chemistry,"  165),  has  been 
since  confirmed  by  experiment.  It  has  been  given  to  animals  in  doses 
of  thirty  grains  without  causing  symptoms  of  poisoning.  In  October, 
1860,  a  woman,  aet.  26,  swallowed  the  composition  scraped  from  a 
number  of  lucifer  matches  made  with  allotropic  phosphorus.  She 
suffered  no  inconvenience.  She  procured  other  matches  of  common 
phosphorus,  took  a  decoction  of  them  in  coffee,  and  she  died  from  the 
effects. 

Analysis. — Allotropic  phosphorus  is  easily  recognized  by  its  red 
color  and  infusibility.  When  a  mixture  containing  it,  is  heated  to 
about  500°,  it  burns  like  common  phosphorus,  and  yields  similar  pro- 
ducts. It  is  insoluble  in  all  liquids,  and  by  its  insolubility  in  sul- 
phide of  carbon,  it  is  distinguished  and  separated  from  common 
phosphorus.  It  has  no'  odor  or  taste,  and  is  not  luminous  in  the 
dark. 


112  ARSENIC.      SYMPTOMS. 


METALLIC  IRRITANTS. 


CHAPTBE    XI. 

Arsenic. — arsenious  acid. — symptoms. — chronic  poisoning. — 
appearances  after  death. — fatal  dose. — chemical  analysis. 
— arsenites. — arsenic  acid. — orpiment  and  other  compounds. 

White  Arsenic.    Arsenious  Acid. 

Symjttoms. — The  symptoms  produced  by  this  poison  vary  accord- 
ing to  the  form  and  dose  in  which  it  has  been  administered.  The 
time  at  which  they  usually  come  on,  is  generally  in  from  half  an  hour 
to  an  hour  after  the  poison  has  been  swallowed.  They  may  appear 
earlier  or  much  later.  In  a  case  in  which  one  drachm  of  white 
arsenic  had  been  taken  on  an  empty  stomach,  no  symptoms  appeared 
for  two  hours ;  in  another  that  occurred  to  Dr.  Lachese,  in  which  a 
large  dose  was  taken,  there  were  no  symptoms  for  seven  hours. 
("  Ann.  d'Hyg."  1837,  vol.  1,  p.  344.  See  also  "  Med.-Chir.  Eev." 
Jan.  1854,  p.  294.)  And  in.  a  third  their  appearance  was  protracted 
for  ten  hours,  the  maximum  period  yet  known.  In  all  cases  in  which 
arsenic  enters  the  system  from  without,  as  by  its  application  to  the 
skin,  or  to  ulcerated  or  diseased  surfaces,  the  symptoms-  are  rarely 
manifested  until  after  the  lapse  of  some  hours  or  even  days. 

The  person  first  experiences  a  feeling  of  sinking  or  faintness,  de- 
pression, nausea,  followed  by  sickness,  with  an  intense  burning  pain 
in  the  region  of  the  stomach,  increased  by  pressure.  The  pain  in 
the  abdomen  becomes  more  and  more  severe ;  and  there  is  violent 
vomiting  of  a  brown  turbid  matter,  mixed  with  mucus,  and  some- 
times streaked  with  blood.  These  symptoms  are  followed  by  purg- 
ing, which  is  more  or  less  violent,  and  this  is  accompanied  by  severe 
cramps  in  the  calves  of  the  legs.  The  matters  discharged  from  the 
stomach  and  bowels  have  had  in  some  instances  a  yellowish  color,  as 
it  was  supposed,  from  a  partial  conversion  of  the  poison  of  sulphuret, 
but  more  probably  from  an  admixture  of  bile.  The  vomited  matters 
are  in  some  cases  colored  with  blood,  and  the  mixture  of  blood  with 
bile  has  often  given  to  them  a  green  or  brown  color.  In  other  oases, 
they  may  consist  of  a  large  quantity  of  mucus  ejected  in  a  flaky 
state  and  having  a  milky -white  appearance,  as  if  from  admixture 
with  the  poison.  The  color  of  the  vomited  matters  may  be  blue  or 
black  when  colored  arsenic  has  been  taken,  or  the  admixture  of  bile 
may  render  them  of  a  deep  green  color.     The  vomiting  is  in  general 


APPEARANCES    AFTER    DEATH.  113 

violent  and  incessant,  and  is  excited  by  any  liquid  or  solid  taken  into 
the  stomach.  There  is  tenesmus  (straining),  and  the  discharges  by 
the  bowels  are  frequently  tinged  with  blood.  There  is  a  sense  of 
constriction,  with  a  feeling  of  burning  heat  in  the  throat,  commonly 
accompanied  by  the  most  intense  thirst.  The  pulse  is  small,  very 
frequent,  and  irregular ;  sometimes  wholly  imperceptible.  The  skin 
is  cold  and  clammy  in  the  stage  of  collapse  ;  at  other  times  it  is  very 
hot.  The  respiration  is  painful  from  the  tender  state  of  the  stomach. 
There  is  great  restlessness,  but  before  death,  stupor  sometimes  super- 
venes, with  paralysis,  tetanic  convulsions,  or  spasms  in  the  muscles 
of  the  extremities.  In  one  instance  trismus  (lock-jaw)  appeared  in 
three-quarters  of  an  hour.  ("  Orfila,"  vol.  1,  p.  449.)  Although 
pain  is  in  general  among  the  early  and  well-marked  symptoms,  arsenic 
appears  in  some  cases  to  destroy  sensibility.  In  a  case  in  which  the 
stomach  was  found  intensely  inflamed  after  death,  the  patient  com- 
plained of  no  pain  during  the  time  she  survived. 

Chronic  Poisoning. — Should  the  person  recover  from  the  first  effects, 
and  the  case  be  protracted,  or  should  the  dose  have  been  small  and 
administered  at  intervals,  there  will  be  inflammation  of  the  conjunc- 
tivas, with  suffusion  of  the  eyes,  and  intolerance  of  light,  conditions 
which  are,  however,  often  present  among  the  early  symptoms  above 
described.  ("  Med.  Times,"  Aug.  30,  1851,  p.  229.)  There  is  also 
irritation  of  the  skin,  accompanied  by  a  vesicular  eruption,  which  has 
been  called  eczema  arsenicale.  Sometimes  this  has  assumed  the  form 
of  nettle-rash  or  of  the  eruption  attending  scarlet  fever.  Local 
paralysis,  preceded  by  numbness  or  tingling  in  the  fingers  and  toes, 
and  other  symptoms  of  nervous  disorder,  are  also  common  conse- 
quences. Exfoliation  of  the  cuticle  and  skin  of  the  tongue,  with  the 
falling  off  of  the  hair,  has  likewise  been  witnessed.  (Case,  of  the 
Turners,  1815,  Marshall,  119.)  Salivation  has  been  observed  to  fol- 
low, especially  when  small  doses  of  the  poison  have  been  given  for 
a  length  of  time.  ("  Med.  Gaz."  vol.  16,  p.  790.)  Strangury  and 
jaundice  have  been  noticed  among  the  secondary  symptoms.  ("  Mar- 
shall on  Arsenic,"  44,  111.) 

Arsenic  is  not  an  accumulative  poison ;  it  is  temporarily  deposited 
in  the  organs  after  absorption,  but  is  rapidly  eliminated  by  the  urine ; 
and  in  from  two  to  three  weeks,  if  the  person  survives,  the  whole  of 
that  which  has  been  absorbed  may  be  removed  from  the  body.  Dr. 
C.  Maclagan  states  that  it  begins  to  pass  out  of  the  body  by  ,the 
urine  as  early  as  thre*e  quarters  of  an  hour  after  it  has  been  taken 
(p.  50). 

Appearances  after  Death. — The  principal  changes  produced  by 
arsenic  are  generally  confined  to  the  stomach  and  bowels.  They  are 
commonly  well  marked  in  proportion  to  the  largeness  of  the  dose,, 
and  the  length  of  time  which  the  person  has  survived  after  taking 
the  poison.  Our  attention  must  be  first  directed  to  the  stomach.. 
Arsenic  seems  to  have  a  specific  effect  on  this  organ :  for,  by  what- 
ever channel  the  poison  may  have  entered  into  the  system,  whether 
through  a  wounded,  diseased,  or  ulcerated  surface,  or  by  the  act  of 
swallowing,  the  stomach  has  been  found   inflamed.     The  mucous. 


11-i  ARSENIC.      APPEARANCES    AFTER    DEATH. 

membrane  of  the  stomach  is  sometimes  partly  detached  and  is  covered 
with  a  layer  of  mucus,  mixed  with  blood  or  bile,  and  with  a  thick 
white  pasty-looking  substance  containing  arsenic.  It  is  commonly 
found  red  and  inflamed  in  dotted  or  striated  patches,  extending  be- 
tween the  two  apertures :  the  color,  which  is  of  a  dull  or  brownish 
red,  becomes  brighter  on  exposure  to  the  air :  at  other  times  it  is  of 
a  deep  crimson  hue,  interspersed  with  black-looking  lines  or  patches 
of  altered  blood.  The  redness  is  usually  most  strongly  marked  at 
the  greater  end ;  in  one  case  it  may  be  found  spread  over  the  whole 
mucous  surface,  giving  to  it  the  appearance  of  red  velvet ;  in  another 
it  will  be  chiefly  seen  on  the  prominences  or  folds  of  the  membrane. 
In  one  instance  the  coats  were  thickened  and  of  a  gelatinous  con- 
sistency, without  any  marked  inflammatory  redness.  The  stomach 
has  been  found  highly  inflamed  in  a  case  which  proved  fatal  in  two 
hours.  Thus  it  would  appear  that  intense  inflammation  of  the  mu- 
cous membrane  may  be  observed  within  a  very  short  period.  This 
organ  usually  contains  a  mucous  liquid  of  a  dark  color  tinged  with 
blood.  The  coats  are  sometimes  thickened  in  patches,  being  raised 
up  into  a  sort  of  tumor,  with  arsenic  imbedded  in  them :  at  other 
times  they  have  been  found  thinned.  The  mucous  membrane  is 
rarely  found  ulcerated,  and  still  more  rarely  gangrenous.  Ulceration 
of  the  membrane,  as  the  result  of  the  action  of  arsenic,  has  been 
found  as  early  as  ten  hours  after  the  poison  had  been  taken.  Per- 
foration of  the  coats  is  not  a  common  result  of  arsenical  poisoniDg : 
there  are  but  few  instances  on  record.  Various  appearances  are  said 
to  have  been  met  with  in  the  lungs,  heart,  brain  and  urinary  organs ; 
but  they  are  not  so  characteristic  of  arsenical  poisoning,  as  to  admit 
of  medico-legal  use  in  enabling  a  medical  man  to  distinguish  poison- 
ing from  disease.  It  is  to  the  stomach  and"  intestines  that  he  must 
look  as  the  basis  of  reliable  evidence  in  regard  to  appearances  after 
death.  Dr.  Wilks  met  with  an  ecchymosed  condition  of  the  lining 
membrane  of  the  left  ventricle  of  the  heart  in  a  case  in  which  a  man 
died  in  twelve  hours  from  acute  poisoning  by  arsenic.  In  a  few  in- 
stances the  mouth,  throat,  and  gullet  have  been  found  inflamed,  but 
in  general  there  are  no  changes  in  these  parts  to  attract  particular 
attention.  The  mucous  membrane  of  the  small  intestines  may  be 
inflamed  throughout,  but  commonly  the  inflammatory  redness  is 
confined  to  the  upper  part,  i.  e.  the  duodenum,  especially  to  that  por- 
tion of  it  which  joins  the  stomach.  Of  the  large  intestines,  the 
rectum  appears  to  be  the  most  prone  to  inflammation.  The  liver, 
spleen,  and  kidneys  present  no  appearances  which  can  be  connected 
with  the  action  of  arsenic,  although  these,  like  the  other  soft  organs, 
may  become  receptacles  of  the  absorbed  poison.  It  is  worthy  of 
observation  in  relation  to  the  known  antiseptic  properties  of  arsenic, 
that  the  parts  especially  affected  by  this  poison  (the  stomach  and 
intestines)  occasionally  retain  the  well-marked  characters  of  irritant 
poisoning  for  a  long  time  after  death.  Absorbed  arsenic  does  not. 
however,  appear  to  prevent  the  decomposition  of  the  soft  organs  in 
which  it  is  deposited. 

Arsenic  may  destroy  life  as  the  result  of  external  application  to 


CHEMICAL    ANALYSIS.      REDUCTION    PROCESS. 


115 


any  diseased  or  ulcerated  surface,  or  to  a  wound.  (See  "Guy's 
Hospital  Eeports,"  Oct.  1864,  p.  220.)  The  smallest  fatal  dose  of 
arsenic  hitherto  recorded  is  two  grains.  ("  Provincial  Med.  Journal," 
June  28,  1848,  p.  347  ;  also  "Medical  Gazette,"  vol.  39,  p.  116.) 
Under  circumstances  favorable  to  the  operation  of  this  poison,  the 
fatal  dose  in  an  adult  may  be  assigned  at  from  two  to  three  grains. 
Large  doses  of  arsenic  commonly  destroy  life  in  from  eighteen  hours 
to  three  days.  The  average  time  at  which  death  takes  place  is  twenty- 
four  hours  ;  but  the  poison  may  destroy  life  within  a  much  shorter 
period.  In  a  case  which  occurred  in  April,  1849,  death  took  place 
in  two  and  a  half  hours.  ("  Guy's  Hospital  Eeports,"  Oct.  1850, 
183.  See  also  "  Ann.  d'Hyg."  1837,  vol.  1,  p.  339.)  Mr.  Foster  of 
Huntingdon,  met  with  the  case  of  a  child  under  three  years  of  age, 
who  died  within  two  hours  from  the  effects  of  arsenic.  One  case  is 
said  to  have  proved  fatal  in  twenty  minutes.  On  the  other  hand  life 
is  occasionally  protracted  for  many  days.  In  October  1847,  a  man 
who  had  swallowed  220  grains  of  arsenic  was  admitted  into  Guy's 


Fig.  2. 


Fig.  3. 


Crystals  of  Arsenious  Acid  by  sublimation,  magnified  30  diameters. 

Hospital,  and  died  on  the  seventh  day.  In  the  case  of 
Dr.  Alexander  death  took  place  on  the  sixteenth  day;  and 
although  a  large  quantity  of  arsenic  had  been  taken,  no 
traces  were  found  in  the  body.  ("  Med.  Times  and 
Gazette,"  April  18,  1857,  p.  389.)  In  an  instance  in 
which  arsenic  was  applied  externally  to  the  head,  the 
person  did  not  die  until  the  twentieth  day. 

Chemical  Analysis.  Arsenic  as  a  solid. — In  the  simple 
state  ;  white  arsenic  may  be  identified  by  the  following 
properties:  1.  A  small  quantity  of  the  powder,  placed 
on  platinum  foil,  is  entirely  volatilized  at  a  moderate 
heat  (370°)  in  a  white  vapor.  If  a  small  portion  of 
the  white  powder  be  very  slowly  heated  in  a  glass  tube 
of  narrow  bore,  it  will  be  sublimed  without  melting, 
and  form  a  ring  of  minute  octahedral  crystals,  remark- 
able for  their  lustre  and  brilliancy.  Under  a  microscope 
of  high  magnifying  power  (250  diameters),  the  appearance  of  these 
crystals  is  highly  characteristic  (Fig.  2).   2.  On  boiling  a  small  quan- 


Ordinary  reduc- 
tion tube,  with 
two  sublimates ; 
the  upper,  brow- 
nish black ;  the 
lower,  the  pure 
metal  in  an  an- 
nular deposit. 


116  ARSENIC.      REDUCTION    PROCESS. 

tity  of  the  powder  in  distilled  water,  it  is  not  readily  dissolved,  but 
it  partly  floats  in  a  sort  of  film,  while  a  part  becomes  aggregated  in 
small  lamps  at  the  bottom  of  the  vessel.  It  requires  long  boiling, 
in  order  that  it  should  become  dissolved  and  equally  diffused  through 
water. 

3.  When  a  small  portion  of  the  white  powder,  i.  e.  from  one-fourth 
to  one-twentieth  part  of  a  grain,  is  heated  with  two  parts  of  soda  flux 
(obtained  by  incinerating  acetate  or  tartrate  of  soda  in  a  close  vessel) 
in  a  glass  tube  about  three  inches  long  and  from  one-eighth  to  a 
quarter  of  an  inch  in  diameter,  it  is  decomposed :  a  ring  of  metallic 
arsenic  of  an  iron-gray  color  is  sublimed  and  deposited  in  a  cool  part 
of  the  tube.  During  the  reduction  there  is  a  perceptible  odor,  resem- 
bling that  of  garlic,  which  is  possessed  by  metallic  arsenic  only,  while 
passing  from  a  state  of  vapor  to  arsenious  acid.  In  this  experiment 
of  reduction,  there  are  frequently  two  rings  deposited  in  the  tube  (fig. 
3) :  the  upper  and  larger  ring  has  a  brown  color,  and  appears  to  be 
a  mixture  of  finely  divided  metallic  arsenic  and  arsenious  acid ;  the 
lower  ring  is  small  and  consists  of  the  pure  metal.  The  appearance 
presented  by  these  sublimates  is  indicated  in  the  annexed  illustration. 
By  heating  gently  the  tube  containing  the  sublimate  (reduced  to 
powder)  in  another  tube  of  larger  diameter,  the  metallic  arsenic, 
during  volatilization,  forms  octahedral  crystals  of  arsenious  acid, 
which,  after  examination  by  the  microscope  may  be  dissolved  in  a  few 
drops  of  water,  and  tested  by  one  or  more  of  the  liquid  reagents. 

The  metallic  sublimates,  or  the  crystals  produced  from  them,  may 
be  further  subjected  to  the  following  process :  Break  the  glass  on 
which  the  sublimate  is  deposited,  into  fragments,  and  digest  these  in 
a  few  drops  of  the  strongest  nitric  acid,  containing  nitrous  acid,  pre- 
viously proved  to  be  free  from  arsenic.  The  sublimate  is  thereby 
converted  into  arsenic  acid.  The  acid  solution  should  be  evaporated 
to  dryness ;  the  white  uncrystalline  residue  obtained  should  be  dis- 
solved in  a  few  drops  of  distilled  water,  and  a  strong  solution  of 
nitrate,  or  of  ammonio-nitrate,  of  silver  added  in  small  quantity  to  the 
residue.  A  brick-red  coloration  indicates  arsenic  acid,  and  thus 
proves  incontestably  that  the  sublimate  was  of  an  arsenical  nature. 
The  upper  or  brownish- looking  sublimate  may  be  readily  converted 
into  one  of  the  pure  metal,  by  gently  heating  it  in  the  flame  of  a 
spirit  lamp.  Arsenious  acid  is  then  volatilized,  and  an  iron-gray 
deposit  of  metallic  arsenic  appears.  If  the  heat  is  continued,  the 
whole  of  the  metallic  sublimate  is  volatilized  and  deposited  in  a  cool 
part  of  the  tube,  in  transparent  and  colorless  octahedra  of  arsenious 
acid.  This  is  the  special  character  of  an  arsenical  sublimate :  it  may 
be  thus  distinguished  from  sublimates  of  all  metals  or  metalloids. 
The  lower  metallic  sublimate  procured  by  reduction,  sometimes  pre- 
sents itself,  not  in  an  annual  form,  but  in  detached  particles  of  a 
somewhat  globular  shape.  These  are  of  an  iron-gray  color,  quite 
unlike  sublimed  mercury,  and  when  examined  by  the  microscope,  it 
may  be  seen  that  they  consist  of  crystalline  masses  nucleated,  and 
that  they  are  not  strictly  spherical.  This  sublimate  is  frequently 
produced  in  the  last  stage,  when  the  residue  in  the  tube  is  strongly 


LIQUID    REAGENTS.  117 

heated.  The  process  of  reduction,  with  the  corroborative  results  above 
mentioned,  is,  when  thus  applied,  conclusive  of  the  arsenical  nature 
of  the  substance  under  examination. 

Arsenic  in  Solution  in  Water.  Liquid  Tests. — The  solution  of  arse- 
nious  acid  is  clear,  colorless,  possesses  scarcely  any  perceptible  taste, 
and  has  but  a  feebly  acid  reaction.  In  this  state,  we  should  first 
evaporate  slowly  a  few  drops  on  a  glass  slide,  when  a  crystalline 
deposit  will  be  obtained.  On  examining  this  with  a  microscope,  it 
will  be  found  to  consist  of  numerous  minute  octahedral  crystals,  pre- 
senting triangular  surfaces  by  reflected  light.     (See  Fig.  4.) 

1.  Silver  Test. — On  adding  to  the  solution  of  white  arsenic  ammonio- 
nitrate  of  silver,  a  pale  yellow  precipitate  of  arsenite  of  silver  falls 
down ;  changing,  under  exposure  to  daylight,  to  an  olive-green 
color.     The  test  is  made*,  by  adding  to  a 

strong  solution  of  nitrate  of  silver,  a  weak  Fig.  4. 

solution  of  ammonia,  and  continuing  to 
add  the  latter,  until  the  brown  oxide  of 
silver,  at  first  thrown  down,  is  almost  re- 
dissolved.  The  yellow  precipitate  is  so- 
luble in  nitric,  tartaric,  citric,  and  acetic 
acids,  as  well  as  in  ammonia.  It  is  not 
dissolved  by  potash  or  soda. 

2.  Copper  Test. — On  adding  to  another 
portion  of  the  solution  ammonio-sulpjiate  of 
copper,  a  light-green  precipitate  (arsenite 
of  copper)  is  formed,  the  tint  of  which 

L  *■  -i.  ,i  ,.  P  Crystals  of  Arsenious  Acid  from  a  so 

varies  according  to  the  proportion  of  ar-      luti011i  magaified  m  diameters. 
senic  present,  and  the  quantity  of  the  test 

added :  hence,  if  the  arsenic  is  in  small  proportion,  no  green  precipi- 
tate at  first  appears ;  the  liquid  simply  acquires  a  blue  color  from 
the  test.  In  less  than  an  hour,  if  arsenic  is  present,  a  bright  green 
deposit  is  formed,  which  may  be  easily  separated  from  the  blue 
liquid  by  decantation.  This  test  is  made  by  adding  ammonia  to  a 
weak  solution  of  sulphate  of  copper,  until  the  bluish- white  precipi- 
tate, at  first  produced,  is  nearly  re-dissolved ;  it  should  not  be  used 
in  large  quantity  if  concentrated,  as  the  deep  blue  color  tends  to 
obscure  or  conceal  the  green  precipitate  formed.  The  dried  precipi- 
tate of  arsenite  of  copper,  when  slowly  and  moderately  heated  in  a 
well-dried  reduction-tube,  will  yield  a  ring  of  octahedral  crystals  of 
arsenious  acid — oxide  of  copper  being  left  as  a  residue. 

3.  Sulphuretted  Hydrogen  Test. — The  gas  may  be  procured  by  adding 
to  sulphide  of  iron  in  a  proper  apparatus,  a  mixture  of  one  part  of 
strong  sulphuric  acid  and  three  parts  of  water.  The  arsenical  liquid 
should  be  slightly  acidulated  with  pure  diluted  hydrochloric  acid, 
before  the  gas  is  passed  into  it :  at  least,  care  should  be  taken  that  it 
is  not  alkaline.  A  yellow  precipitate  (orpiment)  is  immediately  pro- 
duced if  arsenic  is  present,  and  it  may  be  collected  after  boiling  the 
liquid  sufficiently  to  drive  off  any  surplus  gas.  It  is  known  to  be 
sulphide  of  arsenic  by  the  following  properties :     1.  It  is  insoluble 


118 


ARSEXIC.      MARSH'S    PROCESS. 


in  water,  alcohol,  and  ether,  as  well  as  in  diluted  hydrochloric  acid, 
and  vegetable  acids :  but  it  is  decomposed  by  strong  nitric  and  nitro- 
hydrochloric  acids.  2.  It  is  immediately  dissolved  by  potash,  soda, 
or  ammonia;  forming,  if  no  organic  matter  is  present,  a  colorless 
solution.  3.  When  dried  and  heated  with  three  parts  of  soda-flux, 
or  an  equal  part  of  dry  cyanide  of  potassium,  it  yields  a  sublimate  of 
metallic  arsenic. 

Marsh1  s  Process.  Hydrogen  Test. — The  action  of  this  test  depends 
on  the  decomposition  of  arsenious  acid  and  its  soluble  compounds, 
by  nascent  hydrogen  evolved  from  the  action  of  diluted  sulphuric  or 
hydrochloric  acid  on  zinc.  The  materials  should  be  first  proved  to 
be  free  from  arsenic.  The  apparatus  is  of  the  most  simple  kind,  and 
is  so  well  known  as  to  need  no  description  or  illustration.  The 
arsenic  may  be  introduced  into  the  short  leg  of  the  tube  in  the  state 
of  powder;  but  it  is  far  better  to  dissolve  it  in  water,  by  boiling, 
either  with  or  without  the  addition  of  a  few  drops  of  hydrochloric 
acid.  The  metallic  arsenic  combines  with  the  hydrogen,  forming 
arsenuretted  hydrogen  gas,  which  possesses  the  following  properties  : 
1.  Filtering  paper  wetted  with  a  solution  of  nitrate  of  silver  is  imme- 
diately blackened  by  the  gas — the  silver  being  reduced  to  the  metallic 
state.  Lead-paper  is  not  changed  in  color  unless  sulphuretted  hydro- 
gen is  also  present.  2.  It  burns  with  a  pale  bluish- white  flame,  and 
thick  white  smoke  (arsenious  acid).  3.  A  slip  of  glass  or  white  por- 
celain held  in  the  flame  near  tjhe  point  (for  not  too  long  a  time) 
acquires  a  dark  stain  from  the  deposit  of  metallic  arsenic  upon  it. 
This  deposit  presents  a  metallic  lustre  in  the  centre  (a),  a  white  film 
of  arsenious  acid  on  the  outside  (c),  and  between  the  two  a  dark  ring 
of  a  pulverulent  substance  (b),  which,  when  viewed  by  transmitted 

light,  is  hair-brown  in  color  towards  the 
margin,  but  perfectly  opaque  in  the  centre. 
In  order  to  determine  the  arsenical  nature  of 
the  deposits,  the  following  plan  may  be 
adopted :  Several  of  them  should  be  received 
and  accumulated  in  small  porcelain  capsules, 
held  in  the  flame  of  the  burning  gas.  To 
one,  add  a  solution  of  chloride  of  lime ;  the 
arsenical  deposit  is  immediately  dissolved. 
To  a  second,  add  a  solution  of  sulphide  of 
ammonium :  the  metallic  deposit  is  detached, 
but  not  perfectly  dissolved :  yet  on  evapora- 
tion it  yields  a  pale  yellow  film  of  sulphide 
of  arsenic.  To  a  third,  add  a  few  drops  of 
the  strongest  nitric  containing  some  nitrous 
acid.  The  deposit  is  dissolved :  evaporate  the  acid  solution  gently  to 
dryness ;  carefully  neutralize  the  residue,  and  add  one  or  two  drops 
of  a  strong  solution  of  nitrate  of  silver.  A  brick  red  stain  or  a  dark 
red  precipitate  of  arsenate  of  silver  will  be  produced. 

ReinscKs  Process. — In  the  application  of  this  process,  the  liquid 
suspected  to  contain  arsenic,  or  the  solid  dissolved  in  distilled  water, 
is  boiled  with  from  one-sixth  to  one-eighth  part  of  pure  hydrochloric 


Deposit  obtained  by  Marsh's 

Apparatus. 
A  Metal.     B  Mixed  deposit. 
C  Arsenious  acid. 


eeinsch's  process.  119 

acid  (proved  to  be  free  from  arsenic),  and  a  small  slip  of  copper  is 
then  introduced.  A  slip  of  polished  copper  foil  (electric  copper) 
about  a  quarter  of  an  inch  square,  attached  to  the  end  of  a  thin  plati- 
num wire,  may  be  employed  for  the  experiment.  The  copper  must 
be  first  proved  to  be  free  from  arsenic,  as  this  is  a  very  common  con- 
tamination of  commercial  copper  in  the  form  of  foil,  gauze,  or  wire. 
If  arsenic  is  present  in  the  liquid,  even  in  small  quantity,  the  polished 
copper  acquires  either  immediately  or  within  a  few  minutes  a  dark 
iron-gray  coating  from  the  deposit  of  this  metal.  This  is  apt  to  scale 
off,  if  the  arsenic  is  in  large  quantity  or  if  the  liquid  is  very  acid  or 
long  boiled.  We  remove  the  slip  of  copper,  wash  it  in  water,  dry  it, 
and  gently  heat  it  in  a  small  reduction  tube,  when  arsenious  acid 
will  be  sublimed  in  minute  octahedral  crystals :  if  these  should  not 
be  apparent  from  one  piece  of  copper,  several  may  be  successively 
introduced.  When  the  quantity  of  arsenic  is  small,  the  polished 
copper  merely  acquires  a  faint  bluish  tint.  The  deposit  is  in  all  cases 
materially  affected  by  the  quantity  of  water  present,  or,  in  other 
words,  the  degree  of  dilution,  and  sometimes  it  will  appear  only  after 
the  liquid  has  been  much  concentrated  by  evaporation.  The  presence 
of  arsenic  as  an  impurity  in  copper  may  be  detected  by  the  following 
method  suggested  by  Mr.  Abel.  Add  to  pure  hydrochloric  acid, 
diluted  with  six  parts  of  water,  one  or  two  drops  of  a  weak  solution 
of  persulphate  or  perchloride  of  iron.  Boil  the  acid  liquid  and  intro- 
duce the  copper,  well  cleaned  and  polished,  into  the  boiling  liquid. 
Arsenicated  copper  soon  acquires  a  dark  tarnish,  while  the  non- 
arsenicated  (electric)  copper  retains  its  color  under  these  circum- 
stances. 

Arsenic  in  Liquids  containing  Organic  Matter. — Arsenic  may  exist 
in  an  insoluble  form — i.  e.,  as  a  crystalline  powder — in  the  contents 
of  the  stomach  or  any  liquid  article  of  food.  If  coarsely  powdered 
it  may  be  separated  as  a  heavy  sediment,  by  careful  washing  with 
distilled  water,  and  then  dried  and  tested  by  the  reduction  process 
(p.  115).  Any  liquid  for  analysis  should  be  strained  through  muslin 
or  filtered  through  paper  in  order  to  separate  all  insoluble  matters : 
these  should  be  well-pressed  and  drained.  Should  the  liquid  be 
colored,  this  is  of  little  moment,  provided  it  is  clear.  If  viscid,  it 
should  be  diluted  with  water,  and  boiled  with  a  small  quantity  of 
hydrochloric  acid ;  on  standing,  a  deposit  may  take  place,  and  this 
should  be  separated  by  a  filter.  As  a  trial  test,  we  may  now  boil  in 
a  portion  of  the  liquid,  acidulated  with  pure  hydrochloric  acid,  a  slip 
of  pure  copper  highly  polished,  and  examine  any  deposit  on  the 
metal  by  the  method  above  described.  If  the  copper  comes  out  un- 
changed there  is  no  detectable  quantity  of  arsenic  present. 

When  arsenic  is  present  in  an  organic  liquid  in  large  quantity,  it 
may  be  precipitated  as  sulphide  by  a  current  of  washed  sulphuretted 
hydrogen.  The  liquid  should  be  boiled,  filtered,  and  acidulated  with 
hydrochloric  acid  before  passing  the  gas  into  it.  When  precipitation 
has  ceased,  the  liquid  should  be  again  filtered,  the  precipitate  collect- 
ed, dried,  and  weighed.  By  operating  on  a  measured  portion  of  the 
solution,  the  amount  of  white  arsenic  present  may  be  determined  by 


120 


AESENIC    IN    ORGANIC    LIQUIDS. 


the  weight  of  the  sulphide  obtained ;  five  parts  by  weight  of  sulphide 
being  equal  to  four  parts  of  white  arsenic.  The  properties  of  the 
yellow  precipitate  should  be  verified  according  to  the  rules  mentioned 
at  page  117. 

Distillation  Process. — When  the  poison  is  in  so  small  a  quantity 
that  it  does  not  admit  of  precipitation  by  sulphuretted  hydrogen,  and 
no  solid  particles  of  arsenic  are  found  in  the  stomach,  in  its  contents, 
or  in  any  article  of  food,  another  method  may  be  resorted  to  for 
detecting  its  presence.  This  method  equally  applies  to  the  detection 
of  arsenic  deposited  as  a  result  of  absorption  in  the  soft  organs  of  the 
body,  as  in  the  liver,  kidney,  or  heart,  and  to  arsenic  in  all  its  forms, 
except  the  pure  insoluble  sulphide  or  orpiment.  The  substance, 
whether  food,  blood,  mucus,  the  liver,  or  other  organ,  should  be  first 
thoroughly  dried,  either  by  exposure  to  a  current  of  air  or  by  a 
water-bath.  The  dried  solid  should  then  be  broken  into  small  por- 
tions and  placed  in  a  flask  or  retort  of  sufficient  capacity,  with  a 
sufficient  quantity  of  the  strongest  hydrochloric  acid  (free  from 
arsenic)  to  drench  it  completely.  After  some  hours'  digestion  in  the 
cold,  the  retort  or  flask  (a)  coutaining  the  mixture — which  should  be 


Fig.  6. 


Apparatus  for  distilling  organic  and  mineral  substances  containing  Arsenic. 

of  such  a  size  that  the  materials  should  not  fill  it  to  more  than  one- 
third  or  one-half  of  its  capacity — should  be  fitted  with  a  long  con- 
densing tube  (c),  and  then  gradually  heated  by  a  sand-bath  until  the 
acid  liquid  begins  to  pass  over.  A  metallic  head,  formed  of  a  cone 
of  tin  plate,  should  be  placed  over  the  retort  or  flask  so  as  to  concen- 
trate the  heat  and  prevent  condensation  in  the  upper  part  of  the 
vessel.  A  small  flask  receiver  (d)  with  a  loosely-fitting  cork  may  be 
employed  to  collect  the  product.  This  should  contain  a  small  quan- 
tity of  distilled  water  so  as  to  fix  and  condense  any  vapors  that  may 
pass  over.  The  receiver,  as  well  as  the  condensing-tube,  should  be 
kept  cool  by  wetting  its  surface  with  cold  water  diffused  on  a  layer 
of  blotting-paper  placed  over  it.  A  perfect  condensation  of  the  dis- 
tilled liquid  is  insured  by  this  arrangement.  This  distillation  may 
be  carried  to  dryness  on  a  sand-bath,  or  nearly  so ;  and  it  may  be 
sometimes  advisable,  in  order  to  insure  the  separation  of  the  whole 


DISTILLATION    PKOCESS.  121 

of  the  arsenic  as  chloride,  to  add  to  the  residue  in  the  retort  when 
cold,  another  portion  of  pure  and  concentrated  hydrochloric  acid,  and 
distil  to  dryness.  I  have,  however,  found  that  portions  of  dried  liver 
and  stomach  gave  up  every  trace  of  arsenic  by  one  distillation,  when 
a  sufficient  quantity  of  hydrochloric  acid  had  been  used,  and  the 
process  was  slowly  conducted  by  a  regulated  sand-bath  heat. 

The  liquid  product  may  be  colored,  turbid,  and  highly  offensive 
if  distilled  from  decomposed  animal  matter.  Exposure  to  the  air 
for  a  few  hours  sometimes  removes  the  offensiveness,  and  there  is  a 
precipitation  of  sulphur,  or  of  some  sulphide  of  arsenic.  The  dis- 
tillate may  be  separated  from  any  deposit  by  filtration,  and  if  still 
turbid,  it  may  be  again  distilled  at  a  lower  heat  to  separate  it  from 
any  organic  matter  that  may  have  come  over.  If  there  is  a  yellow 
deposit  it  should  be  examined  for  sulphide  of  arsenic. 

If  arsenic  is  present  in  the  substance  submitted  to  distillation,  the 
distillate  will  contain  arsenic  in  the  form  of  soluble  chloride ;  this 
does  not  escape  from  a  diluted  solution  at  common  temperatures. 
The  quantity  of  dry  organic  substance  used  in  the  experiment 
must  depend  on  the  quantity  of  arsenic  present,  as  revealed  by  a 
preliminary  trial  with  Reinsch's  process.  If  large,  two  or  three 
drachms  of  the  dried  substance,  or  even  less,  will  yield  sufficient 
chloride  of  arsenic  for  further  proceedings.  For  the  absorbed  and 
deposited  poison,  half  an  ounce  of  the  dried  organ,  corresponding  to 
two  ounces  of  the  soft  organ,  wi]l  frequently  suffice ;  but  a  negative 
conclusion  of  the  absence  of  arsenic  should  not  be  drawn  from  a 
smaller  quantity  than  two  to  four  ounces  of  the  dried  substance, 
whether  liver,  kidney,  or  heart.  These  tissues  it  must  be  remem- 
bered, contain  about  76  per  cent,  of  water.  If  oily  matter  should  be 
distilled  over,  this  may  be  separated  by  passing  the  distillate  through 
a  paper  filter  wetted  with  water. 

The  distilled  liquid,  containing  chloride  of  arsenic,  should  if  clear 
be  submitted  to  a  further  stage  of  analysis.  For  this  purpose  one 
third  of  it  should  be  distilled  with  three  or  four  parts  of  water  and 
boiled  in  a  clean  flask.  When  boiling,  a  piece  of  bright  copper-foil 
(free  from  arsenic),  of  about  the  size  of  the  sixteenth  of  a  square 
inch,  should  be  introduced.  If  there  is  chloride  of  arsenic  in  the 
liquid,  even  up  to  the  l-4000th  of  a  grain,  its  presence  will  be  indi- 
cated by  a  change  of  color,  and  by  the  deposit  of  a  dark  metallic 
film  on  the  copper.  If  the  liquid  should  be  too  much  diluted  for 
this  purpose,  it  may  be  concentrated  on  the  polished  copper,  and  the 
deposit  will  after  a  time  be  apparent.  If  the  quantity  of  arsenic 
present  is  believed  to  be  very  small,  the  surface  of  copper  introduced 
should  be  proportionately  small.  The  remaining  two-thirds  of  the 
distilled  liquid,  sufficiently  diluted,  should  now  be  introduced  into  a 
Marsh's  tube,  or  into  an  evolution  flask  provided  with  a  funnel-tube, 
the  capacity  of  which  must  be  regulated  by  the  quantity  of  acid 
liquid  to  be  examined.  The  kind  of  apparatus  employed  in  this 
stage  is  represented  in  the  engraving,  Fig.  7.  A  the  flask  with  fun- 
nel tube  B,  and  connecting  piece  c ;  the  funnel  tube  should  be  long 
enough  just  to  dip  below  the  surface  of  the  acid  liquid.     The  short 


122 


DETECTION    OF    ARSENIC 


connecting  piece  is  bent  at  a  right  angle,  and,  like  B,  is  carried  through 
a  closely  fitting  cork  in  the  neck  of  the  flask.  This  tube  should  be 
only  long  enough  to  go  through  the  cork,  and  its  open  end  should 
be  bevelled  off  to  a  fine  point,  so  that  any  vapor  which  is  condensed 


Apparatus  for  testing  chloride  of  arsenic  obtained  by  distillation. 
Fig.  8. 


D 


Portion  of  tube  separated  with  a  deposit  of  metallic  arsenic  in  the  contracted  portion. 

on  it  may  fall  back  as  liquid  into  the  flask,  d  is  the  drying  tube 
containing  fragments  of  chloride  of  calcium,  secured  by  cotton  at 
both  ends.  At  the  flask  end  of  this  tube  should  be  placed  some 
well-dried  bibulous  paper,  saturated  with  acetate  of  lead.  This  has 
the  advantage  of  stopping  any  gaseous  sulphur  compound,  which 
may  escape  from  the  zinc  or  acid  liquid.  E  E,  a  hard  and  not  easily 
fusible  glass  tube,  free  from  lead,  contracted  in  two  situations  k  k', 
to  about  the  diameter  of  the  tenth  of  an  inch  or  less,  the  tube  itself 
having  a  diameter  of  from  a  quarter  to  three-eighths  of  an  inch,  f  f 
are  supports  made  of  a  stout  wire,  to  prevent  the  tube  from  falling 
when  heated  to  redness.  G  is  a  test  glass  to  hold  one  or  two  drachms 
of  a  strong  solution  of  nitrate  of  silver.  H  is  aBunsen's  air-gas  jet, 
which  gives  a  stronger  heat  than  a  spirit-lamp,  although  the  latter 
mav  be  used. 

The  arrangement  being  thus  made,  the  zinc  and  hydrochloric  acid 
are  first  tested  as  to  their  freedom  from  arsenic.  Portions  of  pure 
zinc  are  placed  in  the  flask  a,  the  parts  of  the  apparatus  are  then 
connected,  and  pure  hydrochloric  acid,  diluted  with  three  or  four 
parts  of  water,  is  poured  into  the  flask  by  the  funnel  b,  which  ope- 
rates as  a  safety  valve.  Bubbles  of  air  and  gas  speedily  appear  in 
the  liquid  in  g,  if  the  corks  fit  well  and  the  whole  of  the  arrange- 
ments are  air-tight.  Pure  zinc  is  sometimes  but  imperfectly  acted 
on  by  the  acid.  In  this  case  some  clean  platinum  wire  or  foil  may 
be  wound  round  the  bars  of  the  zinc,  and  the  evolution  of  hydrogen 
will  be  thus  accelerated.  It  is,  however,  better  that  the  hydrogen 
should  come  off  rather  slowly.  If  the  materials  are  pure,  the  solu- 
tion of  nitrate  of  silver  should  undergo  no  change  of  color.  The 
glass  G  should  be  placed  on  a  sheet  of  white  paper,  whereby  the 


IN    THE    TISSUES.  123 

slightest  tinge  of  brown  or  black  is  made  perceptible.  When  all  the 
air  is  expelled  from  the  tube,  the  smokeless  flame  H  may  be  applied 
to  it  at  about  one  inch  in  front  of  a  contraction  of  the  tube,  as  indi- 
cated in  the  engraving,  and  the  glass  heated  to  redness.  No  metallic 
deposit  should  take  place  at  k.  If  the  materials  are  quite  pure,  the 
transparency  of  the  glass  tube  at  K  will  be  unchanged.  From  a 
quarter  to  half  an  hour  will  be  sufficient  for  this  experiment. 

The  silver  solution  is  allowed  to  become  saturated  with  the  gas. 
Any  escape  of  the  gas  from  the  glass,  or  by  leakage  from  any  of  the 
junctions  of  the  apparatus,  is  at  once  indicated  by  holding  near  to 
the  spot,  filtering  paper  wetted  with  nitrate  of  silver.  This  is  in- 
stantly blackened.  The  glass  with  the  silver  solution  is  removed, 
the  end  of  the  tube  well  washed,  or  another  tube  substituted  for  E  E, 
and  this  is  allowed  to  dip  into  about  one  drachm  of  the  strongest 
nitric  acid,  containing  much  nitrous  acid  in  a  test-glass  similar  to  g, 
or  into  a  small  porcelain  capsule.  After  a  time,  the  acid  loses  its 
color,  and  the  metallic  arsenic  of  the  gas  is  converted  into  arsenic 
acid,  which  may  be  obtained  by  evaporation. 

The  further  testing  of  the  products  is  a  very  simple  process.  1. 
The  silver  solution  contains  arsenic  in  the  state  of  arsenious  acid 
dissolved,  with  some  excess  of  nitrate  of  silver.  By  one  or  two  ni- 
trations it  is  obtained  colorless  and  clear.  A  weak  solution  of  ammo- 
nia is  then  added  to  it,  and  yellow  arsenite  of  silver  is  at  once 
precipitated  (see  p.  117).  The  nitric  acid  liquid  is  evaporated  to 
dryness  in  a  small  porcelain  capsule.  One  or  two  drops  of  water  are 
added  to  the  residue,  with  a  drop  of  weak  ammonia  if  it  should  be 
very  acid.  A  strong  solution  of  nitrate  of  silver  is  then  added  to  it ; 
arsenate  of  silver,  of  its  well-known  brick-red  color,  is  immediately 
produced.  3.  The  portions  of  tube  K  k'  with  the  metallic  deposits 
in  them  may  be  separated  by  a  file,  and  then  hermetically  sealed,  or, 
if  necessary,  one  or  more  of  them  may  be  tested  by  the  methods  de- 
scribed in  a  preceding  page  (see  p.  116.) 

With  these  results  the  evidence  of  the  presence  of  Fig.  9. 

arsenic  may  be  considered  to  be  conclusive.  The 
poison  is  obtained  by  this  process,  not  only  in  its  pure 
metallic  state,  but  in  the  distinct  forms  of  its  two  well- 
known  oxides — arsenious  and  arsenic  acids.  Any  de- 
monstration beyond  this  is  superfluous.  It  will  be 
observed  that  Eeinsch's  process  is  here  employed  as 
an  adjunct  to  Marsh's  process  in  an  improved  form, 
in  which  the  burning  of  the  gas  is  unnecessary. 

ReinscKs  Process  alone  may  be  employed  for  detect- 
ing arsenic,  deposited  as  a  result  of  absorption,  in  the 
liver,  kidneys,  or  other  organs.  About  four  ounces  Fiask  employed  in 
of  the  recent  organ,  or  more,  if  necessary,  cut  into  the  analysis  of 
small  pieces,  may  be  boiled  in  a  flask  in  a  mixture  of  ^i***^8  r^ 
one  part  of  pure  hydrochloric  acid  and  four  of  water,  Cess. 
until  the  structure  of  the  organ  is  broken  up.  The 
flask  may  be  of  the  shape  represented,  in  the  annexed  engraving,  and 
either  a  naked  spirit-flame  or  a  sand-bath  may  be  employed.   A  small 


124  QUANTITY    FOUXD    IX    A    BODY. 

glass  funnel  should  be  placed  in  the  neck  of  the  flask.  This  receives 
and  condenses  the  vapor  which  falls  back  into  the  flask.  By  this 
arrangement  the  boiling  may  be  continued  for  a  long  time,  without 
material  loss  by  evaporation.  The  flask  should  not  be  more  than 
half  full,  and  heated  gently  until  all  froth  is  expelled.  A  slip  of 
fine  platinum  wire,  having  a  small  piece  of  pure  copper-foil,  should 
be  immersed  in  the  liquid  when  boiling.  This  enables  the  operator 
to  remove  the  copper  and  examine  it  at  intervals,  after  immersing 
it  in  distilled  water.  If  it  is  much  coated  with  a  metallic  deposit, 
larger  portions  of  copper-foil  may  be  successively  introduced  until 
the  liquid  is  exhausted.  The  deposit  on  the  copper  may  then  be 
tested  by  the  method  described  at  page  119. 

It  might  be  supposed  that  arsenic  would  escape  as  chloride  in  this 
method  of  operating,  but  when  hydrochloric  acid  is  diluted  with  six 
or  eight  parts  of  water,  little  or  no  volatile  chloride  is  distilled  over. 
In  reference  to  the  recent  organs,  a  larger  proportion  of  acid  may  be 
used,  because  three-fourths  of  the  weight  of  the  animal  substance 
really  consists  of  water. 

It  need  hardly  be  observed  that  the  quantity  of  arsenic  found  in  the 
stomach  or  other  organs  can  convey  no  accurate  idea  of  the  quantity 
actually  taken  by  the  deceased,  since  more  or  less  of  the  poison  may 
have  been  removed  by  violent  vomiting  and  purging  as  well  as  by 
absorption  and  elimination.  A  large  quantity  found  in  the  stomach 
or  bowels  indicates  a  large  dose;  but  the  finding  of  a  small  quantity 
does  not  prove  that  the  dose  was  small.  Notwithstanding  these  very 
obvious  causes  for  the  removal  of  a  poison  from  the  body,  there  is  a 
strong  prejudice  among  lawyers  that  the  chemical  evidence  is  defec- 
tive unless  the  quantity  found  is  sufficient  to  cause  death.  It  would 
be  just  as  reasonable,  in  a  case  in  which  a  man  has  been  killed  by  a 
discharge  of  small  shot,  to  insist  upon  a  failure  of  proof  of  the  cause 
of  death,  because  only  a  single  pellet  has  been  found  in  the  body. 
The  value  of  chemical  evidence  does  not  depend  on  the  discovery  of 
any  particular  quantity  of  poison  in  the  stomach — it  is  merely  neces- 
sary that  the  evidence  of  its  presence  should  be  clear,  distinct,  con- 
clusive, and  satisfactory.  At  the  same  time,  a  reasonable  objection 
may  be  taken  to  a  dogmatic  reliance  upon  the  alleged  discovery  in  a 
dead  body,  of  minute  fractional  portions  of  a  grain ;  and,  considering 
the  great  liability  to  fallacy  from  the  accidental  presence  of  arsenic  in 
the  articles  used,  the  chemical  evidence  in  the  French  case  of  Madame 
Laffarge  (1840),  in  which  the  whole  quantity  discovered  in  the  dead 
body  was  stated  to  be  the  hundred  and  thirtieth  part  of  a  grain,  was 
of  a  most  unsatisfactory  kind,  and  should  have  been  rejected  by  the 
court.  No  man  with  any  respect  for  his  character,  or  for  the  com- 
mon sense  of  a  jury,  would  base  chemical  evidence  on  the  thousandth, 
or  less  than  the  thousandth,  part  of  a  grain  of  poison  in  a  case  of  life 
and  death;  although,  for  the  purpose  of  procuring  the  acquittal  of 
a  criminal,  he  may  safely  boast  of  his  alleged  power  to  detect  this, 
or  even  a  smaller  quantity. 

The  condition  of  the  arsenic  found  in  a  dead  stomach  should  be 
specially  noticed.     A  witness  should  be  prepared  to  say  whether  it 


ARSENIC.      FOWLER'S    SOLUTION.  125 

is  in  fine  powder  or  in  coarse  fragments;  whether  it  is  mixed  with 
soot  or  indigo,  or  whether  it  is  in  the  ordinary  state  of  white  arsenic. 
These  points  may  be  material  as  evidence  in  reference  to  proof  of 
possession,  of  purchase,  or  administration. 

Arsenic  is  not  a  normal  constituent  of  the  body.  Under  no  cir- 
cumstances is  it  found  in  the  tissues  after  death,  except  in  cases  in 
which  it  has  been  taken  or  administered. 

Arsenite  of  Potash.    Liquor  Arsenicalis. 
(Fowler's  Solution.) 

Symptoms  and  Appearances. — There  is,  so  far  as  I  know,  only  one 
case  recorded  in  which  this  solution  has  destroyed  life.  A  woman 
took  half  an  ounce  (=two  grains  of  arsenic)  in  divided  doses,  during 
a  period  of  five  days,  and  died  from  the  effects.  There  was  no  vomit- 
ing or  purging,  but  after  death  the  stomach  and  intestines  were  found 
inflamed.     ("Provincial  Journal,"  June  28,  1848,  p.  347.) 

Analysis. — The  solution  has  the  odor  of  tincture  of  lavender,  is  of 
a  reddish  color,  and  has  an  alkaline  reaction.  One  fluidounce  of  it 
contains  four  grains  of  arsenious  acid.  It  gives  at  once  a  green  pre- 
cipitate (arsenite  of  copper)  with  the  sulphate  of  copper,  and  a  yel- 
low precipitate  with  nitrate  of  silver.  Acidulated  with  hydrochloric 
acid,  and  treated  with  a  current  of  sulphuretted  hydrogen  gas,  it 
yields  a  yellow  sulphide;  and  when  boiled  with  this  acid  and  pure 
copper,  a  deposit  is  obtained  which  readily  furnishes  by  heat  octohe- 
dral  crystals  of  arsenious  acid. 

Fly-  Water  is  a  name  applied  to  solutions  of  various  arsenical  com- 
pounds in  water.  Mixtures  of  this  kind  are  formed  by  dissolving 
one  part  of  the  arsenite  of  soda  or  potash  and  two  parts  of  sugar  in 
twenty  parts  of  water.  Paper  soaked  in  this  solution,  and  dried,  is 
used  for  poisoning  flies;  and  perhaps  this  is  the  safest  form  in  which 
arsenic  can  be  used  for  such  a  purpose. 

Arsenite  of  Copper.    Scheele's  Green.    Emerald  Green. 

This  is  the  only  metallic  arsenite  which  is  met  with  in  commerce 
and  the  arts,  and  it  constitutes,  wholly  or  in  part,  a  great  variety  of 
green  pigments,  known  as  Emerald  green  (aceto-arsenite  of  copper) 
employed  for  paper-hangings,  mineral  green,  Brunswick,  Schweinfurt, 
or  Vienna  green.  It  is  thus  found  in  the  form  of  oil-paint  in  cakes, 
in  boxes  of  water  colors,  spread  over  confectionery,  in  wafers,  in  ad- 
hesive envelopes,  in  wrappers  for  chocolate,  isinglass,  &c,  and  lastly, 
and  most  abundantly,  in  various  kinds  of  green  decorative  papers 
used  for  covering  the  walls  of  sitting  and  bedrooms. 

Although  this  compound  is  insoluble  in  water,  it  is  sufficiently 
soluble  in  the  acid  mucous  fluids  of  the  stomach  to  be  taken  up  by 
the  absorbents,  and  carried  as  a  poison  into  the  blood.  The  symp- 
toms and  appearances  which  it  produces  resemble  those  caused  by 
arsenious  acid  or  white  arsenic. 

In  a  case  which  was  the  subject  of  a  criminal  trial,  this  substance 


126  scheele's  green,    arsenic  acid. 

was  proved  to  have  caused  the  death  of  a  gentleman  by  reason  of  its 
having  been  employed  to  give  a  rich  green  color  to  some  blanc-mange 
served  at  a  public  dinner: — the  person  who  employed  it  considering 
that  emerald  or  mineral  green  was  nothing  more  than  an  extract  of 
spinach !  It  led  to  death  under  the  usual  symptoms,  and  the  parties 
were  convicted  of  manslaughter  and  sentenced  to  imprisonment. 
{Reg.  v.  Franklin  and  Randall,  Northampton  Summer  Assizes,  1848.) 

The  symptoms  of  poisoning  which  have  been  observed  in  persons 
who  have  inhabited  rooms  of  which  the  walls  were  covered  with  this 
arsenical  compound,  are  as  follows:  Dryness  and  irritation  of  the 
throat,  with  cough,  irritation  of  the  mucous  membrane  of  the  eyes 
and  nostrils,  dry  cough,  languor,  headache,  loss  of  appetite,  nausea, 
colicky  pains,  numbness,  cramp,  irritability  of  bowels,  attended  with 
mucous  discharges,  great  prostration  of  strength,  a  feverish  condition, 
and  wasting  of  the  body.  These  symptoms  may  not  all  present 
themselves  in  one  case;  they  are  derived  from  the  examination  of 
numerous  cases  which  have  been  referred  to  me.  No  suspicion  of 
the  cause  had  been  entertained  until  all  ordinary  treatment  failed  to 
impart  relief,  and  an  analysis  of  the  paper  had  been  made.  The 
connection  of  the  symptoms  with  this  cause  appears  to  have  been  in 
some  instance  clearly  established  by  the  fact  that  after  the  removal 
of  the  paper  especially  from  bedrooms,  the  symptoms  have  disap- 
peared. It  is,  however,  proper  to  observe  that,  as  in  reference  to  the 
manufacture  of  white  lead,  comparatively  few  of  those  who  are  ex- 
posed, suffer  from  symptoms  of  poisoning.  Various  deaths,  chiefly 
among  children,  from  the  use  of  this  paper  are  now  recorded ;  and  it 
is  probable  that  to  the  noxious  practice  of  covering  the  walls  of  our 
sitting  and  bedrooms  with  arsenic,  many  insidious  cases  of  illness 
and  chronic  disease  may  be  referred. 

Analysis. — For  the  chemical  characters  of  Scheele's  Green,  see 
page  117.  The  wall-paper  pigment  called  Emerald  Green  is  a 
mixture  of  arsenite  and  acetate  of  copper.  The  color  is  most  intense, 
even  by  candle-light.  The  presence  of  arsenic  in  this  compound  may 
be  easily  detected  by  all  the  tests  for  solid  arsenic  (page  115);  but  the 
following  is  a  simple  method  which  admits  of  speedy  application.  A 
slip  of  the  suspected  paper  should  be  soaked  in  a  moderately-strong 
solution  of  ammonia.  The  green  color  is  removed,  and  the  blue 
ammoniuret  of  copper  is  formed  and  dissolved  in  a  few  minutes. 
This  result  establishes  only  the  presence  of  a  compound  of  copper 
soluble  in  ammonia.  If  the  ammonia  does  not  become  blue  there  is 
no  arsenite  present ;  if  it  does  become  blue,  a  large  crystal  of  nitrate 
of  silver  must  be  placed  in  a  white  saucer  and  a  small  portion  of  the 
blue  liquid  poured  over  it.  The  presence  of  arsenic  is  revealed  by 
the  production  of  yellow  arsenite  of  silver  over  the  surface  of  the 
crystal. 

Arsenic  Acid.    Alkaline  Arsenates. 

Arsenic  acid  is  an  artificial  product  almost  entirely  confined  to  the 
chemical  laboratory.     Orfila  states  that  it  is  a  more  powerful  poison 


ORPIMENT.      ARSENURETTED    HYDROGEN.  127 

than  arsenious  acid,  but  he  does  not  adduce  any  instance  in  support 
of  this  opinion.  I  have  not  been  able  to  find  any  case  of  poisoning 
by  it  in  the  human  subject.  The  arsenates  of  potash  and  soda  must 
be  regarded  as  active  poisons,  although  there  are  but  few  instances 
on  record  in  which  life  has  been  destroyed  by  them.  Dr.  Christison 
states  that,  in  the  course  of  his  reading  he  has  met  with  only  two 
reported  cases  of  poisoning  by  arsenate  of  potash.     (Op.  cit.,  284.) 

Analysis. — Arsenic  acid  is  a  white  uncrystalline  deliquescent  solid. 
1.  It  is  very  soluble  in  water,  forming  a  highly  acid  solution.  2.  It 
is  precipitated  of  a  brick-red  color  by  nitrate  or  the  ammonio-nitrate 
of  silver. 

Sulphides,  or  Sulphurets  of  Arsenic.    Orpiment. 

Orpiment  or  Yellow  Arsenic  owes  its  poisonous  properties  to  the 
presence  of  a  variable  proportion  of  arsenious  acid,  sometimes  amount- 
ing to  as  much  as  30  per  cent,  of  its  weight.  Orpiment  is  much  em- 
ployed in  the  arts,  in  painting,  dyeing,  paper-staining,  and  even  in 
the  coloring  of  toys  and  sweetmeats  for  children,  but  is  not  often 
used  as  a  poison ! 

Orpiment  produces  symptoms  and  appearances  similar  to  those 
caused  by  arsenious  acid ;  but  the  dose  required  to  destroy  life  varies 
according  to  the  proportion  of  arsenious  acid  with  which  it  happens 
to  be  mixed.  This  is  not  a  common  form  of  poisoning ;  the  yellow 
color  of  the  poison  would  lead  to  suspicion :  but  by  reason  of  this 
color,  orpiment  may  be  given  or  taken  by  mistake  for  mustard  or 
turmeric. 

Analysis. — The  powdered  sulphide  yields  a  solution  of  arsenious 
acid  on  boiling  it  in  water  acidulated  with  hydrochloric  acid.  It 
readily  gives  the  well-known  sublimates  of  metallic  arsenic,  either 
with  soda-flux  or  cyanide  of  potassium  (see  p.  117). 

Arsenuretted  Hydrogen. 

This  is  a  gaseous  poison  of  arsenic,  producing,  when  respired  in 
small  quantity,  very  serious  effects  upon  the  system.  It  has  already 
occasioned  death  in  at  least  four  instances.  (See  "  On  Poisons.") 
One  of  them  is  comparatively  recent.  ("  Chemical  News,"  Dec.  26, 
1803,  p.  307.) 


128      MERCURIAL    POISONING.      CORROSIVE    SUBLIMATE. 


CHAPTEE  XII. 

Poisoning  by  mercury.  —  corrosive  sublimate.  —  symptoms. — 

chronic  poisoning. appearances  after  death. chemical 

analysis. — process  for  mercury  in  organic  liquids. — white 
and  red  precipitates. — mercuric  methide  and  other  com- 
POUNDS. 

Metallic  Mercury  is  not  regarded  as  a  poison.  A  large  quantity 
of  it  in  the  fluid  state  may  be  swallowed  without  affecting  health,  or 
without  causing  more  uneasiness  than  that  which  may  arise  from  its 
great  weight.  It  rapidly  passes  through  the  bowels.  If  the  mercury 
is  breathed  or  swallowed  in  a  state  of  vapor,  or  if  applied  to  the  skin 
or  mucous  membrane  in  a  state  of  extreme  mechanical  division,  in 
which  state  it  appears  to  be  easily  susceptible  of  oxidation,  it  is  liable 
to  be  absorbed,  and  to  produce  a  poisonous  action  on  the  body.  The 
effects  are  principally  manifested  by  salivation,  by  trembling  and 
involuntary  motions  of  the  limbs,  loss  of  appetite,  and  emaciation. 
These  symptoms  are  occasionally  seen  in  workmen  engaged  in  trades 
in  which  they  are  exposed  to  the  inhalation  of  mercurial  vapors. 

Corrosive  Sublimate. 

This  substance  has  received  a  variety  of  chemical  names.  It  has 
been  at  various  times  called  Oxymuriate,  Chloride,  Bichloride,  and 
Perchloride  of  Mercury.  To  prevent  any  confusion  from  scientific 
chemical  nomenclature,  the  old  and  popular  name  of  Corrosive  Sub- 
limate, expressing  the  principal  properties  of  the  substance,  is  here 
retained.  It  is  commonly  seen  under  the  form  of  heavy  crystalline 
masses,  or  of  a  white  crystalline  powder.  Its  taste  is  powerfully 
austere  and  metallic,  so  that  no  poisonous  quantity  of  it  could  be 
easily  swallowed,  without  the  person  becoming  immediately  aware 
of  it.  It  is  very  soluble  in  water,  hot  or  cold,  and  speedily  sinks  in 
it,  in  which  properties  it  differs  strikingly  from  arsenic. 

Symjitoms. — The  symptoms  produced  by  corrosive  sublimate  gen- 
erally come  on  immediately  or  within  a  few  minutes  after  the  poison 
has  been  swallowed.  In  the  first  place  there  is  perceived  a  strong- 
metallic  taste  in  the  mouth,  often  described  as  a  coppery  taste  ;  and 
there  is,  during  the  act  of  swallowing,  a  sense  of  constriction  almost 
amounting  to  suffocation,  with  burning  heat  in  the  throat,  extending 
downwards  to  the  stomach.  In  a  few  minutes  violent  pain  is  felt  in 
the  abdomen,  especially  in  the  region  of  the  stomach,  which  is  in- 
creased by  pressure.  There  is  nausea,  with  frequent  vomiting  of 
long  stringy  masses  of  white  mucus,  mixed  with  blood,  attended 


CORROSIVE    SUBLIMATE.      SYMPTOMS.  129 

with  severe  pain  in  the  abdomen  and  profuse  purging.  The  counte- 
nance is  sometimes  swollen  and  flushed,  in  other  cases  it  has  been 
pale  and  anxious.  The  pulse  is  small,  frequent,  and  irregular,  and 
is  scarcely  perceptible  when  the  symptoms  become  aggravated.  The 
tongue  is  white  and  shrivelled  —  the  skin  cold  and  clammy,  the 
breathing  difficult ;  and  death  is  commonly  preceded  by  fainting, 
convulsions,  or  general  insensibility.  The  external  parts  of  the 
mouth,  when  examined,  are  swollen,  and  sometimes  present  a  white 
appearance,  as  if  the  cavity  had  been  washed  with  a  solution  of  ni- 
trate of  silver ;  the  lips  are  often  swollen.  Suppression  of  urine  has 
also  been  frequently  noticed  among  the  symptoms ;  it  existed  in  a 
well-marked  case  of  poisoning  by  this  substance,  at  Guy's  Hospital  ; 
the  patient  lived  four  davs,  but  did  not  pass  any  urine  during  the 
whole  of  this  time.  ("  Guy's  Hospital  Eeports,"  April,  1844,  p.  24.) 
This  symptom  was  observed  in  a  case  reported  by  Dr.  Wegeler 
(Casper's  Wochenschrift,"  Jan.  10,  1846,  p.  30),  in  which  a  youth, 
set.  17,  swallowed  three  drachms  of  the  poison,  and  died  on  the  sixth 
dajr.  During  the  last  three  days,  no  urine  was  secreted.  The  case 
was  otherwise  remarkable  from  the  fact,  that  no  pain  was  experienced 
on  pressure  of  the  abdomen,  and  that  the  pulse  underwent  no  change 
until  shortly  before  death.  In  another  case,  reported  by  Dr.  Herapath, 
in  which  a  scruple  of  corrosive  sublimate  in  solution  was  swallowed, 
suppression  of  urine  and  salivation  came  on  on  the  third,  and  the 
patient  died  on  the  ninth  day.  ("  Lancet,"  Dec.  13  and  27,  1845,  pp. 
650,  698.)  The  external  application  of  corrosive  sublimate  to  tumors 
or  ulcers  may  destroy  life  with  all  the  usual  symptoms  of  acute  mer- 
curial poisoning. 

This  poison  differs  from  arsenic:  1,  in  having  a  well-marked  taste ; 
2,  in  producing  violent  symptoms  in  a  few  minutes ;  and  3,  in  the 
fact  that  the  evacuations  are  more  frequently  mixed  with  blood.  The 
symptoms  produced  by  corrosive  sublimate,  in  the  first  instance, 
resemble  those  of  cholera ;  if  the  person  should  survive  several 
days,  they  are  more  like  those  of  dysentery — violent  straining  and 
shreddy  mucous  discharges  mixed  with  blood,  being  frequently  ob- 
served. 

Slow  or  Chronic  Poisoning. — The  symptoms  are  much  modified 
when  the  poison  is  taken  in  small  doses  at  intervals  for  some  days 
or  weeks.  There  are  colicky  pains  with  nausea,  vomiting,  general 
uneasiness  and  depression.  The  salivary  glands  become  inflamed 
and  painful ;  the  tongue  and  gums  are  red  and  swollen,  sometimes 
ulcerated,  and  there  is  foetor  of  the  breath.  A  deep  blue  line,  like 
that  observed  in  poisoning  by  lead,  is  sometimes  found  around  the 
edges  of  the  gums.  The  patient  experiences  difficulty  of  swallowing 
and  breathing.  The  constitutional  effects  are  indicated  by  irritability 
or  looseness  of  the  bowels,  difficulty  of  breathing,  spitting  of  blood, 
cough,  general  trembling  or  convulsive  movements  of  the  limbs  and 
palsy,  with  fever  and  emaciation,  under  which  the  patient  sinks. 
One  of  the  most  marked  effects  of  slow  or  chronic  poisoning  by 
mercurial  preparations  is  salivation,  or  ptyalism,  indicated  by  an  in- 
creased flow  of  saliva.  This  is  by  no  means  a  necessary  symptom 
9 


130  APPEARANCES.      ANALYSIS. 

in  cases  of  acute  poisoning  by  corrosive  sublimate,  but  it  not  unfre- 
quently  shows  itself  about  the  second  or  third  day.  In  some  instances 
the  patient  dies  too  rapidly  for  this  effect  to  follow;  but  even  when 
he  survives  some  days,  salivation  is  not  always  observed.  In  placing 
reliance  upon  this  symptom,  it  must  be  remembered  that  saliva- 
tion may  arise  from  a  variety  of  causes  irrespective  of  the  use  of 
mercury. 

Appearances  after  Death. — These,  as  in  the  case  of  arsenic,  are 
chiefly  confined  to  the  stomach  and  bowels.  Corrosive  sublimate, 
however,  affects  the  mouth,  throat,  and  gullet ;  the  mucous  membrane 
is  softened,  of  a  white  or  bluish-gray  color,  and  sometimes  inflamed ; 
that  lining  the  gullet  is  similarly  affected,  and  partly  corroded  and 
softened.  The  mucous  membrane  of  the  stomach  is  more  or  less 
inflamed,  sometimes  in  patches ;  and  there  are  masses  of  black  ex- 
travasated  blood  found  beneath  it.  Occasionally  it  has  a  slate-gray 
color  and  the  mucous  coat  beneath  may  be  found  reddened.  A  case 
occurred  in  Guy's  Hospital,  in  which  the  mucous  membrane  was 
simply  inflamed ;  it  much  resembled  the  condition  presented  in  cases 
of  arsenical  poisoning.  The  coats  of  the  stomach  are  sometimes 
corroded,  and  so  much  softened  that  they  cannot  be  removed  from 
the  body  without  laceration.  Similar  appearances  have  been  met 
with  in  the  large  and  small  intestines,  especially  in  the  caecum.  In 
a  case  reported  by  Dr.  Herapath,  in  which  a  scruple  was  taken,  and 
death  occurred  on  the  ninth  day,  the  mucous  membrane  of  the  stomach 
was  softened,  but  there  were  no  well-marked  appearances  of  the  irri- 
tant action  of  the  poison  on  this  organ.  The  caecum  had  been  the 
seat  of  the  most  violent  inflammation,  the  whole  surface  being  of  a 
deep  black-red  color,  and  there  were  patches  of  sloughing  in  the 
coats.  ("Lancet,"  Dec.  27,  1845,  p.  700;  "Edinburgh  Monthly 
Journal,"  Dec.  1851,  p.  532.)  Perforation  of  the  stomach-is  rare  as 
an  effect  of  this  poison ;  there  is,  I  believe,  only  one  case  on  record. 
Appearances  like  those  just  described,  have  been  seen  in  the  alimen- 
tary canal,  not  only  where  the  case  has  terminated  fatally  in  a  few 
hours,  but  where  it  has  been  protracted  for  sis,  eight,  and  even 
eleven  days. 

The  smallest  dose  which  is  reported  to  have  destroyed  life  is  three 
grains.  This  was  in  the  case  of  a  child,  and  the  quantity  was  accu- 
rately determined  from  the  fact  of  its  having  been  made  up  by  mistake 
for  three  grains  of  calomel,  which  a  physician  intended  to  order.  It 
is  probable  that,  under  favorable  circumstances,  from  three  to  five 
grains,  or  even  less,  would  destroy  an  adult. 

In  an  acute  case  a  person  commonly  dies  in  from  one  to  five  days, 
but  death  may  take  place  much  sooner  or  later  than  this.  In  the 
shortest  fatal  case  on  record  the  man  died  in  less  than  half  an  hour, 
but  the  quantity  of  poison  was  not  ascertained.  ("  Ox  Poisons, 
Corrosive  Sublimate. ") 

Chemical  Analysis. — Corrosive  sublimate  is  usually  seen  in  heavy 
crystalline  masses,  or  in  the  form  of  a  white  powder.  In  the 
solid  state.  1.  When  the  powder  is  heated  on  platinum  foil  or  mica, 
it  melts,   and  is  volatilized  in  a  white  vapor  without  leaving  any 


CORROSIVE    SUBLIMATE. 


131 


Fig.  10. 


Stellated  crystals  obtained  by  heat- 
ing corrosive  sublimate,  magnified 
30  diameters. 


residue.  2.  When  heated  in  a  close  tube,  it  melts  and  forms  a  sub- 
limate, consisting  of  prismatic  cr}rstals  sometimes  stellated.  (See 
illustration,  Fig.  10.)  3.  The  powder  is  changed  in  color  by  the  fol- 
lowing reagents :  iodide  of  potassium  produces  a  bright  scarlet,  pot- 
ash a  yellow,  and  sulphide  of  ammonium  a  black  compound ;  ammo- 
nia does  not  alter  its  color.  4.  The  mercury  and  chlorine  may  be 
discovered  by  one  process.  Mix  the  powder 
with  four  parts  of  dried  carbonate  of  soda 
(obtained  by  incinerating  the  bicarbonate), 
until  the  residue  in  the  reduction  tube 
fuses  and  becomes  white.  A  sublimate  of 
metallic  mercury  in  distinct  and  well-de- 
fmod  globules  will  be  obtained.  Detach  by 
a  file,  the  end  of  the  tube  containing  the 
fused  residue,  which  is  chloride  of  sodium 
with  some  undecomposed  carbonate.  Di- 
gest it  in  water  with  nitric  acid,  and  apply 
heat  until  it  is  entirely  dissolved ;  then  add 
to  the  solution  nitrate  of  silver.  A  white 
precipitate  of  chloride  of  silver,  insoluble 
in  nitric  acid,  will  be  at  once  produced. 
The  solid  is  thus  proved  to  contain  both 
mercury  and  chlorine,  and  the  only  compound  of  these  elements 
which  is  soluble  in  water  is  corrosive  sublimate. 

In  solution  in  water.  A  few  drops  of  the  solution  of  corrosive 
sublimate  evaporated  on  a  glass-slide  yield  slender  opaque  silky 
prisms.  When  a  weak  solution  of  iodide 
of  potassium  is  dropped  on  them  they  ac- 
quire a  bright  scarlet  color.  This  scarlet 
coloration,  which  may  be  obtained  from 
the  minutest  crystal  and  only  one  drop  of 
solution,  proves  that  the  body  dissolved  in 
water  is  corrosive  sublimate ;  it  is  thus 
distinguished  from  every  other  mineral 
poison,  and  all  other  substances  whatever. 

1.  Chloride  of  tin  added  to  a  solution  of 
corrosive  sublimate,  produces  a  black  pre- 
cipitate which,  after  it  has  been  boiled,  is 
resolved  into  globules  of  metallic  mercury. 

2.  Sulphuretted  hydrogen  and  sulphide  of 
ammonium  produce,  after  a  time,  a  black 
sulphide,  not  soluble  in  alkalies  or  diluted 
acids.  3.  If  the  liquid  is  acidulated  with  hydrochloric  acid,  and 
bright  copper-foil  wire  or  gauze,  is  plunged  into  it,  the  copper  will 
acquire  a  silvery-white  deposit,  even  in  the  cold,  but  more  rapidly 
by  heat.  When  the  copper  with  the  metallic  deposit  is  heated  in  a 
tube,  globules  of  mercury  are  sublimed. 

In  Organic  Liquids. — The  liquid  should  be  separated  by  filtration 
from  any  insoluble  portions.  The  latter  should  be  pressed,  dried, 
and  set  aside  for  a  separate  analysis.     The  liquid  portion  should  be 


Fiff.  ll. 


Prismatic  crystals  of  corrosive  sub- 
limate from  a  solution  in  water, 
magnified  ;!0  diameters. 


132 


CHEMICAL    ANALYSIS. 


slightly  acidulated  with  hydrochloric  acid,  farmed,  and  a  slip  of 
copper  foil  or  gauze  introduced ;  if  this  is  not  immediately  coated 
with  mercury,  it  should  be  allowed  to  remain  for  some  hours.  When 
a  deposit  has  taken  place  on  the  copper,  it  should  be  removed,  washed 
in  water,  and  afterwards  in  ether  and  dried.  vVhen  the  quantity  of 
corrosive  sublimate  dissolved  in  an  organic  liquid  is  moderately 
large,  it  may  be  removed  by  means  of  ether.  Place  the  filtered 
liquid  supposed  to  contain  the  poison,  in  a  stoppered  tube :  add  to 
it,  twice  its  volume  of  pure  ether,  and  agitate  the  liquid  at  intervals 
for  a  few  minutes.  Allow  the  liquid  to  subside,  pour  off  the  ether 
into  a  dial-glass,  and  submit  it  to  spontaneous  evaporation.  As  the 
ether  passes  off,  the  corrosive  sublimate  will  be  deposited  in  white 
silky-looking  prisms.  These  may  be  purified,  if  necessary,  by  solu- 
tion in  water  or  alcohol,  and  the  solution  again  crystallized.  Cor- 
rosive sublimate  may  thus  be  separated  from  arsenic  and  other 
mineral  poisons  in  solution.  If  mercury  and  arsenic  are  associated 
in  a  poisonous  mixture,  or  in  the  tissues,  the  arsenic  may  be  entirely 
removed  by  distillation  (page  120).  Masses  of  corrosive  sublimate 
maybe  sometimes  locked  up  in  thick  viscid  mucus;  and  in  such, 
cases,  the  coarse  powder  being  heavy,  it  may  be  separated  by  simply 
agitating  the  viscid  liquid  in  water,  and  then  decanting  the  upper 
portion  suddenly.  This  poison  is  decomposed  and  precipitated  by 
many  organic  principles,  such  as  albumen,  fibrin,  mucous  membrane, 
also  by  gluten,  tannic  acid,  and  other  vegetable  substances.     Thus. 

then,  we  cannot  always  expect  to  find  it 
in  the  stomach,  in  a  state  of  solution. 
Other  methods  of  analysis  are  chiefly 
directed  to  the  separation  of  the  mercury 
only.  The  suspected  liquid  is  boiled,  fil- 
tered, and  acidulated  with  hydrochloric 
acid.  1.  To  one  portion  add  chloride  of 
tin  in  excess,  again  boil  the  liquid  and 
filter  to  separate  the  mercury,  the  whole 
of  which  is  precipitated  as  a  black  powder, 
or  in  gray  globules.  On  boiling  this  de- 
posit in  strong  hydrochloric  acid,  the  small 
globules  coalesce  to  form  liquid  mercury. 
2.  Into  another  portion  of  the  liquid,  in- 
troduce copper-gauze,  foil,  or  wire,  and  gently  warm  it.  The  cop- 
per is  covered  with  a  layer  of  silvery-white  metal,  either  immediately 
or  in  a  few  hours.  A  large  quantity  of  copper  may  be  thus  coated. 
The  coated  copper  should  be  digested  in  warm  alcohol  or  ether, 
dried  and  heated  in  a  reduction-tube,  when  a  sublimate  in  silvery- 
white  globules  will  be  obtained,  well  marked  by  their  opacity,  lustre, 
and  sphericity  when  examined  by  the  microscope.  (See  illustration. 
Fig.  12.)  The  sublimate  of  metallic  mercury  differs  from  that  of 
arsenic  in  the  fact  that  when  heated,  it  sublimes  simply  as  metal 
without  change.  It  is  not  oxidized  (like  metallic  arsenic),  by  heat- 
ing it  in  a  reduction-tube,  but  is  simply  transferred  with  its  metallic 
lustre  and  globular  form  from  one  part  of  the  tube  to  another.     In 


Fig.  12. 


WHITE    PRECIPITATE.  133 

the  event  of  a  doubt  existing  respecting  the  nature  of  the  sublimate, 
the  following  experiment  will  remove  it.  Cut  off  by  a  file  the  por- 
tion of  glass  on  which  the  globules  are  deposited :  introduce  this 
into  a  wide  short  tube,  with  a  few  drops  of  hydrochloric  and  half  the 
quantity  of  nitric  acid.  Heat  the  acid  liquid,  and  carry  it  to  dryness 
on  a  sand-bath.  White  prismatic  crystals  of  corrosive  sublimate 
will  remain,  if  the  sublimate  was  of  a  mercurial  nature,  and  too 
great  a  heat  has  not  been  applied.  On  touching  the  white  residue 
cautiously  with  a  drop  of  solution  of  iodide  of  potassium,  the  crys- 
tals will  acquire  a  scarlet-red  color. 

In  place  of  copper,  a  slip  of  gold  foil  may  be  wound  round  a  slip 
of  zinc  foil,  and  introduced  into  the  liquid.  The  gold  is  soon  covered 
with  a  silvery- white  layer  of  mercury,  which  may  be  separated  from 
it  by  heat  in  a  reduction-tube,  or  by  the  action  of  nitric  acid,  and 
the  nitrate  thus  formed  may  be  subsequently  tested  by  the  chloride 
of  tin. 

The  Tissues. — Insoluble  substances  suspected  to  contain  mercury, 
as  well  as  the  soft  organs,  e.  g.,  liver  and  kidney,  may  be  cut 
up  and  boiled  in  one  part  of  hydrochloric  acid  and  four  of  water 
until  dissolved.  The  mercury  may  then  be  separated  by  either  of 
the  above  processes.  The  analysis  may  show  the  presence  of  mer- 
cury, but  not  of  corrosive  sublimate,  in  the  body.  Whether  the 
mercurial  compound  had  acted  as  a  poison  or  not,  must  be  deter- 
mined from  symptoms  and  appearances :  whether  it  had  been  given 
or  taken  as  a  medicine  or  not,  is  a  conclusion  which  must  also  be 
determined  from  other  circumstances.  The  proof  that  the  mercury 
was  really  in  the  form  of  corrosive  sublimate,  could  only  be  derived 
from  the  discovery  of  some  undissolved  portions  of  the  solid  poison 
in  the  stomach  or  its  contents,  or  from  a  separation  of  the  poison 
itself  by  means  of  ether.  If  thus  obtained  after  filtration  of  an 
organic  liquid,  it  would  show  its  presence  in  the  form  of  a  soluble 
salt :  and  it  may  be  remarked  that  all  the  soluble  salts  are  poisonous, 
and  are  rarely  used  internally  as  medicines.  If  undissolved,  the 
absorbed  mercury  may  have  been  derived  from  some  mercurial 
medicine  innocently  taken  by  the  deceased.  Nothing  is  more  com- 
mon than  to  discover  traces  of  mercury  in  the  stomach,  bowels,  liver, 
kidneys,  or  other  organs  of  a  dead  body.  No  importance  can  be 
attached  to  this  discovery  in  the  absence  of  evidence  that  the  deceased 
has  actually  suffered  from  symptoms  of  mercurial  poisoning.  As  to 
the  mercury  found  in  the  tissues,  it  may  have  been  derived  from  a 
soluble  or  insoluble  compound,  or  from  exposure  to  the  vapors  of 
the  metal  or  of  its  salts,  in  various  trades. 

White  Precipitate. 

Ammonialed  Mercury. — The  symptoms  which  it  produces  are  violent 
vomiting,  cramps,  great  thirst,  purging  and  pain  in  the  stomach  and 
bowels,  with  convulsions.  Tenderness  of  the  gums  and  salivation 
have  been  observed  among  the  symptoms.  After  death  there  is  more 
or  less  inflammation  of  the  stomach  and  bowels.     Experiments  on 


131  POISONING    BY    MERCURIC    METHIDE. 

dogs  and  rabbits  have  shown  that  this  is  a  formidable  poison.  The 
greater  number  of  recoveries  have  been  probably  owing  to  the  sub- 
stance being  early  ejected  by  vomiting.  Rabbits,  which  do  not  vomit, 
were  killed  by  a  dose  of  four  and  five  grains  in  a  few  hours.  After 
death,  mercury  was  found  deposited  in  various  organs,  but  more  in 
the  kidneys  than  in  the  other  viscera.  •  For  additional  facts  connected 
with  the  action  of  this  poison  see  "  Guy's  Hosp.  Reports,"  October, 
1860,  p.  483. 

Analysis. — White  precipitate  is  a  chalky-looking  compound  con- 
taining about  eighty  per  cent,  of  mercury.  It  is  insoluble  in  water 
and  alcohol.  As  it  is  sold  in  the  shops  it  frequently  contains  as  an 
impurity  corrosive  sublimate  to  the  amount  of  one  or  two  per  cent. 
It  is  not  used  internally,  but  it  is  much  employed  by  the  poorer 
classes  in  the  treatment  of  ringworm.  It  is  soluble  in  acids,  is  not 
blackened  by  alkalies,  and  it  yields  a  mercurial  sublimate  when 
heated  with  carbonate  of  soda.  Chloride  of  tin  produces  with  it  a 
black  deposit  of  mercury.  If  boiled  in  a  solution  of  potash,  it  evolves 
ammonia,  and  yellow  oxide  of  mercury  is  precipitated.  It  may  be 
detected  in  organic  fluids  and  solids  by  boiling  them  in  one  part  of 
hydrochloric  acid  and  four  parts  of  water.  The  mercury  may  then 
be  separated  by  means  of  copper. 

Red  Precipitate. 

Red  Oxide  of  Mercury. — This  substance  is  poisonous,  but  instances 
of  poisoning  by  it  are  very  rare.  One  case  occurred  at  Guy's  Hos- 
pital in  1833.     The  patient  recovered  in  four  days. 

Analysis. — By  its  great  weight  and  insolubility  in  water,  it  may  be 
separated  from  all  liquids.  Its  red  color  identifies  it.  When  heated 
in  a  close  tube,  it  is  resolved  into  oxygen  and  mercury,  which  is 
deposited  in  globules. 

Other  compounds  of  mercury,  such  as  calomel,  the  nitrates,  sul- 
phates, the  cyanides,  sulpho-c\~anide,  and  sulphide  have  given  rise  to 
accidents,  and  in  a  few  instances  have  destroyed  life,  but  they  rarely 
require  the  notice  of  the  practitioner. 

A  new  form  of  mercurial  poisoning,  however,  has  been  brought  to 
light  by  a  fatal  accident  which  occurred  at  St.  Bartholomew's  Hos- 
pital in  1865,  and  this,  from  its  exceptional  character,  is  deserving  of 
a  short  notice. 

Mercuric  Methide  or  Methyl. 

Symptoms. — In  February,  1865,  a  chemical  assistant  in  the  labo- 
ratory of  St.  Bartholomew's  Hospital,  who  had  been  engaged  for 
nearly  three  months  in  preparing  mercuric  methide,  and  who  had 
been  thus  exposed  to  breathe  the  noxious  vapors  evolved  in  the 
process,  was  seized  with  dimness  of  sight,  numbness  of  the  hands, 
deafness,  great  weakness,  swelling  and  tenderness  of  the  gums:  he 
moved  his  arms  and  legs  with  difficulty,  and  could  not  stand  without 
support.     In  spite  of  treatment  he  became  worse;  an  offensive  odor 


ACETATE  OR  SUGAR  OF  LEAD.  135 

issued  from  his  breath  and  body,  he  became  at  times  maniacal,  and 
he  died  eleven  days  after  his  admission  into  the  hospital. 

Appearances. — The  brain  was  congested,  especially  the  gray  matter, 
and  there  was  congestion  of  the  liver  and  kidneys.  As  none  of  the 
liquid  had  been  swallowed,  there  was  no  appearance  in  the  stomach 
and  bowels  calling  for  special  notice. 

Another  assistant  who  had  been  exposed  to  the  noxious  vapors  for 
a  shorter  time,  suffered  from  similar  symptoms.  He  had  offensive 
breath,  spongy  gums,  general  impairment  of  the  senses,  and  an  affec- 
tion of  the  brain  producing  idiocy,  in  which  state  he  remains.  ("  St. 
Bartholomew's  Hospital  Reports,"  Oct.  1865;  also  "Chem.  News," 
Nov.  3,  1865,  p.  213.) 

The  mercuric  methide  is  a  heavy  colorless  liquid  containing  87 
per  cent,  of  mercury.  Its  effects  on  the  nervous  system  are  more 
intensified  than  those  observed  among  workmen  who  have  been 
engaged  in  water-gilding.  It  would  have  been  more  satisfactory  had 
it  been  determined  whether  mercury  was  present  in  the  tissues  of  the 
person  who  died  from  the  effects  of  the  vapor. 


CHAPTER   XIII. 

On  poisoning  with  lead. — SUGAR  of  LEAD. — SYMPTOMS. — APPEAR- 
ances after  death. — chemical  analysis. — lead  in  organic 
mixtures. — carbonate  or  white  lead. — chronic  poisoning. — 
poisoning  with  copper. blue  vitriol. symptoms. appear- 
ances.— chemical  analysis. — copper  in  organic  liquids. 

Sugar  of  Lead. 

Acetate  of  Lead.  Symptoms. — Acetate  or  sugar  of  lead  is  by  no 
means  an  active  poison.  In  medical  practice  it  has  often  been  given 
in  considerable  doses  without  any  serious  effects  resulting.  When 
it  has  been  taken  in  a  dose  of  from  one  to  two  ounces,  the  following 
symptoms  have  been  observed :  a  burning  pricking  sensation  in  the 
throat,  with  dryness  and  thirst,  vomiting  and  uneasiness  at  the  pit  of 
the  stomach,  followed  by  severe  colic.  The  abdomen  is  tense,  and 
the  skin  covering  it  is  sometimes  drawn  in.  The  pain  is  relieved  by 
pressure,  and  has  intermissions.  There  is  generally  constipation  of 
the  bowels.  If  any  feces  are  passed,  they  are  commonly  of  a  dark 
color,  indicative  of  the  conversion  of  a  portion  of  the  lead  into  sul- 
phide. The  skin  is  cold,  and  there  is  great  prostration  of  strength. 
When  the  case  is  protracted,  the  patient  has  been  observed  to  suffer 
from  cramp  in  the  calves  of  the  legs,  pain  in  the  inside  of  the  thighs, 
numbness,  and  sometimes  paralysis  of  the  limbs.  The  affection  of 
the  nervous  system  is  otherwise  indicated  by  giddiness,  torpor,  and 
even  coma.     A  well-marked  blue  line  has  been  noticed  round  the 


136 


SUGAR    OF    LEAD.      ANALYSIS. 


margin  of  the  gums,  where  they  join  the  teeth.  For  a  remarkable 
series  of  cases  of  poisoning  by  acetate  of  lead  which  has  been  re- 
}3orted  by  Mr.  Bancks,  of  Stourbridge,  see  "Lancet,"  May  5,  1849, 
p.  478. 

Appearances. — In  one  acute  case  the  mucous  membrane  of  the 
stomach  was  found  removed  in  several  places,  especially  near  the 
intestinal  opening;  and  most  of  the  intestines  were  in  a  state  of  high 
inflammation.  In  animals,  according  to  Dr.  Mitscherlich,  when  the 
dose  is  large,  the  mucous  coat  of  the  stomach  is  attacked  and  cor- 
roded; this  change  appears  to  be  purely  chemical,  and  takes  place 
in  those  parts  of  the  body  with  which  the  salt  of  lead  comes  in  con- 
tact. If  given  in  a  small  dose,  it  is  decomposed  by  the  gastric  secre- 
tions, and  exerts  no  corrosive  action  on  the  mucous  membrane. 
"When  the  acetate  of  lead  was  given  in  a  state  of  albuminate  dis- 
solved in  acetic  acid,  death  took  place  with  great  rapidity;  but  on 
inspection,  the  stomach  was  not  found  corroded.  This  corrosive 
action  belongs  to  the  neutral  salt,  and  is  not  manifested  when  the 
dose  is  small,  or  when  the  poison  is  combined  with  an  acid. 

Nothing  is  actually  known  concerning  the  fatal  dose  of  this  sub- 
stance; but  it  may  be  taken  in  comparatively  large  quantity  without 
producing  serious  effects.  Thirty  or  forty  grains  have  been  given 
daily  in  divided  doses  without  injury. 

Chemical  Analysis.  Acetate  of  Lead  as  a  Solid. — 1.  If  a  portion  of 
the  powder  is  heated  in  a  small  reduction-tube,  it  melts,  then  becomes 
solid:  again  melts,  acquiring  a  dark  color,  and  gives  off  vapors  of 
acetic  acid,  easily  recognized  by  its  odor  and  reaction  on  litmus 
paper.  A  black  mass  is  left  in  the  tube,  consisting  of  carbon  and 
reduced  metallic  lead.  No  sublimate  is  formed.  If  heated  on  mica, 
yellow  oxide  of  lead  with  reduced  metal  remains.  2.  It  is  very  so- 
luble in  water,  even  when  cold;  spring  water  is  turned  milky  by  it, 
from  the  presence  of  carbonic  acid  and  sulphates.  3.  A  small  por- 
tion of  the  powder  dropped  into  a  solution  of  iodide  of  potassium 
acquires  a  bright  yellow  color.  4.  "When  dropped  into  solution  of 
potash  it  remains  white.  5.  Into  sulphuretted  hydrogen  water  or 
sulphide  of  ammonium,  it  is  turned  black,  in  which  respect  it  resem- 
bles the  white  salts  of  some  other  metals.     6.  When  the  powder  is 

boiled  in  a  tube  with  diluted  sulphuric 
acid,  acetic  acid,  known  by  its  odor  and 
volatility,  escapes.  All  these  properties 
taken  together,  prove  that  the  salt  is  the 
acetate  of  lead. 

Acetate  of  Lead  in  Solution. — 1.  A  small 
quantity,  slowly  evaporated  on  a  glass 
slide,  will  give  slender  white  prismatic 
crystals,  which  are  turned  yellow  by  iodide 
of  potassium,  and  black  by  sulphide  of 
ammonium.  2.  Diluted  sulphuric  acid  pro- 
duces an  abundant  white  precipitate,  inso- 
luble in  nitric  acid,  but  soluble  in  hydro- 

Crvstals  of  acetate  of  lead,  magnified         i  i       ■  •  i  i  •  i  o  1 

30  diameters.  chloric  acid  and  in  a  large  excess  ol  potash. 


Fig.  13. 


DETECTION    OF    LEAD    IN    OEGANIC    LIQUIDS.  137 

3.  It  is  precipitated  of  a  bright  yellow  color  by  the  iodide  of  potas- 
sium; the  yellow  iodide  of  lead  is  soluble  in  potash,  forming  a  color- 
less solution.     It  is  also  dissolved  by  concentrated  hydrochloric  acid. 

4.  Sulphide  of  ammonium  or  sulphuretted  hydrogen  gas,  produces  a 
deep  black  precipitate,  even  when  less  than  the  100,000th  part  of  the 
salt  is  dissolved.  5.  Place  a  few  drops  of  the  solution  on  clean  pla- 
tinum foil,  acidulate  it  with  acetic  acid,  then  apply  through  the  solu- 
tion, to  the  surface  of  the  platinum,  a  thin  polished  slip  of  zinc : — 
crystals  of  metallic  lead  are  instantly  deposited  on  the  zinc :  by  this 
method,  a  small  quantity  of  the  metal  may  be  detected  and  collected. 

Lead  in  Organic  Liquids. — The  acetate  of  lead  is  precipitated  by 
many  organic  principles,  especially  by  albumen  and  tannic  acid. 
Thus,  we  may  have  to  analyze  either  an  organic  liquid  containing 
lead,  or  a  solid  precipitate  consisting  of  mucus  or  mucous  membrane, 
or  albumen  intimately  united  to  oxide  of  lead.  The  liquid  should  be 
filtered  and  examined  by  a  trial  test,  i.  e.,  either  by  adding  to  a  por- 
tion, sulphuric  acid,  when  sulphate  of  lead  is  precipitated,  or  by  ex- 
posing bibulous  paper,  dipped  into  the  suspected  liquid,  to  a  free 
current  of  sulphuretted  hydrogen  gas.  If  the  paper  is  not  stained 
brown,  there  is  no  perceptible  quantity  of  lead  dissolved ;  if  it  is 
stained  brown,  we  dilute  the  liquid  if  necessary,  in  order  to  destroy 
its  viscidity,  and  pass  into  it  a  current  of  washed  sulphuretted  hydro- 
gen gas  until  all  chemical  action  has  ceased.  The  black  sulphide  of 
lead  should  be  collected  on  a  filter,  washed  and  dried,  then  boiled  for 
a  quarter  of  an  hour  in  a  mixture  of  one  part  of  nitric  acid,  diluted 
with  four  parts  of  water.  This  has  the  effect  of  transforming  it,  at 
least  in  part,  into  nitrate  of  lead  soluble  in  water.  This  liquid,  when 
filtered,  may  be  evaporated  to  dryness,  the  crystalline  residue  dis- 
solved in  water,  and  the  tests  for  lead  then  applied  to  the  solution. 
If  the  quantity  is  too  small  for  the  application  of  all  the  tests,  we 
may  first  add  sulphuric  acid ;  should  a  white  precipitate  be  formed, 
soluble  in  potash  (free  from  oxide  of  lead),  and  this  alkaline  solution 
be  again  turned  black  by  sulphide  of  ammonium,  this  is  sufficient 
evidence  of  the  presence  of  lead.  Should  there  be  no  lead  dissolved, 
we  must  decompose  the  solid  and  insoluble  matters  by  boiling  them 
in  nitric  acid  slightly  diluted,  filter,  and  test  the  filtered  liquid,  pre- 
viously neutralized ;  or  we  may  evaporate  at  once  to  dryness,  destroy 
the  organic  matter  by  heat,  and  redissolve  the  residue  in  nitric  acid 
for  testing. 

In  the  Tissues. — The  organic  matter,  such  as  a  part  of  the  liver  or 
other  organ,  should  be  dried  and  incinerated  in  a  porcelain  vessel. 
The  ash  should  be  heated  with  a  small  quantity  of  strong  nitric  acid, 
and  then  evaporated  to  dryness.  The  dry  residue  should  be  digested 
in  a  small  quantity  of  distilled  water  (free  from  lead),  filtered,  and 
after  it  has  been  slightly  acidulated  with  nitric  acid,  a  current  of 
washed  sulphuretted  hydrogen  gas  should  be  passed  into  it.  The 
production  of  a  brown  color  or  a  brown  precipitate  in  a  slightly  acid 
liquid,  indicates  the  presence  of  lead.  Lead  may  be  detected  in  the 
dry  residue  of  urine  and  of  spring  or  river  water. 

Goulard1  s  Extract  is  a  solution  of  subacetate  of  lead,  the  oxide  of 


138  CHKONIC    POISONING    WITH    LEAD. 

the  metal  being  in  excess;  and  Goulard  ivater  is  a  mixture  of  one 
drachm  and  a  half  of  this  solution  with  a  pint  of  water.  The  effects 
of  these  compounds  when  swallowed  or  applied  locally  are  similar  to 
those  caused  bj  the  acetate. 

White  Lead.  Carbonate  of  Lead. — This  is  an  insoluble  chalky- 
looking  compound,  which,  like  other  salts  of  lead,  may  give  rise  to 
the  usual  symptoms  of  lead  poisoning.  In  one  instance  it  appears  to 
have  proved  fatal.  Most  of  the  cases  of  poisoning  by  that  substance 
have  been  of  a  chronic  character,  carbonate  of  lead  being  one  of  the 
products  of  the  action  of  water  upon  lead. 

Chronic  Poisoning. —  Colica  pictonum,  or  Painter's  Colic,  may  be 
considered  as  the  chronic  form  of  poisoning  by  carbonate  of  lead. 
The  symptoms  are  usually  well  marked.  There  is  at  first  pain  with  a 
sense  of  sinking  commonly  in  or  about  the  region  of  the  navel  (the 
seat  of  the  colon).  Next  to  pain  there  is  obstinate  constipation, 
retraction  of  the  skin  and  abdomen,  loss  of  appetite,  thirst,  fetid  odor 
of  the  breath,  and  general  emaciation,  with  paralysis  of  a  peculiar 
kind  affecting  the  extensor  muscles,  and  causing  a  dropping  of  the 
wrist,  or  showing  itself  in  a  general  paralysis  of  the  limbs.  The  skin 
acquires  a  sallow  or  earthy  color,  generally  well  marked  in  the  face, 
and  the  patient  experiences  a  sweetish,  styptic,  or  astringent  taste  in 
the  mouth.  A  symptom  of  a  peculiar  nature  was  first  pointed  out 
by  the  late  Dr.  Burton  ("  Med.  Gaz.,"  vol.  25,  p.  687),  namely,  a  blue- 
ness  of  the  edges  of  the  gums,  where  these  join  the  bodies  of  the  teeth ; 
the  teeth  are  of  a  brownish  color.  The  blue  line  on  the  gums  may 
be  regarded  as  a  distinguishing  sign  of  lead-colic.  Chronic  poisoning 
with  lead  often  kills  the  patient,  since  a  great  amount  of  mischief  is 
done  before  the  cause  is  discovered.  The  only  appearances  found 
after  death  have  been  a  contraction  of  the  cavity  of  the  large  and 
small  intestines,  and  a  considerable  thickening  of  the  coats.  Then 
changes  have  been  especially  noticed  in  the  colon — the  seat  of  colic. 
The  various  circumstances  under  which  this  form  of  poisoning  is 
liable  to  occur  are  elsewhere  fully  described.  (See  "  On  Poisons," 
also  "  Principles  of  Med.  Jur.,"  1865.)  Cases  of  poisoning  are  some- 
times observed  as  the  result  of  the  introduction  of  oxide  of  lead  into 
the  system  through  wine,  beer,  cider,  milk,  and  other  liquids.  Earth- 
enware glazed  with  litharge  imparts  oxide  of  lead  to  fat  in  dripping, 
also  to  acid  liquids.  Snuff  is  sometimes  adulterated  with  red  lead, 
to  improve  its  color,  and  some  cases  of  lead  poisoning  have  occurred 
from  the  use  of  such  snuff.  A  spurious  tinfoil,  consisting  chiefly  of 
lead  faced  with  tin,  is  much  used  as  a  covering  or  wrapper  for  articles 
of  food.  When  exposed  to  damp,  this  metallic  alloy  undergoes 
chemical  changes  whereby  carbonate  of  lead  is  produced.  Children's 
farinaceous  food  has  thus  become  impregnated  with  lead.  [During 
the  present  year  (1866),  whole  families,  in  one  of  the  counties  of  the 
State  of  New  York,  have  been  poisoned  by  the  use  of  flour  manufac- 
tured at  a  mill,  the  owner  of  which  had  been  in  the  habit  of  filling 
the  cavities  in  the  millstones  with  lead. — P.] 


POISONING    WITH    COPPER.  139 


Poisoning  with  Copper. 


All  the  salts  of  copper  are  poisonous.  The  two  most  commonly 
known  in  commerce  are  the  Sulphate  or  Blue  Vitriol,  and  the 

SUBACETATE  Or  VERDIGRIS. 

Blue  Vitriol.  Sulphate  of  Copper.  Symptoms. — Sulphate  of 
copper  has  been  frequently  given  for  the  purpose  of  procuring  abor- 
tion. In  doses  of  half  an  ounce  and  upwards,  it  acts  as  a  powerful 
irritant  on  adults,  and  a  much  smaller  quantity  would  suffice  to 
destroy  infants  or  children.  The  salt  speedily  causes  vomiting  of 
the  most  violent  kind;  this  sometimes  expels  the  poison  from  the 
stomach,  and  the  person  recovers.  There  is  headache,  pain  in  the 
abdomen,  with  purging ;  the  pain  is  of  a  colicky  character ;  and  in 
aggravated  cases,  there  are  spasms  of  the  extremities  and  convulsions. 
Dr.  Perceval  met  with  an  instance  in  which  violent  convulsions  were 
produced  in  a  young  woman  by  two  drachms  of  the  sulphate  of 
copper.  Paralysis,  insensibility,  and  even  tetanus,  have  preceded 
death,  when  the  poison  was  administered  to  animals.  Among  the 
symptoms  casually  met  with  in  the  human  body,  may  be  mentioned 
jaundice.  This  has  been  observed  to  attend  poisoning  by  the  sul- 
phate, as  well  as  by  Scheele's  green.  The  vomited  matters  are  re- 
markable for  being  generally  of  a  blue  or  green  color ;  broken  crystals 
of  blue  vitriol  were  discovered  in  them,  in  a  case  in  which  the  poison 
was  taken  in  the  state  of  coarse  powder.  If  the  green  color  of  the 
vomited  liquid  is  owing  to  altered  bile,  it  will  not  acquire  a  blue 
tint  on  adding  to  a  portion  of  it  a  strong  solution  of  ammonia ;  but 
if  caused  by  a  salt  of  copper,  this  change  of  color  will  serve  to  indi- 
cate the  fact.  The  medicinal  dose  of  sulphate  of  copper  as  an  emetic, 
is  from  five  to  fifteen  grains,  and  as  a  tonic  from  one  to  three  or  four 
grains. 

Appearances. — In  the  few  fatal  cases  which  have  been  hitherto 
examined,  the  mucous  membrane  of  the  stomach  and  intestines  has 
been  found  more  or  less  thickened  and  inflamed,  and  in  some  cases 
eroded  and  softened.  The  gullet  has  presented  an  inflammatory 
appearance.  In  one  case  of  poisoning  by  verdigris  the  stomach  was 
inflamed  and  thickened,  especially  towards  the  intestinal  opening, 
the  orifice  of  which,  from  the  general  thickening,  was  almost  oblite- 
rated. The  small  intestines  were  throughout  inflamed,  and  perfora- 
tion had  taken  place,  so  that  part  of  the  green  liquid  was  effused 
into  the  abdomen.  The  large  intestines  were  distended  in  some 
parts,  and  contracted  in  others,  and  the  rectum  was  ulcerated  on  its 
inner  surface.  ("  Orfila  Toxicologic,"  vol.  1,  p.  623.)  The  lining 
membrane  of  the  alimentary  canal  has  been  found  throughout  of  a 
deep  green  color,  owing  to  small  particles  of  the  copper  salt  (verdi- 
gris) adhering  to  it. 

Chemical  Analysis. — The  salts  of  copper,  whether  in  the  solid  state 
or  in  solution,  are  generally  known  by  their  blue  or  green  color. 
Tests. — 1.  Solution  of  ammonia:  this  gives,  in  a  solution  of  a  salt  of 
copper,  a  bluish-white  precipitate,  which  is  soluble  in  excess  of  the 
test,  forming  a  deep  violet-blue  liquid.     2.  Ferrocyanide  of  potassium 


140  SALTS    OF    COPPER.      CHEMICAL    ANALYSIS. 

gives  in  a  very  diluted  solution  a  rich  claret-red  precipitate ;  if  the 
quantity  of  copper  is  small,  the  liquid  acquires  merely  a  light-red 
color ;  if  large,  the  precipitate  is  of  a  deep  red-brown  color,  and  of 
a  gelatinous  consistency.  The  ferrocyanide  of  potassium  will  act  on 
the  violet-blue  solution  produced  by  ammonia,  provided  it  is  diluted, 
and  a  few  drops  of  diluted  sulphuric  acid  are  added  in  order  to  neu- 
tralize the  ammonia.  One  portion  of  the  liquid  may  thus  be  tried 
by  the  two  tests.  3.  Sulphuretted  hydrogen  gas,  or  sulphide  of  ammo- 
nium, gives  a  deep  chocolate-brown  precipitate,  even  in  an  acid  solu- 
tion ;  or  if  the  copper  is  in  small  proportion,  merely  a  light-brown 
color.  4.  A  slip  of  polished  iron  (a  common  needle)  suspended  by 
a  thread  in  the  liquid  slightly  acidulated  with  sulphuric  acid  is 
speedily  coated  with  a  red  layer  of  copper,  even  when  the  salt  is  in 
very  small  proportion.  If  the  needle  is  left  some  days  in  the  liquid, 
the  iron  will  be  slowly  removed,  and  a  hollow  cylinder  of  metallic 
copper  will  remain.  This  may  be  dissolved  in  diluted  nitric  acid, 
and  tested  with  the  foregoing  tests ;  or  the  iron  coated  with  copper, 
may  be  at  once  immersed  in  ammonia  and  exposed  to  air.  The 
liquid  then  becomes  slowly  blue.  Half  a  grain  of  sulphate  of  copper 
dissolved  in  sixteen  ounces  of  water  may  be  thus  easily  detected. 
It  was  long  since  proposed  by  Orflla  to  substitute  phosphorus  for 
polished  iron.  This  substance  most  effectually  separates  metallic 
copper  from  its  salts,  even  when  they  are  dissolved  in  organic  liquids. 
5.  The  Galvanic  Test. — If  a  few  drops  of  the  copper  solution  are 
placed  on  platinum-foil,  slightly  acidulated  with  a  diluted  acid,  and 
the  platinum  is  then  touched  through  the  solution  with  a  slip  of 
zinc-foil,  metallic  copper,  of  its  well-known  red  color,  is  immediately 
deposited  on  the  platinum.  When  the  quantity  of  copper  is  small, 
there  is  merely  a  brown  stain  ;  but  a  blue  liquid  is  formed  by  pour- 
ing on  it  ammonia,  and  exposing  it  to  air.  A  coil  of  fine  platinum 
and  zinc  wire  may  be  substituted  for  the  foil. 

Copper  in  Organic  Liquids. — The  oxide  of  copper  is  liable  to  be 
precipitated  by  certain  organic  principles,  e.  g.,  albumen,  fibrin,  and 
mucous  membrane :  but  some  of  these  organic  compounds  are  easily 
dissolved  by  acids,  or  even  by  an  excess  of  the  solution  of  cupreous 
salt.  A  portion  at  least  of  the  salt  of  copper  is,  therefore,  commonly 
held  dissolved.  In  such  cases  the  liquid  is  usually  of  a  greenish  color, 
and  has  a  strong  coppery  or  metallic  taste,  even  when  the  copper 
salt  is  in  far  less  than  a  poisonous  proportion.  Having  filtered  the 
organic  liquid,  let  a  portion  of  it  be  placed  in  a  clean  platinum 
capsule  or  crucible.  A  few  drops  of  diluted  sulphuric  acid  may  be 
added,  and  a  slip  of  zinc  foil  introduced.  Wherever  the  platinum  is 
touched  by  the  zinc,  metallic  copper  is  deposited ;  and  after  having 
in  this  way  coated  the  platinum  capsule,  the  surplus  liquid  may  be 
poured  off  and  the  capsule  well  washed  out.  The  deposited  copper 
is  then  dissolved  in  nitric  acid,  and  the  tests  may  be  applied  after 
the  excess  of  acid  has  been  driven  off  by  heat,  and  the  residue  dis- 
solved in  water. 

In  the  Tissues. — Dry  and  incinerate  the  organic  matter.  Digest  the 
residuary  ash  in  pure  hydrochloric  acid  by  heat,  and  then  evaporate 


POISONING    WITH    TARTAR    EMETIC.  141 

nearly  to  dryness.  The  residue  may  be  dissolved  in  a  small  quantity 
of  water,  and  a  polished  needle  immersed  for  some  hours.  The  me- 
tallic deposit,  if  any,  on  the  needle,  may  be  recognized  as  copper, 
either  by  its  color  or  by  the  action  of  ammonia.  Traces  of  copper 
have  been  found  in  many  kinds  of  food  as  well  as  in  the  tissues  of 
the  body,  irrespective  of  the  introduction  of  a  copper  salt  as  a 
poison. 


CHAPTEE    XIV, 


Tartar  emetic. — symptoms. — appearances. — chronic  poisoning. 
— chemical  analysis. — chloride  or  butter  of  antimony. — 
poisoning  with  salts  of  zinc  and  iron. 

Tartar  Emetic. 

Stibiated  Tartar,  Tartarated  Antimony.  Symptoms  and  Effects. — 
When  tartar  emetic  is  taken  in  a  poisonous  dose,  a  strong  metallic 
taste  is  perceived  in  the  mouth  during  the  act  of  swallowing.  There 
is  great  heat  and  constriction  of  the  throat,  with  difficulty  of  swal- 
lowing, violent  burning  pain  in  the  region  of  the  stomach,  followed 
by  incessant  vomiting,  profuse  purging,  faintness,  and  extreme  de- 
pression. The  pulse  is  small  and  rapid,  sometimes  imperceptible ; 
the  skin  cold,  and  covered  with  a  clammy  perspiration;  and  the 
respiration  is  painful.  Should  the  case  prove  fatal,  death  may  be 
preceded  by  giddiness,  insensibility,  great  prostration  of  strength, 
and  sometimes  violent  spasms  of  the  muscles  of  the  limbs,  which 
may  assume  either  a  clonic  or  a  tetanic  character.  Such  are  the 
symptoms  in  an  acute  case  of  poisoning  by  this  substance.  The 
quantity  actually  required  to  destroy  life  is  unknown.  One  drachm 
taken  at  a  dose  proved  fatal  in  ten  hours,  in  spite  of  early  and  fre- 
quent vomiting.     ("Med.  Gaz."  vol.  45,  p.  801.) 

Appearances. — The  following  cases  show  the  nature  of  the  appear- 
ances likely  to  be  found  after  death.  Two  children,  a  boy  aged  five 
years,  and  a  girl  aged  three  years,  each  swallowed  a  powder  contain- 
ing ten  grains  of  tartar  emetic  mixed  with  a  little  sugar.  It  was 
stated  that,  in  twenty  minutes  after  taking  the  powders,  they  were 
seized  with  violent  vomiting  and  purging,  and  great  prostration  of 
strength,  followed  by  convulsions  and  tetanic  spasms ;  there  was  also 
great  thirst.  The  boy  died  in  eight  hours,  and  the  girl  in  twelve  or 
thirteen  hours  after  swallowing  the  dose.  The  bodies  were  inspected 
between  four  and  five  days  after  death.  In  that  of  the  boy  there  was 
effusion  of  serum  in  the  right  pleura ;  the  lower  lobe  of  the  right 
lung  posteriorly  was  redder  than  natural,  and  the  peritoneum  was 
injected  from  recent  inflammation.  The  mucous  membrane  of  the 
duodenum  was  inflamed,  and  covered  with  a  whitish-yellow  viscid 
secretion ;  this  was  observed  throughout  the  intestines,  although  the 


142  CHEMICAL    ANALYSIS. 

color  was  of  a  deeper  yellow  in  the  large  intestines;  there  was  no 
ulceration.  The  peritoneal  coat  of  the  stomach  was  inflamed.  The 
mucous  membrane  of  this  organ  was  also  much  inflamed,  especially 
about  the  larger  curvature  and  at  the  cardiac  orifice;  there  was  no 
ulceration.  The  contents  (about  two  ounces  and  a  half  of  dark 
bloody  fluid,  having  a  slightly  acid  reaction)  were  adherent  to  it ; 
and  in  one  case  there  was  a  patch  of  lymph.  The  tests  used  did  not 
indicate  the  presence  of  antimony.  AYith  regard  to  other  appear- 
ances, the  tongue  was  covered  with  a  white  fur,  and  appeared  sod- 
dened;  the  throat  was  not  inflamed  ;  the  windpipe  and  gullet  had  a 
natural  appearance.  On  opening  the  head  the  dura  mater  was  found 
congested ;  the  longitudinal  sinus  contained  a  coagulum  of  lymph,  and 
but  little  blood.  The  vessels  of  the  surface  of  the  brain  were  much 
injected  with  dark  blood,  the  whole  surface  having  a  deep  purple 
color.  Every  portion  of  the  brain,  when  cut,  presented  many  bloody 
points.  The  cerebellum  and  medulla  oblongata  were  also  congested ; 
there  was  no  effusion  in  the  ventricles  or  at  the  base  of  the  brain. 
In  the  body  of  the  girl  the  morbid  appearances  were  similar ;  there 
was  in  addition  on  the  arms,  legs,  and  neck,  patches  resembling  the 
eruption  of  scarlatina.  The  arachnoid  membrane  was  more  opaque 
than  usual ;  and  on  the  mucous  membrane  of  the  stomach,  where  the 
inflammation  was  greatest,  were  two  or  three  white  spots,  each  about 
the  size  of  a  split  pea,  which  appeared  to  be  the  commencement  of 
ulceration.     ("  Lancet,"  April  25,  1846,  160.) 

In  cases  of  chronic  poisoning  by  this  substance  the  principal  symp- 
toms are  as  follows:  great  nausea,  vomiting  of  mucus  and  bilious 
liquids,  great  depression,  watery  purging,  followed  often  by  consti- 
pation of  the  bowels,  small,  contracted,  and  frequent  pulse,  loss  of 
voice  and  muscular  strength,  coldness  of  the  skin,  with  clammy  per- 
spiration, and  death  from  complete  exhaustion.  Several  cases  have 
occurred  in  this  country,  which  show  that  tartar  emetic  has  been 
thus  criminally  employed. 

Chemical  Analysis.  Tartar  Emetic  as  a  Solid. — In  the  state  of  pow- 
der it  is  white  and  crystalline.  1.  It  is  easily  dissolved  by  water — 
it  is  taken  up  by  fourteen  parts  of  cold,  and  two  of  boiling  water ; 
the  solution  has  a  faint  acid  reaction,  and  an  acrid  metallic  taste  ;  it 
is  not  very  soluble  in  alcohol.  2.  The  powder  dropped  into  sulphide 
of  ammonium  is  turned  of  a  deep  reddish-brown  color,  and  is  thereby 
known  from  other  poisonous  metallic  salts.  3.  AYhen  heated  in  a 
reduction-tube,  it  is  charred,  but  does  not  melt  before  charring,  like 
the  acetate  of  lead.  The  metal  is  partially  reduced  by  the  carbon  of 
the  vegetable  acid,  and  the  decomposed  mass  has  a  grayish-blue  me- 
tallic lustre.  No  metallic  sublimate  is  produced  in  this  experiment 
by  the  heat  of  a  spirit-lamp.  -4.  When  boiled  in  water  containing 
one-sixth  of  pure  hydrochloric  acid  and  metallic  copper  is  immersed 
in  the  liquid,  a  gray  deposit  of  antimony  takes  place  on  this  metal. 
The  color  of  the  deposit  is  violet  red  if  the  quantity  is  very  small, 
but  the  deposit  is  black  and  pulverulent  if  very  large.  5.  The  solu- 
tion acidulated  with  one-tenth  part  of  hydrochloric  acid  gives  in  the 
cold  a  black  deposit  on  a  surface  of  pure  tin.     A  slip  of  pure  tin- 


CHEMICAL    ANALYSIS.  143 

foil  may  be  used  in  this  experiment.  This  serves  to  distinguish 
antimony  from  arsenic. 

Tartar  Emetic  in  Solution. — 1.  On  slowly  evaporating  a  small  quan- 
tity on  a  slip  of  glass,  it  will  crystallize  in  tetrahedra,  and  in  deriva- 
tives of  the  octahedron.  If  obtained 
from  a  very  diluted  solution,  this  crystal- 
lization is  confused,  and  resembles  that  of 
arsenic.  2.  Diluted  nitric  acid,  added  to 
the  solution,  throws  down  a  white  pre- 
cipitate (sub-nitrate  of  antimony);  the 
other  two  mineral  acids  act  in  the  same 
way;  but,  as  Jhey  precipitate  numerous 
other  metallic  solutions,  there  are  objec- 
tions to  them  which  do  not  hold  with  re- 
spect to  nitric  acid.  The  white  precipitate 
thus  formed  possesses  the  remarkable 
property  of  being  easily  and  entirely  dis- 
solved by  a  solution  oi  tartaric  acid :  it  is  30  diameters, 
also  soluble  in  a  large  excess  of  nitric 

acid,  so  that  if  much  of  the  test  be  added  at  once,  no  precipitate  is 
produced.  3.  Ferrocyanide  of  potassium  does  not  precipitate  the  so- 
lution, whereby  tartarized  antimony  is  known  from  most  other  me- 
tallic poisons.  4.  Sulphide  of  ammonium  or  sulphuretted  hydrogen 
gas,  produces  in  the  solution  a  reddish  orange- colored  precipitate, 
differing  in  color  from  every  other  metallic  sulphide.  The  precipi- 
tate is  not  readily  soluble  in  ammonia  or  tartaric  acid,  but  it  is  dis- 
solved in  the  dry  state  by  strong  hydrochloric  acid.  The  only  test 
available  when  the  quantity  of  tartarized  antimony  present  is  small, 
is  a  current  of  sulphuretted  hydrogen  gas. 

In  liquids  containing  Organic  Matter. — Tartar  emetic  is  precipitated 
by  tannic  acid  in  all  its  forms,  but  not  readily  by  albumen  or  mucous 
membrane;  therefore  it  may  be  found  sometimes  dissolved  in  the 
liquids  of  the  stomach,  and  sometimes  precipitated.  The  insoluble 
compounds  of  antimony  are  very  soluble  in  tartaric  acid,  and  thus 
if  there  should  be  no  antimony  dissolved,  it  may  easily  be  brought 
into  a  state  of  solution  by  means  of  this  acid.  The  liquid,  acidu- 
lated with  tartaric  acid,  should  be  filtered,  and  a  current  of  sulphuret- 
ted hydrogen  gas  passed  into  it,  until  there  is  no  further  precipitation. 
The  sulphide  is  collected,  washed,  and  dried.  If  it  is  the  sulphide  of 
antimony,  it  will  have  an  orange-red  or  brown  color,  it  will  be  inso- 
luble in  a  solution  of  ammonia,  and  when  dried,  will  be  dissolved 
by  a  small  quantity  of  boiling  hydrochloric  acid  (forming  chloride 
of  antimony)  with  the  evolution  of  sulphuretted  hydrogen  gas.  The 
boiling  should  be  continued  for  several  minutes  until  the  liquid  is 
colorless.  On  adding  this  solution,  if  not  too  acid,  to  water,  a  white 
precipitate  of  oxychloride  of  antimony  (powder  of  Algaroth  or  Al- 
garotti,  Mercurius  Vitoe)  falls  down.  This  is  characteristic  of  anti- 
mony. 

The  following  method  of  detecting  this  metal  when  dissolved  in 
any  organic  liquid,  is  based  upon  the  principle  by  which  copper  and 


144  DETECTION    OF    ANTIMONY. 

other  metals  may  be  detected  under  similar  circumstances.  1.  Acidu- 
late a  portion  of  the  suspected  liquid  with  hydrochloric  acid,  and 
place  it  in  a  shallow  platinum  capsule.  Touch  the  platinum,  through 
the  acid  liquid,  with  a  slip  of  pure  zinc  foil.  Hydrogen  is  evolved, 
and  wherever  the  metals  come  in  contact,  metallic  antimony,  in  the 
state  of  a  black  powder,  is  deposited  upon  the  surface  of  the  plati- 
num. The  liquid  should  be  poured  off,  and  the  capsule  thoroughly 
washed  with  distilled  water.  This  may  be  effected  without  disturb- 
ing the  deposit.  A  small  quantity  of  sulphide  of  ammonium  poured 
on  the  black  deposit,  speedily  dissolves  it  (if  antimony)  by  the  aid 
of  heat,  and  on  evaporation,  an  orange-red  sulphide  of  antimony  re- 
mains. This  may  be  dissolved  in  a  few  drops  of  strong  hydrochloric 
acid,  and  on  adding  the  acid  liquid  to  water,  hydrated  oxychloride 
of  antimony  is  precipitated.  2.  The  black  deposit  may  be  treated 
with  strong  nitric  acid — evaporated  to  dryness — the  white  residue 
dissolved  in  strong  hydrochloric  acid  and  this  solution,  not  too  much 
diluted,  may  be  precipitated  by  a  current  of  sulphuretted  hydrogen. 
A  reddish-colored  sulphide  indicates  antimony.  By  this  process  an- 
timony in  small  quantity  may  be  detected  in  any  liquid  containing 
organic  matter.  If  no  deposit  take  place  under  these  circumstances 
— a  slip  of  zinc  or  tin-foil  with  a  layer  of  thin  platinum  foil  wound 
round  it,  should  be  suspended  in  the  acid  liquid  sufficiently  diluted 
for  some  hours.  If  antimony  is  present  it  will  be  deposited  on  both 
metals  as  a  black  powder. 

In  the  Tissues. — The  antimony  may  be  in  so  small  a  quantity,  as  it 
is  deposited  in  the  organs,  that  neither  the  sulphuretted  hydrogen 
nor  the  galvanic  process  will  yield  any  satisfactory  results.  The 
liver  or  other  organ  should  be  cut  into  small  pieces  and  boiled  in  a 
mixture  of  one  part  of  hydrochloric  acid,  and  five  parts  of  water. 
After  some  time,  the  liquid  may  be  tested  by  introducing  into  it  a 
slip  of  polished  copper  foil  free  from  antimony.  If  antimony  is 
present  in  small  quantity,  the  copper  will  acquire  a  reddish  or  violet- 
colored  deposit  on  its  surface :  if  in  large  quantity,  the  deposit  will 
be  gray  with  a  metallic  lustre,  or  sometimes  in  the  state  of  a  loose 
black  powder.  These  deposits  when  heated  in  a  reduction-tube,  do 
not  yield  octahedral  crystals  like  those  obtained  from  arsenic.  A 
slip  of  pure  tin-foil  may  be  suspended  in  the  cold  in  another  portion 
of  the  acid  liquid,  diluted  so  that  the  hydrochloric  acid  forms  only 
one-tenth  part  by  measure.  Either  immediately,  or  in  the  course  of 
a  few  hours,  if  antimony  is  present,  the  tin  is  covered  with  a  black 
deposit  of  metallic  antimony.  As  arsenic  is  not  deposited  on  pure 
tin  under  similar  circumstances,  this  furnishes  a  ready  method  of 
detecting  the  admixture  of  antimony  with  arsenic. 

The  separation  of  antimony  from  the  tissues  does  not  necessarily 
indicate  that  it  has  been  criminally  administered  or  has  caused  death  ; 
but  its  presence  there  should  be  reasonably  accounted  for,  as  anti- 
mony may  have  been  unlawfully  administered.  In  several  cases  of 
suspected  death  from  poison,  deposits  on  copper,  evidently  of  an 
antimonial  nature,  have  been  obtained  from  the  liver  or  tissues.     On 


PREPARATIONS    OF    IROX.  145 

inquiry  it  has  been  found  that  antimonial  medicines  had  been  taken 
shortly  before  death. 

Chloride  or  Butter  of  Antimony. — This  is  a  strongly  corrosive  poison 
by  reason  of  the  acid  with  which  the  antimony  is  combined.  It  has 
caused  death  in  several  instances.  The  symptoms  and  appearances 
resemble  those  produced  by  concentrated  hydrochloric  acid. 

Poisoning  with  Zinc. 

Sulphate  of  Zinc.  White  Vitriol.  Symptoms  and  Appearances. — 
The  symptoms  produced  by  an  over-dose  of  sulphate  of  zinc  are  pain 
in  the  abdomen  and  violent  vomiting,  coming  on  almost  immediately, 
followed  by  purging.  After  death  the  stomach  has  been  found  in- 
flamed. The  sulphate  appears  to  act  as  a  pure  irritant ;  it  has  no 
corrosive  properties.  This  salt  may  cause  death  indirectly  as  the 
result  of  exhaustion  from  violent  vomiting,  when  an  ordinary  dose 
has  been  given  to  a  person  already  debilitated  by  disease. 

Chloride  of  Zinc.  Symptoms  and  Appearances. — This  which  is  com- 
monly sold  under  the  name  of  "  Sir  W.  Burnett's  fluid"  is  a  corrosive 
poison,  and  is  much  used  as  a  deodorizer.  The  patient  experiences 
a  sense  of  heat  and  burning  in  the  mouth  and  throat,  in  the  act  of 
swallowing  the  liquid,  which  has  been  frequently  fatally  mistaken 
for  fluid  magnesia.  There  is  a  burning  and  griping  pain  in  the  stomach, 
nausea  followed  by  violent  retching  and  vomiting — the  vomited  mat- 
ters being  streaked  with  blood  and  mixed  with  much  flaky  mucus, 
with  shreds  of  mucous  membrane.  This  has  produced  an  appearance 
of  frothiness  about  the  mouth.  Violent  purging  has  been  observed 
among  the  symptoms.  A  stage  of  collapse  supervenes,  and  the  skin 
becomes  cold  and  livid. 

After  death  from  this  poison  the  lining  membrane  of  the  mouth 
and  throat  has  been  found  white  and  opaque,  that  of  the  stomach  has 
sometimes  been  hard  and  leathery,  at  others  corrugated,  opaque,  and 
of  a  dark  leaden  color.  The  lungs  and  kidneys  are  congested.  The 
chloride  is  both  a  corrosive  and  irritant  poison,  exerting  also  a  pecu- 
liar action  on  the  nervous  system.  If  a  person  survives  the  acute' 
stage,  he  may  die  in  the  chronic  stage  from  stricture  of  the  gullet  or 
pylorus,  or  from  emaciation  and  exhaustion  as  a  result  of  the  local 
action  of  the  poison  on  this  organ. 

Analysis. — In  these  two  compounds  the  zinc  is  detected  by  the 
aqueous  solutions  giving  white  precipitates,  with  a  current  of  sul- 
phuretted hydrogen  gas,  while  the  sulphuric  acid  or  chlorine  may  be 
recognized  by  their  respective  tests. 

Preparations  of  Iron. 

Sulphate  of  Iron.  Copperas.  Green  Vitriol. — This  compound  has 
been  several  times  administered  with  malicious  intention.  One  death 
from  it  took  place  in  1837-8.  It  cannot,  however,  be  an  active  pre- 
paration ;  for  a  girl  who  swallowed  an  ounce  of  it  recovered,  although 
she  suffered  for  some  hours  from  violent  pain,  vomiting,  and  purging. 
10 


146  PREPARATIONS    OF    IRON. 

("  Christison  on  Poisons,"  p.  506.)  Green  vitriol  or  copperas  is  some- 
times given  as  an  abortive.  At  the  Nottingham  Autumn  Assizes, 
1859,  a  woman  of  the  name  of  Riley  was  indicted  for  administering 
copperas  to  two  children.  She  put  the  substance  into  gruel.  It  gave 
to  the  gruel  a  greenish  color  and  a  peculiar  taste,  which  led  to  the 
discovery.  It  caused  sickness,  but  no  other  serious  symptoms.  As 
there  was  no  evidence  of  an  intent  to  murder,  and  it  was  then  not 
unlawful  to  administer  poison  with  any  other  intent,  the  prisoner 
was  acquitted.  This  salt  has  been  much  used  for  criminal  purposes 
in  France.  (See  "Medical  Gazette,"  vol.  -47,  p.  307;  also  "Ann. 
d'Hyg.,"  1850,  vol.  1,  pp.  180,  416 ;  and  1851,  vol.  1,  p.  155 ;  vol.  2, 
p.  337.) 

Muriate  of  Iron.  Tincture  of  Perchloride  of  Iron. — This  is  an  acid 
solution  of  perchloride  of  iron  in  rectified  spirit ;  it  is  of  a  red-brown 
color,  and  is  much  employed  as  a  medicine.  It  is  sometimes  made 
with  wood-spirit  or  methylated  spirit,  which  gives  to  it  a  peculiar 
odor.  Dr.  Christison  relates  an  instance  in  which  a  man  by  mistake 
swallowed  an  ounce  and  a  half  of  this  liquid.  The  symptoms  were 
somewhat  like  those  produced  by  hydrochloric  acid.  He  at  first 
rallied,  but  died  in  about  five  weeks.  The  stomach  was  found  par- 
tially inflamed,  and  thickened  towards  the  intestinal  end. 

Comparatively  small  doses  of  this  solution  may  seriously  affect 
pregnant  females,  and  among  the  criminal  uses  to  which  it  has  been 
put,  may  be  mentioned  that  of  procuring  abortion.  At  the  Lincoln 
Lent  Assizes,  1863  {Reg.  v.  Rumble),  a  druggist  was  convicted  of 
having  supplied  this  noxious  compound  to  a  woman  with  the  intent 
to  procure  her  miscarriage.  The  health  of  the  woman  was  greatly 
injured  by  the  administration  of  this  liquid. 

These  are  the  principal  metallic  irritants ;  but  the  compounds  of 
tin,  silver,  gold,  bismuth,  and  chromium  have  also  an  irritant  action. 
Cases  of  poisoning  by  these  substances  are,  however,  very  rare. 


VEGETABLE    IRRITANTS.  147 


VEGETABLE  AND  ANIMAL  IRRITANTS. 


CHAPTER    XV. 

Vegetable  irritants. — aloes. — savin. — croton  oil. — colchi 
cum. — hellebore. — animal  irritants. — cantharides. — nox- 
ious animal  food. — [trichiniasis.] 

General  Remarks. — The  poisonous  substances  of  an  irritant  nature 
which  belong  to  the  vegetable  kingdom  are  very  numerous  as  a 
class ;  but  it  will  here  be  necessary  to  notice  only  those  which  have 
either  caused  death,  or  have  given  rise  to  accidental  poisoning. 

Aloes.  Colocynth.  Gamboge.  Jalap.  Scammony. — These  different 
substances,  which  are  used  in  small  doses  as  medicines,  are  liable, 
when  taken  frequently  or  in  large  quantities,  to  excite  severe  vomit- 
ing, purging,  and  other  symptoms  of  irritation. 

Hierapicra  {Holy  bitter)  is  a  popular  aloetic  compound,  and  one 
death  is  recorded  to  have  been  produced  by  it  in  1837-8.  There 
is  reason  to  believe  that  it  is  occasionally  used  for  the  purpose  of 
procuring  criminal  abortion.  A  man  was  tried  and  convicted  of 
this  offence  at  the  Aylesbury  Lent  Assizes,  1857  {Reg.  v.  White),  and 
the  noxious  properties  of  this  compound  then  became  a  subject  of 
inquiry.  The  dose,  and  the  condition  of  the  woman  to  whom  it  is 
administered,  will  of  course  affect  the  answer  to  this  question.  At 
the  trial  above  mentioned,  it  was  properly  considered  to  be  a  noxious 
substance  within  the  meaning  of  the  statute.  The  fact  that,  under 
the  name  of  Pulvis  Aloes  cum  Canelld,  it  was  formerly  admitted  into 
the  British  Pharmacopoeia,  cannot  justify  the  mischievous  uses  to 
which  it  may  be  put.  Hierapicra  is  a  snuff-colored  powder,  of  an 
intensely  bitter  taste.  It  consists  of  four  parts,  by  weight,  of  aloes, 
and  one  part,  by  weight,  of  powdered  canella  bark.  The  proper 
medicinal  dose  was  formerly  fixed  at  from  five  to  fifteen  grains.  Its 
injurious  effects  on  pregnant  females  are  chiefly  due  to  the  aloes.  This 
specially  affects  the  rectum,  and  by  contiguity,  under  violent  irritation 
or  purging,  may  affect  the  uterus.  From  the  taste  and  color  which  it 
imparts  to  liquids,  it  is  not  probable  that  it  could  be  taken  by  a 
female  unknowingly. 

Savin  {Juniperus  Sabina). — This  is  a  well-known  plant,  the  leaves 
of  which  contain  an  irritant  poison  in  the  form  of  an  acrid  volatile 
oil  of  a  remarkable  odor.  They  exert  an  irritant  action,  both  in  the 
state  of  infusion  and  powder.     They  yield  by  distillation  a  light  yel- 


148 


POISONING    WITH    COLCHICUM. 


Fig.  15. 


Tips  of  the  leaves  of  Savin  magnified 
30  diameters. 


low  oil,  on  which  the  irritant  properties  of  the  plant  depend.     The 
powder  is  sometimes  used  in  medicine,  in  a  dose  of  from  five  to 

twenty  grains.  Savin  is  not  often  taken 
as  a  poison  for  the  specific  purpose  of  de- 
stroying life ;  but  this  is  occasionally  an  in- 
direct result  of  its  use  as  a  popular  means 
of  procuring  abortion.  In  this  manner 
it  appears  to  have  proved  fatal  in  one 
case  in  1837-8.  From  the  little  that  is 
known  of  its  effects,  it  acts  by  producing 
violent  pain  in  the  abdomen,  vomiting, 
and  strangury.  After  death,  the  gullet, 
stomach,  and  intestines,  with  the  kidneys, 
have  been  found  either  much  inflamed  or 
congested.  It  has  no  action  as  an  abor- 
tive, except,  like  other  irritants,  by  caus- 
ing a  violent  shock  to  the  system,  under 
which  the  uterus  may  expel  its  contents.  Such  a  result  can  never 
be  obtained  without  placing  in  jeopardy  the  life  of  a  woman ;  and 
when  abortion  follows,  she  generally  falls  a  victim. 

Croton  Oil. — This  is  an  oil  extracted  from  the  seeds  of  the  Croton 
tigliwn.  It  is  a  powerful  drastic  purgative,  producing,  in  a  large 
dose,  severe  purging,  collapse,  and  death.  A  case  occurred  in  Paris, 
in  1839,  in  which  a  man  swallowed  by  mistake  two  drachms  and  a 
half  of  croton  oil.  In  three-quarters  of  an  hour  the  surface  was 
cold  and  clammy,  the  pulse  imperceptible,  breathing  difficult,  and 
the  extremities  and  face  were  as  blue  as  in  the  collapsed  stage  of 
cholera.  In  an  hour  and  a  half  purging  set  in;  the  stools  were 
passed  involuntarily,  and  the  abdomen  was  very  sensitive  to  the 
touch.  The  patient  complained  of  a  burning  pain  in  the  course  of 
the  gullet.  He  died  in  four  hours  after  swallowing  the  poison. 
There  was  no  marked  change  in  the  mucous  membrane  of  the 
stomach.  (For  another  fatal  case,  see  "  Pharm.  Journal;"  Feb.  1863, 
p.  379.) 

Meadow- Saffron  (Colchicum). — Meadow-saffron  (Colchicum  Autum- 
Nale)  contains  a  poisonous  alkaloid — colchicina — the  effects  of  which 
on  animals  are  similar  to  those  of  veratria,  the  alkaloid  existing  in 
"White  Hellebore.  The  most  noxious  parts  of  the  plant  are  the 
bulbs  (or  roots)  and  seeds,  but  the  leaves  and  flowers  have  also  an 
irritant  action. 

Symptoms  and  Appearances. — The  symptoms  in  cases  of  poisoning 
bv  colchicum  are  generally  well  marked.  There  is  burning  pain  in 
the  throat  and  stomach,  intense  thirst,  violent  vomiting  and  purging 
leading  rapidly  to  exhaustion,  coldness  and  clamminess  of  the  skin, 
excessive  depression,  and  great  weakness.  The  pulse  is  small,  weak, 
and  fluttering,  and  death  appears  to  take  place  from  complete  ex- 
haustion without  convulsions  or  loss  of  consciousness.  Among  four 
cases  presenting  these  symptoms,  one  person  died  on  the  second,  one 
on  the  fifth,  one  on  the  eighth,  and  one  on  the  fourteenth  day.  In 
another  case  of  poisoning  by  wine  of  colchicum,  the  symptoms  did 


POISONING    WITH    HELLEBORE.  149 

not  come  on  for  an  hour  and  a  half;  there  was  then  copious  vomit- 
ing of  a  yellow  fluid,  severe  pain  with  great  tenderness  in  the  abdo- 
men, tenesmus,  and  thirst.  The  patient  died  in  forty-eight  hours, 
without  being  convulsed  or  manifesting  any  sign  of  cerebral  disturb- 
ance. The  chief  morbid  appearance  was  a  patch  of  redness  in  the 
mucous  membrane  of  the  stomach,  near  the  cardiac  orifice;  the  in- 
testines were  slightly  inflamed.  The  head  was  not  examined. 
("Medical  Gazette,"  vol.  10,  p.  161;  see  also  Casper,  "Ger.  Med.,"  p. 
450.)  In  a  case  of  poisoning  by  the  medicinal  administration  of 
colchicum,  communicated  to  me  by  Mr.  Mann,  of  Bartholomew 
Close,  three  and  a  half  drachms  of  the  wine  of  colchicum  were  taken 
in  divided  doses,  and  caused  death  on  the  fourth  day.  There  was  no 
inflammation  of  the  mucous  membrane,  but  simply  extravasation  of 
blood  into  the  mucous  follicles.  The  mucous  membrane  has  been 
found  softened  in  two  cases  of  poisoning  by  the  tincture.  In  two 
other  cases,  in  which  an  ounce  and  a  half  of  the  tincture  was  taken, 
aud  death  ensued  in  forty-eight  hours,  no  morbid  appearances  were 
found.  (Casper,  "Ger.  Med.,"  1857,  p.  451,  and  see  his  "  Vierteljahr- 
schrift,"  1860,  vol.  1,  p.  1.) 

Golchicina. — The  noxious  properties  of  colchicum  are  owing  to  the 
presence  of  this  alkaloid,  which  is  remarkable  for  acquiring  a  reddish 
violet  color  on  the  addition  of  strong  nitric  acid.  It  may  be  sepa- 
rated from  liquids  containing  it  by  a  process  similar  to  that  described 
for  strychnia.     (See  Strychnia.) 

Black,  "White,  and  Green  Hellebore. 

Symptoms  and  Appearances. — According  to  Wibmer,  the  roots  of 
the  black  hellebore  possess  the  greatest  activity;  but  the  leaves  are 
also  highly  poisonous  when  used  in  the  form  of  infusion.  By  long 
boiling  the  poisonous  properties  of  the  plant  are  diminished,  proba- 
bly owing  to  the  loss  of  the  volatile  principle,  which  is  an  acrid  oil. 
The  roots  and  leaves  have  a  local  irritant  action,  producing  violent 
vomiting  and  purging  in  small  doses,  with  severe  pain  in  the  abdo- 
men, followed  by  cold  sweats,  convulsions,  insensibility  and  death. 
The  powdered  root,  in  a  dose  of  a  few  grains,  acts  like  a  drastic  pur- 
gative. In  a  case  reported  by  Morgagni,  half  a  drachm  of  the 
aqueous  extract  killed  a  man,  get.  50,  in  eight  hours.  The  sj^mptoms 
were  severe  pain  in  the  abdomen  and  violent  vomiting.  After  death 
the  whole  of  the  alimentary  canal  was  found  inflamed,  but  especially 
the  large  intestines.  (Wibmer,  op.  cit.,  Helleborus.)  A  case  is 
quoted  by  the  same  writer,  in  which  a  tablespoonful  of  the  finely- 
powdered  root  (taken  by  mistake  for  rhubarb)  caused  severe  symp- 
toms of  irritant  poisoning,  which  did  not  disappear  for  four  hours. 
The  man  recovered  on  the  fourth  day.  The  experiments  performed 
by  Orflla  on  animals,  show  that  this  poison  acts  like  a  local  irritant 
when  applied  to  a  wound.  (Op.  cit.,  vol.  2,  p.  309.)  Hellebore  is  a 
favorite  remedy  for  worms  among  quacks  and  rural  doctresses.  It 
is  not,  therefore  surprising  that  it  should  be  occasionally  adminis- 
tered in  an  overdose,  and   cause  death.     In  December,   1862,   Dr. 


150  NOXIOUS    PROPERTIES    OF    VERATRIA. 

Edwards  met  with  a  case  in  which  a  gentleman  had  swallowed  ex- 
perimentally one  drachm  of  tincture  of  green  hellebore  (veratrum 
vimde),  equal  to  twelve  grains  of  the  powder.  He  was  found  soon 
afterwards  in  a  collapsed  state,  features  sunk,  skin  cold,  and  covered 
with  a  profuse  clammy  sweat,  pulse  scarcely  perceptible.  He  com- 
plained of  intense  pain  in  the  region  of  the  stomach.  There  was  no 
purging.  These  symptoms  were  relieved  by  treatment,  and  the  next 
morning  the  patient  had  recovered.  ("Med.  Times  and  Gazette," 
1863,  1,  5.) 

Veratria. — White  hellebore  owes  its  noxious  properties  to  the 
alkaloid  veratria,  which  is  itself  a  powerful  poison.  The  late  Mr. 
Callaway  communicated  to  me  the  following  case.  A  physician  pre- 
scribed medicinally  for  a  lady,  one  grain  of  veratria  divided  into 
fifty  pills,  and  three  were  directed  to  be  taken  for  a  dose.  Not  long 
after  the  dose  had  been  swallowed,  the  patient  was  found  insensible, 
the  surface  cold,  the  pulse  failing,  and  there  was  every  symptom  of 
approaching  dissolution.  She  remained  some  hours  in  a  doubtful 
condition,  but  ultimately  recovered.  Supposing  the  medicine  to 
have  been  well  mixed,  and  the  pills  equally  divided,  not  more  than 
one-sixteenth  of  a  grain  of  veratria  was  here  taken !  The  common 
veratria  of  the  shops  is  sometimes  given  medicinally,  in  doses  of 
one-sixth  of  a  grain.  Poisoning  by  veratria  is  a  rare  occurrence.  I 
have  not  met  with  an  instance  in  which  this  alkaloid  has  been  ad- 
ministered with  criminal  intention.  "With  the  exception  of  the  case 
above  mentioned,  there  is  no  experience  of  its  operation  as  a  poison 
on  man.  Judging  from  its  effects  on  animals,  it  would  cause  vomit- 
ing and  convulsions  with  insensibility. 

Analysis. — In  the  state  in  which  it  is  usually  seen,  it  is  a  brownish - 
v/hite  powder,  scarcely  soluble  in  boiling  water,  but  dissolved  by 
alcohol,  ether,  and  benzole.  Acids  readily  dissolve  it,  forming  salts 
which  on  evaporation  do  not  yield  crystals.  The  powder  has  a  hot, 
acrid  taste,  and  if  any  portion  enters  the  nostrils,  it  causes  most  violent 
sneezing,  lasting  for  some  time.  Strong  nitric  acid  gives  to  the  pow- 
der a  light  red  color,  becoming  ochreous  after  a  time.  Hydrochloric 
acid,  strong,  and  diluted,  with  the  aid  of  heat,  produces  a  dingy  red 
tint.  The  best  test  for  its  presence  is  the  dilute  sulphuric  acid,  which 
by  a  gentle  heat  strikes  a  rich  pink  color,  which  is  destroyed  by  a 
solution  of  chlorine,  but  not  by  chloride  of  tin.  Strong  sulphuric 
acid  turns  the  powder  yellow,  but  on  heating  the  mixture,  the  color 
deepens,  and  finally  becomes  of  a  deep  red.  When  the  liquid  is 
diluted,  this  color  changes  to. a  dingy  yellow. 

Veratria  differs  from  colchicina  in  its  insolubility  in  water,  as  well 
as  in  the  action  of  strong  nitric  and  diluted  sulphuric  acids.  Veratria 
may  be  brought  into  solution  in  organic  liquids,  by  acetic  acid  and 
heat.  The  liquid  is  treated  with  potash,  and  two  parts  of  benzole 
will  yield  the  alkaloid  if  present,  on  decanting  and  evaporating  the 
benzolic  solution.  The  tests  may  then  be  applied  to  the  residue.  It 
has  not  yet  been  detected  in  the  tissues.  A  case  occurred  in  Septem- 
ber, 1865,  in  which  death  was  attributed  to  the  action  of  veratria 
criminally  administered.     The  deceased,  a  woman,  was  advanced  in 


POISONING    WITH    C  A  XT  II  A  RIDES.  151 

pregnancy,  and  from  the  medical  evidence  she  died  from  puerperal 
convulsions  and  Blight's  disease  of  the  kidney,  with  effusion  of  blood 
on  the  brain.  It  was  said  that  veratria  Avas  detected  in  her  body  and 
in  the  urine,  but  there  were  no  symptoms  of  poisoning  by  veratria, 
and  there  was  no  evidence  of  administration  by  any  one.  The  che- 
mical analysis  was  not  published  or  it  might  have  appeared  that  too 
great  a  reliance  had  been  placed  upon  the  tests  employed.  ("  Med. 
Times  and  Gazette,"  Oct.  28,  1865,  p.  472.)  It  was  a  case  of  death 
from  natural  causes  mistaken  for  poisoning. 

Animal  Irritants. 

Cantharides  (Spanish  Flies).  Symptoms. — When  cantharides 
are  taken  in  powder,  in  the  dose  of  one  or  two  drachms,  they  give  rise 
to  the  following  symptoms :  a  burning  sensation  in  the  throat,  great 
difficulty  of  swallowing,  violent  pain  in  the  abdomen,  with  nausea 
and  vomiting  of  a  bloody  mucus :  there  is  also  great  thirst  with  dry- 
ness of  the  fauces.  As  the  case  proceeds,  a  heavy  dull  pain  is  com- 
monly experienced  in  the  loins,  and  there  is  an  incessant  desire  to 
void  urine,  but  only  a  small  quantity  of  blood  or  bloody  urine  is 
passed  at  each  effort.  The  abdominal  pain  becomes  of  a  violent 
griping  kind.  Purging  supervenes,  but  this  is  not  always  observed : 
the  matters  discharged  from  the  bowels  are  mixed  with  blood  and 
mucus,  and  there  is  often  tenesmus  (straining).  In  these,  as  well  as 
in  the  vomited  liquids,  shining  green  or  copper-colored  particles  may 
be  commonly  seen  on  examination,  whereby  the  nature  of  the  poison 
taken,  if  it  has  been  taken  in  powder,  will  be  at  once  indicated. 
After  a  time  there  is  priapism,  and  the  genital  organs  are  swollen 
and  inflamed  both  in  the  male  and  female.  When  the  case,  proves 
fatal,  death  is  usually  preceded  by  faintness,  giddiness,  and  convul- 
sions. The  tincture  of  cantharides  produces  similar  symptoms :  they 
are,  however,  more  speedily  induced,  and  the  burning  sensation  in 
the  stomach  and  constriction  of  the  throat  are  more  strongly  marked : 
this  symptom  is  often  so  severe  as  to  render  it  impossible  for  the 
person  to  swallow;  and  the  act  of  swallowing  gives  rise  to  excruci- 
ating pain  in  the  throat  and  abdomen. 

Appearances. — In  one  well-marked  case,  the  whole  of  the  alimen- 
tary canal,  from  the  mouth  downwards,  was  in  a  state  of  inflammation. 
The  mouth  and  tongue  seemed  to  be  deprived  of  their  mucous  mem- 
brane. The  ureters,  kidneys,  and  internal  organs  of  generation  were 
also  inflamed.  In  another  instance,  in  which  an  ounce  of  the  tincture 
was  swallowed,  and  death  did  not  occur  for  fourteen  days,  the  mucous 
membrane  of  the  stomach  was  not  inflamed ;  but  it  was  pulpy,  and 
easily  detached.  The  kidneys  were,  however,  inflamed.  The  brain 
has  been  found  congested,  and  ulceration  of  the  bladder  is  said  to 
have  been  met  with.  There  are  few  fatal  cases  reported,  in  which 
the  appearances  have  been  accurately  noted ;  indeed,  the  greater 
number  of  those  who  have  taken  this  poison  have  recovered. 

The  quantity  required  to  produce  serious  symptoms,  or  to  destroy 
life,  has  been  a  frequent  subject  of  medico-legal  inquiry.     The  medi- 


152  NOXIOUS    ANIMAL    FOOD. 

cinal  dose  of  the  tincture  is  from  ten  minims  gradually  increased  to 
one  fluidrachm ;  of  the  powder  from  one  to  two  grains.  (Pereira, 
"  Mat.  Med."  part  2,  vol.  2,  p.  754.)  Doses  above  these,  whether  of 
the  powder  or  the  tincture,  are  likely  to  be  injurious,  and  to  give 
rise  to  symptoms  of  poisoning.  The  smallest  quantity  of  the  powder 
which  has  been  known  to  destroy  life,  was  in  the  case  of  a  young 
woman,  quoted  by  Orfila — the  quantity  taken  was  estimated  at 
twenty-four  grains  in  two  doses.  She  died  in  four  days ;  but  as  abor- 
tion preceded  death,  this  may  have  been  concerned  in  accelerating 
that  event.  An  ounce  of  the  tincture  has  been  known  to  destroy  life. 
It  was  taken  by  a  boy,  set.  17,  and  he  died  in  fourteen  days.  This, 
I  believe,  is  the  smallest  dose  of  the  tincture  which  has  proved  fatal. 
Chemical  Analysis. — For  the  detection  of  the  powder,  M.  Poumet 
recommends  that  the  sediment  obtained  from  the  suspected  liquids, 
should  be  mixed  with  alcohol  spread  on  sheets  of  glass,  and  allowed 
to  evaporate  spontaneously  to  dryness.  The  shining  scales  will  then 
be  seen,  on  examining  the  glass  by  reflected  light,  either  on  one  or 
both  surfaces.  ("Ann.  d'Hyg."  Oct.  1842.)  As  the  powder  is  inso- 
luble in  water,  some  portion  of  it  may  generally  be  obtained  by 
washing  and  decantation.  The  sediment  may  also  be  examined  on 
a  glass-slide  with  the  microscope.  If  no  portion  of  the  powdered 
flies  can  be  obtained,  the  suspected  liquids  or  solids  should  be  brought 
to  dryness  and  the  dry  residue  digested  in  successive  quantities  of 
ether  until  exhausted.  This  will  dissolve  the  cantharadine.  The 
ethereal  solutions  are  evaporated  to  an  extract,  and  some  of  this 
extract,  spread  on  oil-silk,  may  be  applied  to  a  thin  portion  of  the 
skin  of  the  arm  or  to  the  lips.  The  production  of  a  blister,  with 
serum,  under  these  circumstances  is  considered  to  indicate  the  pre- 
sence of  cantharadine.  By  this  method  Burruel  discovered  can- 
tharides  in  chocolate  ("Ann.  d'Hyg.,"  1835,  1,  p.  455).  Chloroform 
has  been  employed  in  preference  to  ether.  As  the  extract  contains 
frequently  a  green  oil  and  fat,  which  prevent  cantharadine  from  crys- 
tallizing, it  has  been  recommended  to  employ  sulphide  of  carbon,  in 
order  to  separate  these  impurities,  the  cantharadine  not  being  soluble 
in  the  sulphide. 

Noxious  Animal  Food. 

Certain  kinds  of  animal  food  are  found  to  produce,  occasionally, 
symptoms  resembling  those  of  irritant  poisoning.  In  some  instances 
this  poisonous  effect  appears  to  be  due  to  idiosyncrasy ;  for  only  one 
person  out  of  several  partaking  of  the  food,  may  be  affected.  These 
cases  are  of  importance  to  the  medical  jurist,  since  they  may  give 
rise  to  unfounded  charges  of  criminal  poisoning.  In  the  absence  of 
any  demonstrable  poison,  we  must  test  the  question  of  idiosyncrasy 
by  observing  whether  more  than  one  person  is  affected,  and  whet h er 
the  same  kind  of  food,  given  to  animals,  produces  symptoms  of  poi- 
soning. If,  with  this  latter  condition,  several  persons  are  affected 
simultaneously  with  similar  symptoms,  we  cannot  refer  the  effects  to 
idiosyncrasy;  they  are  most  probably  due  to  the  presence  of  an 


NOXIOUS    ANIMAL    FOOD.      SHELL-PISH.  153 

animal  poison.  Among  the  articles  of  food  which  have  caused  symp- 
toms of  irritant  poisoning,  may  be  mentioned  certain  shell-fish  (mus- 
sels), cheese,  bacon,  sausages,  diseased  pork,  and  animal  flesh  in  a 
diseased  or  putrescent  state. 

1  Poisonous  Fish.  Mussels. — Of  all  varieties  of  shell-fish,  none 
have  so  frequently  given  rise  to  accidents  as  the  common  mussel.  The 
symptoms  which  it  produces,  are  uneasiness  and  sense  of  weight  in 
the  stomach,  sensation  of  numbness  in  the  extremities  ;  heat,  dryness, 
and  constriction  in  the  mouth  and  throat ;  thirst,  shivering,  difficulty 
of  breathing,  cramps  in  the  legs,  swelling  acd  inflammation  of  the 
eyelids,  with  a  profuse  secretion  of  tears,  and  heat  and  itching  of  the 
skin,  followed  by  an  eruption  resembling  nettle-rash.  These  symp- 
toms are  sometimes  accompanied  by  colic,  vomiting,  and  purging. 
They  may  occur  within  ten  minutes  or  a  quarter  of  an  hour ;  but 
their  appearance  has  been  delayed  for  twenty-four  hours.  There  is 
generally  great  exhaustion  and  debility.  These  symptoms  have  pro- 
ceeded from  the  eating  of  not  more  than  ten  or  twelve  mussels.  Two 
cases,  reported  by  Dr.  Christison,  proved  fatal,  the  one  in  three,  and 
the  other  in  about  seven  hours.  In  general,  however,  especially 
when  there  is  free  vomiting,  the  patients  recover.  In  the  inspection 
of  the  two  fatal  cases  above  mentioned,  no  appearance  was  found  to 
account  for  death.  A  case  in  which  two  mussels  produced,  in  a  boy 
aged  ten,  alarming  symptoms,  followed  by  an  eruption  resembling 
scarlatina  and  nettle-rash,  will  be  found  elsewhere  reported  ("  Guv's 
Hosp.  Reports,"  Oct.  1850,  p.  213).  In  July,  1860,  a  number  of  per- 
sons living  at  Tralee  were  poisoned  under  the  following  circumstances. 
A  woman  picked  up  some  mussels  wrhich  she  found  at  the  bottom  of 
the  basin  of  a  ship-canal.  She  distributed  them  among  her  neigh- 
bors, and  during  the  night,  twenty-one  persons  who  had  eaten  them, 
were  attacked  with  symptoms  of  poisoning.  Three  children  died, 
and  six  individuals  were  placed  in  imminent  peril.  The  rest  were, 
soon  out  of  danger.  Eight  of  the  twenty-one  persons  attacked  were 
adults.  ("  Med.  Times  and  Gazette,"  July  28,  1860.)  In  October, 
1862,  an  accident  occurred  at  Liverpool  in  which  a  woman  died  in 
about  four  hours,  after  having  eaten  some  mussels  taken  from  a  ship 
in  the  docks.  There  was  severe  pain  and  vomiting  among  the  symp- 
toms, which  generally  resembled  those  of  arsenical  poisoning.  Several 
other  persons  were  made  seriously  ill,  but  recovered.  Although  the 
vessel  was  not  sheathed  wTith  copper  or  yellow  metal,  it  was  coated 
with  a  green  pigment,  of  which  arsenic  may  have  been  a  constituent. 

The  poisonous  action  of  mussels  can  be  referred  neither  to  putre- 
faction nor  disease  ;  nor  in  all  cases  to  idiosyncrasy,  since  in  one 
instance  those  mussels  only  which  had  been  taken  from  a  particular 
spot  were  poisonous;  all  persons  who  partook  of  them  suffered,  and 
a  dog  to  which  some  of  them  were  given,  was  killed.  From  a  case 
which  occurred  to  M.  Bouchardat,  it  would  appear  that  copper  is 
sometimes  present,  and  may  be  the  cause  of  the  poisonous  effects. 

1  [The  remainder  of  this  chapter  is  extracted  from  Dr.  Taylor's  "  Principles  and 
Practice  of  Medical  Jurisprudence." — P.] 


154  NOXIOUS    ANIMAL    FOOD.      SAUSAGE    POISON. 

Two  -women  were  poisoned  by  mussels,  and  he  found  on  analysis 
sufficient  copper  in  the  fish  to  account  for  the  symptoms  of  irritation 
from  which  they  suffered.  ("  Ann.  dTIyg."  1837,  vol.  1,  p.  358.) 
Copper  is  not,  however,  present  in  all  cases,  and  it  is  therefore  pro- 
bable that  there  is  in  some,  if  not  in  all  instances,  an  animal  poison 
present  in  the  fish.  (See  "  Ann.  d'Hyg."  1851,  vol.  1,  p.  387,  vol.  2, 
p.  108.)  Oysters  and  periwinkles  have  occasionally  given  rise  to  simi- 
lar symptoms.  Salmon,  sold  in  the  state  of  pickled  salmon,  or  even 
herrings  salted,  may  also  act  as  irritants ;  this  may  be  due  to  the  fish 
being  partially  decayed  before  it  is  used,  or  to  the  noxious  effects  of 
the  pickle.  For  some  remarks  by  Dr.  Hamilton  on  the  poisonous 
properties  of  fish,  see  the  "  PharmaceuticalJournal,"  Jan.  1853,  p.  31-1. 

Cheese. — The  symptoms  produced  by  cheese  have  been  those  of 
irritant  poisoning.  The  nature  of  the  poison  is  unknown.  In  some 
cases  the  irritant  property  is  undoubtedly  due  to  a  putrefied  state  of 
the  curd,  or  to  the  production  of  an  irritant  oil.  Again,  it  has  been 
supposed  that  the  poison  is  occasionally  derived  from  certain  vege- 
tables on  which  the  cows  feed.  In  1858  a  case  was  referred  to  me 
for  examination,  in  which  twenty-five  persons  had  suffered  from 
vomiting  and  purging  more  or  less  violent,  owing  to  their  having 
partaken  of  cheese.  The  only  articles  of  food  taken  in  common 
were  bread,  beer,  and  cheese.  The  bread  and  beer  were  excluded 
from  any  suspicion  of  containing  poison.  All  the  persons  recovered. 
On  a  close  examination  of  the  cheese  I  found  it  to  be  strongly  acid ; 
it  had  an  offensive  musty  smell,  and  yielded  a  quantity  of  acrid  oil 
to  ether.  It  had  not  been  properly  pressed,  and  the  casein  had  un- 
dergone a  chemical  change.  The  ashes  yielded  copper  and  lead  in 
traces.  The  cheese  had  acquired  irritant  properties,  not  from  the 
presence  of  any  poisonous  matter  added  to  it,  but  from  partial  decay. 
There  was  abundant  evidence  that  cheese  from  the  same  dairy  had 
been  eaten  without  causing  any  injurious  symptoms.  This  negative 
evidence,  however,  is  quite  consistent  with  one  cheese  acquiring 
noxious  properties.  We  must  not  lose  sight  of  the  fact  that  cheese 
may  actually  contain  poison  mixed  with  it  through  ignorance.  Orpi- 
ment  or  chromate  of  lead  may  be  used  as  coloring,  and  the  discovery 
of  such  mineral  substances  would  at  once  account  for  the  irritant 
effects.  (See  "  Pharmaceutical  Journal,"  Aug.  1862,  p.  89.)  The  milk 
and  cheese  of  some  of  the  North  American  provinces,  is  said  to  be 
occasionally  rendered  poisonous  by  the  fact  that  cows  pasture  at  cer- 
tain seasons  on  vegetables  of  a  noxious  kind. 

Sausage  Poison. — The  symptoms  caused  by  sausage-poison  partake 
of  a  narcotico-irritant  character;  they  are  very  slow  in  appearing — 
sometimes  two,  three,  or  four  days  may  elapse  before  they  manifest 
themselves.  This  poison  is  of  a  formidable  kind;  its  effects  have 
been  chiefly  observed  in  Germany.  In  the  "  Medical  Gazette"  for  Nov. 
1842,  there  is  an  account  of  the  cases  of  three  persons,  who  had  died 
from  the  effects  of  liver-sausages,  which  had  been  made  from  an  ap- 
parently healthy  pig,  slaughtered  only  a  week  before.  The  inspection 
threw  no  light  on  the  cause  of  death.  The  poisonous  property  was 
supposed  to  depend  on  a, partial  decomposition  of  the  fatty  parts  of 


NOXIOUS    ANIMAL    FOOD.      DISEASED    PORK.  155 

the  sausages.  It  is  said,  that  when  extremely  putrefied,  the}r  are  not 
poisonous.  In  a  case  in  which  I  was  consulted,  a  few  slices  of  a 
German  sausage,  evidently  of  old  manufacture,  but  not  putrescent, 
caused  the  death  of  a  child,  with  violent  symptoms  of  irritation  of 
the  stomach  and  bowels.  I  examined  a  portion  of  the  sausage ;  it 
contained  no  poisonous  matter  which  admitted  of  detection.  The 
fatty  portions  were  rancid,  and  the  lean  portions  very  dry.  There 
was  no  doubt,  however,  that  it  had  been  the  cause  of  the  symptoms 
and  death  of  the  child.  Dr.  Tripe  has  published  a  complete  account 
of  the  effects  produced  by  sausage  poison  ("  Brit,  and  For.  Med.  Rev." 
Jan.  1860,  page  197).  It  appears  that  in  November,  1859,  sausages 
made  and  sold  by  a  pork  butcher,  at  Kingsland,  were  eaten  more  or 
less  by  sixty-six  persons,  of  whom  sixty-four  were  attacked  with 
violent  symptoms  in  from  three  and  a  half  to  thirty-six  hours  sub- 
sequently to  the  meal.  One  case  only  proved  fatal,  on  the  seventh 
day.  No  symptoms  appeared  in  this  man  until  after  the  lapse  of  six 
hours.  It  seems  that  he  had  eaten  one  of  the  sausages  raw  and  three 
cooked.  He  was  attacked  with  severe  vomiting,  and  purging  fol- 
lowed by  shivering ;  there  was  pain  in  the  abdomen ;  violent  head- 
ache and  great  prostration.  The  pulse  was  feeble  and  quick,  and 
there  was  delirium.  These  symptoms  underwent  a  remission,  but  he 
had  a  relapse,  became  comatose,  and  died  on  the  seventh  day.  Lat- 
terly, he  chiefly  complained  of  pain  in  the  bowels.  Dr.  Letheby 
found,  on  inspection,  no  signs  of  inflammation  or  of  the  action  of  an 
irritant  in  the  stomach.  The  small  intestines  were  much  inflamed  at 
the  lower  end,  and  the  gall-bladder  was  distended.  The  other  organs 
were  healthy.  The  viscera  contained  no  vegetable  or  mineral  poison. 
The  sausages  were  made  with  heifer-beef,  pork-fat,  sage,  and  pepper. 
There  was  no  evidence  of  anything  noxious  about  them,  and  a 
chemical  analysis  yielded  nothing  of  a  poisonous  nature.  There 
could,  however,  be  no  doubt  that  the  sausages  had  caused  the  symp- 
toms and  death ;  the  food  in  this  case  acting  as  a  narcotico-irritant 
poison.  Other  persons  suffered  from  burning  in  the  throat  and 
stomach,  followed  by  vomiting  and  purging;  then  giddiness  or  con- 
fusion in  the  head,  and  in  some  there  was  delirium.  In  the  man  who 
died,  the  delirium  was  well  marked,  and  the  eyes  were  red.  In 
those  persons  who  recovered,  the  noxious  animal  matter  was  proba- 
bly early  thrown  off  by  vomiting  and  purging.  (See  "  Trichiniasis," 
p.  278.) 

Pork.  Bacon. — These  common  articles  of  food  occasionally  give 
rise  to  symptoms  so  closely  resembling  those  of  irritant  poisoning, 
as  to  be  easily  mistaken  for  them.  In  some  cases,  the  effect  appears 
to  be  due  to  idiosyncrasy ;  but  in  others  it  can  be  explained  only  by 
supposing  the  food  to  have  a  directly  poisonous  action.  The  noxious 
effects  of  pork  have  been  particularly  shown  by  the  cases  published 
by  the  late  Dr.  Mac-Divitt.  ("  Ed.  Med.  and  Surg.  Jour.,"  Oct.  1836.) 
As  pork  is  sometimes  salted  in  leaden  vessels,  lead  may  be  found  in 
it :  but  fresh  pork  has  been  observed  to  have  a  noxious  action.  In 
January,  1864,  Mr.  Kesteven  met  with  a  case  in  which  all  the  mem- 
bers of  a  family  were  attacked  with  symptoms  of  irritant  poisoning, 


156  NOXIOUS    ANIMAL    FOOD.      DISEASED    PORK. 

after  eating  a  leg  of  pork.  The  principal  symptoms  were  nausea, 
vomiting,  griping  pains  in  the  abdomen,  and  purging :  but  dogs  and 
cats  fed  upon  the  meat  did  not  appear  to  suffer.  Other  portions  of 
of  the  animal  from  which  the  leg  was  taken,  were  eaten  by  other 
families,  and  no  symptoms  of  poisoning  were  produced.  I  examined 
the  fatty  portion  of  the  food  without  discovering  any  trace  of  the 
ordinary  poisons.  The  effects  could,  therefore,  only  be  referred  to 
some  change  in  this  particular  joint. 

These  cases  of  poisoning  by  animal  food  have  of  late  been  very 
fully  examined  by  Mr.  Simon  and  Mr.  Gamgee.  These  gentlemen 
have  traced  the  injurious  effects  of  pork  to  a  diseased  condition  of 
the  pig,  owing  to  the  animal  having  been  fed  on  improper  food.  The 
term  measly  pork  is  now  very  well  known  to  consist  in  a  diseased 
condition  of  the  flesh  of  the  animal,  in  which  it  is  filled  with  a  para- 
site called  cysticercus,  which  is  believed  to  be  the  larva  of  the  tape- 
worm. This  parasite  undergoes  full  development  when  in  the  shape 
of  food  it  reaches  the  human  intestines.  Mr.  Gamgee  expresses  his 
confidence  that  there  are  between  40,000  and  50,000  measly  pigs  in 
Ireland,  most  of  which  are  sent  to  Great  Britain  for  consumption; 
and  his  impression  is  that  for  every  measly  pig  in  the  kingdom,  there 
is  at  least  one  human  being  affected  with  tapeworm.  These  parasites 
may  not  directly  kill  a  person  who  eats  this  noxious  food,  but  they 
favor  the  development  of  fatal  disease.  He  also  remarks  that  a 
microscopical  thread-worm,  the  trichina  spiralis,  brings  the  muscular 
flesh  of  swine  into  a  state  in  which  a  small  quantity  of  it  eaten  raw, 
or  in  an  imperfectly  cooked  state,  may  suffice  to  destroy  life.  As 
regards  the  possible  ill  effects  from  consuming,  in  a  well-cooked 
state,  the  flesh  of  animals  afflicted  with  anthrax  or  carbuncular  fever, 
evidence  is  still  imperfect,  but  he  believes  that  human  life  may  be 
endangered  by  it.  An  opinion  has  been  expressed  that  boils  and 
perhaps  other  like  affections  are  caused  in  the  human  subject  by  the 
consumption  of  diseased  meat.  According  to  Mr.  Gamgee,  at  a  con- 
vict establishment  where  diseased  cattle  are  eaten  in  large  quantities, 
and  especially  cattle  afflicted  with  lung-disease,  as  many  as  40  ami 
50  cases  of  boils  and  carbuncles  occur  in  a  month  among  1,500  convicts. 
(Simon's  "  Annual  Report,"  1863.)  This  lends  support  to  the  theory 
that  diseased  animal  food  is  highly  favorable  to  the  production  of 
carbuncular  disease. 

There  is  reason  to  believe  that,  in  spite  of  every  precaution,  a 
large  amount  of  diseased  and  unwholesome  meat  is  sold  to  the  pub- 
lic, and  that  of  the  various  kinds  of  flesh  used  as  food  none  is  - 
subject  to  disease  as  pork.  Some  of  the  changes  which  it  undergoes 
are  of  a  microscopical  character,  and  are  not  likely  to  be  noticed. 
This  subject  has  attracted  the  attention,  not  only  of  the  Board  of 
Health  in  England,  but  of  the  Governments  of  France  and  the  Ger- 
man States,  with  a  view  to  the  protection  of  public  health.  For  a 
full  account  of  the  diseases  affecting  the  flesh  of  the  pig,  their  mode 
of  production,  and  the  prevention  of  accidents.  I  must  refer  the 
reader  to  papers  by  M.  Belpech,  in  the  "Aimales  D'Hygiene,"  1864, 
vol.  1,  pp.  5,  241  (il  Be  la  Ladrerie  du  pore,"  kc.)  It  has  been  clearly 


TRICHURIASIS.      THE    TRICHINA    SPIRALIS. 


157 


shown  that  the  parasites  found  in  the  flesh  of  this  and  other  animals, 
are  not  easily  killed  by  boiling,  roasting,  or  smoking,  and  that  those 
are  liable  to  suffer  the  most,  who  habitually  eat  the  raw  or  partly- 
cooked  flesh.  The  flesh  of  the  pig  containing  cysticercus,  presents 
in  the  cooked  state  the  following  appearances.  When  boiled  it  is 
paler  than  wholesome  meat :  it  appears  dryer  in  patches,  and  the 
muscular  fibres  are  more  separated  than  usual.  When  these  are 
opened,  the  parasites  are  seen  in  the  interstices,  appearing  as  opaque 
white  spots  of  the  size  of  a  hemp-seed,  and  presenting  much  the 
same  aspect  as  when  living.  The  caudal  bladder  attached  to  their 
bodies  disappears  when  the  meat  is  thoroughly  cooked,  and  the  body 
of  the  animal  then  appears  isolated  in  the  middle  of  the  muscular 
tissue.  It  is  friable  and  breaks  down  easily  under  pressure  with  a 
crackling  sound,  owing  to  the  presence  of  calcareous  matter.  In 
tBis  state  it  does  not  appear  to  be  necessarily  productive  of  injury 
("Ann.  d'Hyg."  1864,  vol.  1,  p.  249),  although  such  food  must  be 
regarded  as  most  unwholesome.  All  the  members  of  a  family  were 
seized  with  vomiting,  purging  and  syncope  after  having  eaten  a  dish 
of  pork.  A  medical  man  examined  the  meat,  and  found  it  full  of 
cysticercus.  A  pork-butcher  was  accused  of  having  sold  bad  meat, 
but  it  was  proved  to  have  been  some  cheap  pork  bought  of  a  hawker 
of  provisions.  ("Ann.  d'Hyg."  1864,  vol.  1,  p.  246.)  If  the  cysticer- 
cus did  not  cause  the  symptoms  in  this  case,  the  meat  had  under- 
gone some  change  sufficient  to  impart  to  it  irritant  properties.  These 
parasites  occur  in  all  the  fleshy  parts  of  the  body.  I  have  seen 
them  in  the  human  heart,  as  well  as  in  the  flesh  of  animals.  My 
colleague,  Mr.  Hilton,  first  showed  them  to  me  in  the  living  state,  in 
the  muscles  of  the  thigh  of  a  man,  in  1834.  They  are  not  com- 
monly found  in  the  fatty  portions  of  man  and  animals,  and  are  less 
common  in  sheep  and  oxen  than  in  pigs. 

Trichiniasis. — The  fatal  malady,  arising  from  the  introduction  of 
the  trichina  spiralis  into  the  human  body,  has  recently  attracted 
much  attention  in  France  and  Germany ;  and  among  others,  Dr. 
Keller,  of  Darmstadt,  has  published  some  important  facts  illustrating 


Fig.  16. 


Fig.  17. 


Maguifled  view  of  Trichina 
spiralis  In  its  Capsule. 
a  The  worm  coiled. 
b  The  capsules. 


ACTUAL  SIZE 


Tri  Una  spiralis  in  the  abdominal  muscles 
of  a  man:  natural  size  of  the  capsules 
containing  the  worm. 


the  symptoms  produced,  and  the  mode  in  which  this  parasite  causes 
death.     Dr.  Keller  considers  that  it  is  a  question  well  worthy  of  the 


158  THE    TRICHINA    SPIRALIS. 

attention  of  medical  jurists,  whether  many  cases  of  death  from 
suspected  irritant  poisoning,  in  which  no  poisonous  matter  could  be 
detected  in  the  body,  may  not  have  been  really  due  to  trichina  disease. 

The  trichina  (from  %'£,  a  hair)  spiralis,  a  flesh- worm,  is  found 
chiefly  in  the  course  of  the  fibres  of  all  the  striped  muscles  of  the 
trunk  and  limbs,  most  frequently  on  those  of  the  front  of  the  chest, 
neck,  and  abdomen.  It  has  also  been  found  on  the  muscular  fibres 
of  the  heart  and  oesophagus.  The  parasites  appear  in  the  form  of 
very  small  ovoid  bodies,  or  capsules,  perceptible  to  the  eye  as  white 
specks,  in  the  midst  of  the  muscular  fibres,  but  only  distinctly  seen 
by  the  aid  of  a  magnifying  glass.  The  trichina,  or  worm,  is  coiled 
up  in  the  centre  of  each  oval  capsule,  the  greater  diameter  of  which 
is  always  parallel  to  the  muscular  fibre  with  which  it  is  closely  in- 
corporated. The  engraving  at  the  foot  of  page  157,  is  taken  from 
a  preparation  in  the  Museum  of  Guy's  Hospital ;  it  represents*  a 
portion  of  the  abdominal  muscles  of  a  man,  covered  with  trichinae 
in  situ,  and  as  nearly  as  possible  of  the  natural  size.  Other  illus- 
trations in  the  same  page  represent  three  of  the  capsules  h  b  b  mag- 
nified, with  the  trichina  coiled  up  in  the  centre  of  one  of  them. 

These  parasites  are  frequently  so  numerous  as  to  give  to  the  red 
flesh  a  white  speckled  appearance.  According  to  Dr.  Keller,  as  many 
as  300,000  have  been  counted  in  half  a  pound  of  raw  meat ;  and  Dr. 
Pietra  Santa  affirms  that  one  gramme  (about  sixteen  grains)  of  dis 
eased  meat  may  contain  6,000  trichina?,  each  having  from  sixty  to 
eighty  embryos.     ("Ann.  d'Hyg."  1864,  vol.  1,  p.  317.) 

The  actual  size  of  the  capsule  has  been  variously  stated.  From 
an  examination  of  two  sets  of  specimens  in  the  muscles  of  the  throat 
and  abdomen,  I  estimated  the  long  diameter  to  be  the  gVh  of  an 
inch,  and  the  short  diameter  T^nth.  The  worm  itself  is  said  to  be 
the  g'oth  of  an  inch  in  length.  The  capsules  are  remarkably  uniform 
in  size.  They  are  built  up  at  the  expense  of  the  muscular  structure 
by  which  they  are  surrounded. 

The  history  of  this  animal  has  been  given  by  numerous  pathologists. 
("Hodgkin's  Lectures  on  Morbid  Anatomy,"  1836,  vol.  1,  p.  211.) 
A  full  description  of  its  anatomy  and  habits  by  Dr.  Bristowe  and 
Mr.  Kainey  will  be  found  in  the  "  Transactions  of  the  Pathological 
Society"  for  1853-4,  p.  274.  More  recent  accounts  of  its  influence 
on  health  bv  Dr.  Pietra  Santa,  have  been  published  in  the  "  Ann. 
d'Hyg."  1864,  vol.  1,  p.  305  ("La  Trichina  spiralis"),  and  by  Drs. 
Sclmltze  and  Lucke  in  Casper's  "  Vierteljahrschrift  fur  oerichtliehe 
Medicin,"  1864,  No.  1,  p.  103,  and  No.  2,  p.  269.  Dr.  Liicke's  paper 
is  of  especial  interest,  as  its  title,  "  Die  Trichinen  vor  dem  Forum." 
implies,  since  it  points  to  the  medico-legal  bearings  of  the  subject, 
and  the  possible  danger  of  confounding  the  ravages  of  this  parasite, 
with  the  obscure  effects  produced  in  certain  forms  of  chronic  irritant 
poisoning. 

From  these  researches,  it  is  now  clearly  established,  that  the  trichina 
is  a  viviparous  parasite,  which  passes  the  greater  part  of  its  existence 
in  the  crysalis  state  in  the  muscular  system,  until,  by  the  .consump- 
tion of  this  muscle  as  food,  it  finds  in  the  stomach  and  intestines  of 


THE    TRICHINA    SPIRALIS.  159 

another  warm-blooded  animal  a  favorable  medium  for  its  full  de- 
velopment into  an  intestinal  worm.  According  to  Virchow  and 
Zenker,  the  trichina  not  only  frequently  presents  itself  in  the  human 
organism,  but  this  organism  is  most  favorable  to  its  development. 
The  period  of  incubation  of  the  chrysalis  in  the  stomach  and  bowels 
of  man  or  of  warm-blooded  animals,  is  from  six  to  eight  days ;  and 
during  this  time  it  there  thrives  and  propagates  to  an  almost  incre- 
dible extent.  Dr.  Keller  states  that  in  three  or  four  days  the  females 
produce  100  or  more  young  ones,  which  begin  on  the  sixth  day  to 
leave  the  parent  animal ;  and  he  estimates  that  in  a  few  days  after 
the  ingestion  of  half  a  pound  of  meat,  the  stomach  and  intestinal 
canal  of  a  person  may  contain  thirty  millions  of  these  minute  worms. 
M.  Herbst  found  the  muscles  of  two  dogs  which  had  been  fed  upon 
parts  of  a  badger  containing  worms,  to  be  loaded  with  these  parasites. 
When  once  introduced  into  the  stomach  and  intestines,  the  worms 
leave  their  capsules,  become  free,  and  produce  young,  which  migrate 
through  the  walls  of  the  intestines  into  the  muscles ;  there  they  be- 
come encysted,  and  are  ultimately  found  appropriating  and  destroying 
the  muscular  substance  to  a  greater  or  less  extent.  The  sudden 
liberation  of  a  large  number  of  these  worms  causes  irritation  and 
inflammation  in  the  bowels,  attended  by  peculiar  symptoms  resem- 
bling in  some  respects  those  of  poisoning. 

It  is  worthy  of  note  that  trichinae  are  more  frequently  found  in 
pork  and  articles  of  food  derived  from  it,  than  in  any  other  kind  of 
meat.  Measly  pork  appears  to  be  sometimes  of  a  trichinous  charac- 
ter. Further,  the  vitality  of  the  parasites  is  not  destroyed  unless  the 
meat,  or  other  substances  in  which  they  are  located,  has  been  sub- 
jected to  a  temperature  equal  to  that  of  boiling  water  for  a  sufficient 
time  to  insure  that  every  particle  has  been  exposed  to  this  degree 
of  heat.  Salting  and  smoking,  or  partial  cooking,  is  not  sufficient 
to  destroy  the  worms  in  all  parts  of  the  food,  and  they  have  even  been 
found  living  in  putrefied  meat.  This  may  serve  to  account  in  some 
cases  for  the  serious  symptoms  which  have  followed  the  use  of  pork 
as  food,  also  of  bacon,  sausages,  and  German  sausages,  which  are 
generally  made  of  raw  ham. 

The  symptoms  produced  by  the  use  of  such  food  are,  in  the  first 
stage,  those  of  intestinal  irritation,  loss  of  appetite,  sickness,  pain, 
general  weakness  of  the  limbs,  with  diarrhoea,  swelling  of  the  eye- 
lids and  of  the  joints,  profuse  clammy  perspiration,  and  a  wasting 
fever,  sometimes  of  a  typhoid  character.  Death  is  either  the  result 
of  paralysis  (from  destruction  of  the  muscular  fibres),  or  of  peritonitis 
and  irritative  fever.  During  the  perforation  of  the  coats  of  the  in- 
testines by  these  worms,  the  mucous  membrane  becomes  irritated 
and  inflamed :  pus  is  formed  on  its  surface,  and  bloody  evacuations 
are  sometimes  passed.  No  case  is  known  in  which  trichiniasis,  after 
having  once  declared  itself,  was  arrested  by  medical  treatment. 

The  noxious  effects  of  this  food  on  human  beings  are  well  illus- 
trated by  a  series  of  cases  which  occurred  at  Hettstadt,  in  the  Hartz 
mountains,  in  1863.  ("British  Med.  Journal,"  Jan.  It),  1864,  p.  75.) 
One  hundred  and  three  persons  partook  of  smoked  sausages  made 


160  EPIDEMIC    TRICHINIASIS. 

from  a  pig  affected,  as  it  turned  out,  with  trichinous  disease.  The 
sausages  were  fried,  and  served  for  dinner  in  the  usual  way.  On  the 
following  day,  several  persons  who  had  partaken  of  this  food  were 
attacked  with  severe  pain  in  the  bowels,  purging,  loss  of  appetite, 
great  prostration  of  strength,  and  fever.  The  number  of  persons 
attacked  rapidly  increased,  symptoms  of  peritonitis  and  pneumonia 
manifested  themselves,  and  these  were  followed  by  paralysis  of  the 
intercostal  muscles,  and  of  the  muscles  in  front  of  the  neck.  Eighty- 
three  persons  died  from  the  effects  of  this  noxious  food,  and  the 
remainder  were  seriously  injured  in  health.  The  remnants  of  sau- 
sage and  of  pork  not  eaten  at  this  festival  were  examined,  and  were 
found  to  be  literally  swarming  with  encysted  trichinas.  (See  Casper's 
"  Vierteljahrschrift,"  April,  1864,  p.  286.)  The  writer  in  the  above 
journal  affirms  that  this  parasitic  disease  does  not  attack  sheep,  oxen, 
or  horses,  and  that  beef  is  the  safest  of  all  descriptions  of  food,  as  no 
parasites  have  ever  been  discovered  in  it.  They  have  not  been  found 
in  the  blood  of  animals  whose  muscles  are  liable  to  their  attacks. 

Dr.  Eeyber  relates  that  in  the  year  1862,  a  series  of  cases  of  illness 
to  the  number  of  thirty  occurred  in  Plauen,  as  the  result  of  the  use 
of  pork  containing  trichinas.  Among  the  symptoms  were  great  lan- 
guor, loss  of  appetite,  fever,  and  pains  in  the  muscles  of  the  arms 
and  legs.  The  effects  spread  like  an  epidemic.  A  female  patient 
under  Professor  Virchow  died,  at  Dresden,  with  typhoid  and  rheu- 
matic symptoms.  "When  the  body  was  inspected,  trichinas  were 
found  in  her  muscles.  On  inquiry,  it  was  found  that,  four  weeks 
before,  a  diseased  pig  had  been  killed  and  eaten  in  the  town  in  which 
she  resided ;  the  butcher  that  killed  it  suffered,  but  this  woman  alone 
died  from  the  effects.  ("Ann.  d'Hyg."  Oct.  1863,  p.  471.)  Pietra 
Santa  relates  that,  at  a  nuptial  festival  at  Wiesbaden,  twenty  persons 
partook  of  the  food  placed  on  the  table.  In  the  evening,  the  bride 
was  suddenly  seized  with  symptoms  of  poisoning,  and  in  spite  of 
medical  assistance,  died  in  a  few  hours.  The  bridegroom  himself 
suffered  from  similar  symptoms,  and  died  after  two  chays'  illness. 
The  other  guests  were  not  seriously  affected.  A  physician-expert, 
who  examined  the  case,  found  trichinas  in  the  body  of  the  deceased, 
as  Avell  as  in  certain  articles  of  food  prepared  from  pork  which  had 
been  served  at  the  table  ("  Ann.  d'Hyg."  April  1,  1864,  p.  321.)  The 
fact  that  only  two  out  of  the  party  suffered  from  symptoms  resem- 
bling poisoning,  and  that  one  died  rapidly,  was  calculated  to  excite 
grave  suspicion.  Sudden  deaths  from  trichinous  food  are  not  com- 
mon, and  it  is  to  be  regretted  that  this  case  is  not  given  with  fuller 
details.  The  real  cause  of  death  in  this  instance  does  not  appear  to 
have  been  clearly  traced  to  the  trichinous  food. 

[The  "Chicago  Medical  Journal"  for  August,  1866,  contains  an 
article  contributed  by  Dr.  E.  M.  Smith  of  Linn  County,  Iowa,  in  which 
is  reported  a  case  of  poisoning  of  a  family' of  nine  persons  by  eating 
trichinous  pork.  They  were  all  taken  sick  about  the  same  time  in 
the  early  part  of  May,  1866,  after  having  eaten  portions  of  raw- 
smoked  ham  some  five  or  ten  days  before.  Dr.  Smith  was  not  called 
iu  until  they  had  been  sick  for  a  week  or  more;  at  which  time  "the 


EPIDEMIC    TRICHIXIASIS.  161 

prominent  symptoms  observable  were :  more  or  less  diarrhoea ;  tender- 
ness of  the  abdomen  ;  tongue  thickly  coated,  contracted  and  red  about 
the  edges;  oedema  of  the  face  in  several  of  the  cases;  considerable 
pneumonic  irritation  in  some;  fever  of  a  typhoid  character;  pulse 
ranging  from  100  to  120  per  minute ;  great  thirst  and  profuse  sweat- 
ing ;  complaint  of  soreness  and  stiffness  of  the  muscles,  a  difficulty  of 
extending  the  limbs,  wakefulness  at  night,  and  excessive  exhaustion. 
Each  case  exhibited  more  or  less  of  the  symptoms  enumerated,  the 
difference  being  merely  in  intensity."  Five  of  the  patients  died  (the 
first  death  occurring  on  the  30th  May  and  the  last  on  the  17th  June), 
upon  two  of  whom  post-mortem  examinations  were  made.  "  Upon 
placing  minute  particles  of  these  muscles"  (the  rectus  femoris  and 
biceps)  "  under  the  glass,  the  parasites  were  seen  in  great  numbers ; 
the  veritable  trichinae  spiralis.  Many  of  these  were  very  active,  and 
were  readily  seen  to  coil  and  uncoil,  and  to  exhibit  an  activity  com- 
mensurate with  the  terrible  work  they  had  done.  I  counted  twenty- 
six  trichinae  in  one  field  of  the  glass ;  and  upon  placing  a  piece  of 
the  rectus  fempris  ^2  °f  an  inch  in  diameter,  untler  the  object  glass, 
104  trichinae  were  counted,  which  would  give  nearly  200,000  parasites 
to  the  cubic  inch."  "  ISTo  lesions  of  a  pathological  character  were 
found,  the  appearance  of  the  viscera  being  nearly  or  quite  normal. 
Portions  of  the  muscles  from  different  parts  of  the  body  were  re- 
moved for  microscopic  investigation ;  also  of  the  liver,  spleen,  and 
lungs.  The  voluntary  muscles  were  swarming  with  trichinae;  some 
were  found  in  the  lungs  and  spleen,  but  none  in  the  heart  and  liver." 
The  patients  who  recovered  had  eaten  but  a  very  small  quantity  of 
the  raw  meat.  The  observations  of  Dr.  Smith  showed  that  it  was 
probable  that  the  "  activity  of  the  parasite  begins  to  subside  in  from 
forty  to  fifty  days  from  the  first  indications  of  the  malady."— P.] 

Although  little  has  been  heard  of  trichinous  disease  in  England, 
it  appears  to  have  been  prevalent  in  Germany.  Among  the  official 
notices  recently  published  by  the  Prussian  Government,  is  one  which 
points  out  the  danger  arising  from  the  use  of  pork  in  a  diseased 
state,  and  warning  those  who  sell  it  to  the  public,  of  the  penalties 
which  they  thereby  incur.  (Casper's  "  Vierteljahrschrift,"  July,  1863, 
p.  177.)  Under  this  notice,  it  is  stated  in  addition  to  the  cases  above 
given,  that  in  1862,  thirty-eight  persons  in  Kalbe,  suffered  severely 
from  the  use  of  such  food,  and  of  these,  eight  died  from  the  effects. 

Dr.  Shultze  refers  to  other  groups  of  cases,  which,  however,  do 
not  appear  to  have  been  attended  with  great  fatality.  In  Magde- 
burg, Neustadt,  and  Buckau,  over  a  period  of  five  years,  1858-62, 
from  three  to  four  hundred  cases  of  illness  were  traceable  to  this 
cause.  ("  Die  Trichinen  Krankheit,"  Casper's  "  Vierteljahrsch.," 
April  1864,  p.  278.)  In  Burg  more  than  fifty  persons  suffered,  and 
eleven  died.  Other  fatal  cases  have  been  reported.  For  these  I 
must  refer  the  reader  to  Dr.  Shultze's  paper.  In  February,  1864,  a 
whole  family  was  poisoned  at  New  York,  and  one  member  died  from 
eating  part  of  a  ham,  whieli,  on  microscopic  examination,  was  found 
to  be  full  of  the  trichina  spiralis.  Death  was  referred  by  the  medi- 
cal attendant  to  this  cause. 
11 


162  EPIDEMIC    TRICHURIASIS. 

It  is  probable  that  some  unexplained  cases  of  death  from  irritation 
of  the  stomach  and  bowels,  simulating  chronic  irritant  poisoning, 
may  have  been  the  result  of  eating  food  containing  trichina  spiralis. 
Medical  men  have  been  unable  to  group  the  symptoms  under  any 
known  form  of  disease,  while  the  marks  of  irritation  and  inflam- 
mation in  the  mucous  membrane  of  the  bowels  have  given  strength 
to  the  supposition  that  poison  must  have  been  taken  by  the  deceased, 
although  chemical  analysis  had  failed  to  show  the  presence  of  any 
ordinary  poison  in  the  fluids  and  solids  of  the  body.  In  the  course 
of  many  years'  practice,  I  have  met  with  several  cases  of  this  descrip- 
tion, and  there  has  been  sometimes  manifested  a  disposition  to  doubt 
the  accuracy  of  chemical  analysis.  Dr.  Liicke  has  related  a  series 
of  fatal  cases  which  occurred  in  1845,  attributed  at  the  time  to  poison, 
which  as  he  suggests  were  most  probably  caused  by  the  use  of 
trichinous  food.  (Casper's  "  Vierteljahrschrift,"  January,  1861,  p. 
102.) 

As  means  of  distinction  from  irritant  poisoning  may  be  pointed 
out  the  long  time  wftch  commonly  elapses  between  the  taking  of  the 
food  and  the  commencement  of  the  symptoms.  The  pain,  vomiting, 
and  purging  are  comparatively  slight:  the  pain  is  in  the  bowels 
rather  than  in  the  stomach,  and  peritonitis,  pneumonia,  and  fever  are 
not  commonly  results  of  the  action  of  irritant  poisons,  while  they 
appear  to  be  constant  symptoms  in  trichiniasis.  The  absence  of 
ordinary  poison  in  the  food,  in  the  urine,  and  the  evacuations,  at  any 
stage,  may  also  be  taken  as  conclusive  evidence  against  irritant 
poisoning  in  its  usual  form. 

In  suspected  cases,  a  new  method  of  research  must  be  added  to 
those  already  in  use.  If  any  of  the  food  can  be  obtained,  this  must 
be  examined  for  the  parasite  by  the  aid  of  the  microscope.  If  the 
case  proves  fatal,  the  voluntary  muscles  of  the  deceased  must  undergo 
a  similar  examination. 

["  A  committee  was  appointed  some  time  since  by  the  Chicago 
Academy  of  Sciences  to  ascertain,  first,  whether  trichina?  actually 
exist  in  the  hogs  of  this  country,  and  in  those  of  the  Northwest  in 
particular;  and  secondly,  should  they  exist,  to  determine  the  extent 
of  the  danger  thereby  incurred,  and  to  ascertain  the  best  means  of 
averting  it.  For  the  attainment  of  the  first  object  portions  of  muscles 
from  1394  hogs  in  the  different  packing  houses  and  butcher  shops 
of  Chicago  have  been  examined,  and  the  results  presented  in  tables. 

These  tables  show  that  the  committee  "  have  found  trichinae  in  the 
muscles  of  twenty-eight  hogs  out  of  1394  examined.  We  may  there- 
fore conclude  that  in  the  hogs  brought  to  Chicago  one  in  fifty  is 
affected  with  trichiniasis  in  a  greater  or  less  degree.  We  must  con- 
fess our  surprise  at  arriving  at  this  result,  which  indicates,  with  little 
doubt,  the  startling  fact  that  trichiniasis  in  pork  is  even  more  com 
mon  in  this  country  than  in  Germany,  where  it  caused  so  much 
suffering  and  death.  For  instance,  in  the  city  of  Brunswick,  where 
a  most  careful  inspection  of  19,747  hogs  was  made  in  the  years 
1864-5,  only  two  were  found  to  contain  trichinae  in  their  muscles, 
the  proportion  being  1  to  10,000  against  1  to  50,  as  before  stated,  in 


POISONED    GAME.  1G3 

our  country.  The  comparative  immunity  from  disease  which  our 
own  people  have  enjoyed,  undoubtedly  results  from  our  habit  of 
cooking  meat  before  eating  it,  while  in  Germany  it  is  eaten  raw  by 
the  poorer  classes,  on  account  of  the  high  price  of  fuel." 

The  committee  have  found  the  spinal  muscles  more  liable  to  be 
infested  with  the  trichinae  than  other  muscles."' — P.] 

Putrescent  Food. — The  effects  of  disease  on  animal  food  must  not 
be  confounded  with  those  which  result  from  decay  or  putrefaction. 
The  flesh  of  the  most  healthy  animal  is  rendered  unfit  for  food  when 
it  has  passed  into  a  putrescent  state.  It  is  not  merely  unwholesome, 
but  highly  irritant,  causing  rapidly  vomiting,  purging,  pain,  and 
other  symptoms  of  a  severe  kind.  Fortunately  these  symptoms  lead 
at  once  to  the  expulsion  of  the  noxious  food  from  the  body,  and  the 
person  then  recovers :  the  young,  the  old,  and.  the  infirm  may,  how- 
ever, be  so  prostrated  by  vomiting  and  purging,  that  they  may  sink 
from  exhaustion.  Animal  matter  in  a  state  of  partial  decay,  or  in 
the  transition  stage  of  putrefaction,  must  be  regarded  as  of  a  poison- 
ous nature.  Much  of  the  cheap  butcher's  meat  sold  to  the  poor  is 
in  a  state  of  decay,  and  is  quite  unfit  for  human  food.  In  1868, 
11-1,000  pounds  of  diseased,  and  76,000  pounds  of  putrid  meat  were 
seized  and  condemned  in  the  city  of  London  alone.  In  January, 
1851,  the  family  of  a  surgeon  near  London,  were  all  affected  with 
symptoms  resembling  irritant  poisoning,  after  having  partaken  of  a 
hare  which  had  been  stewed  in  a  clean  earthen  vessel.  The  surgeon 
informed  me  that  on  the  second  day,  his  wife  was  seized  with  vomit- 
ing and  purging,  giddiness,  heat  in  the  throat,  and  general  numbness, 
with  inflamed  eyes.  Other  members  of  the  family  vomited,  and  in 
the  course  of  a  few  days  the  symptoms  disappeared.  I  examined 
the  vomited  matter,  and  found  it  to  consist  of  portions  of  the  hare 
partially  digested,  but  in  a  state  of  putrefaction,  so  that  there  was 
abundant  evidence  of  sulphuretted  hydrogen  in  the  liquid.  There 
was  no  mineral  poison  of  any  kind,  although  the  symptoms,  it  will 
be  observed,  were  rather  like  those  occasioned  by  arsenic.  It  had 
been  remarked  by  the  family,  that  a  silver  spoon,  which  had  been 
used  in  serving  out  this  unwholesome  food,  was  turned  of  a  brown 
color,  no  doubt  from  the  chemical  action  of  sulphuretted  hydrogen ; 
and  this  may  be  taken  as  a  good  domestic  test  of  the  putrefied  con- 
dition of  such  food.  Nature  generally  applies  an  appropriate  remedy, 
in  the  fact  that  the  food  itself  produces  copious  vomiting  and  purg- 
ing. 

Cases  of  this  kind  must  be  distinguished  from  those  in  which  poi- 
soned game  is  sold  to  the  public.  The  game  may  be  quite  free  from 
putrefaction,  but  noxious  from  the  poisoned  grain  which  may  have 
caused  death.  It  is  a  very  common  practice  to  steep  grain  in  a  solu- 
tion of  arsenic,  previous  to  sowing,  and  pheasants,  partridges,  and 
other  birds  may  be  accidentally  destroyed  by  eating  the  grain.  In 
some  instances,  grouse  and  other  game  are  maliciously  destroyed  by 
the  laying  of  corn,  saturated  with  arsenic  or  other  poisons,  in  the 

1  Medical  News  and  Library,  Philadelphia,  May,  1866. 


164  POISONED    GAME. 

localities  "where  the  birds  abound.  There  is  no  law  to  prevent  the 
sale  of  poisoned  game  by  poulterers,  and  there  is  no  precaution  which 
can  be  taken  by  the  purchasers,  except  by  observing  whether  the 
birds  have  or  have  not  been  shot.  (See  on  this  subject,  "  Ox  Poi- 
SONS;"  also  a  letter  by  Dr.  Fuller,  "  Med.  Gaz."  vol.  42,  p.  1036.) 

Mr.  Taylor,  of  Komsey,  has  directed  attention  (Sept.  1862)  to  the 
serious  symptoms  produced  by  Canadian  partridges  eaten  as  food.  A 
lady  who  had  partaken  of  this  food  was,  in  about  two  hours  and  a 
half,  attacked  with  the  following  symptoms.  She  had  sickness,  and 
became  insensible ;  the  skin  was  cold,  and  no  pulse  could  be  felt. 
She  was  in  a  hopeless  state  for  some  hours,  and  only  slowly  recov- 
ered. The  birds  were  quite  fresh,  having  been  packed  in  ice.  In 
another  case,  there  were  similar  symptoms  with  constriction  of  the 
throat  and  great  pain.  Animals  were  made  ill  by  this  food.  It  was 
believed  that,  in  these  cases,  the  birds  had  not  been  killed  by  poison, 
but  that  their  flesh  had  been  rendered  poisonous  by  some  vegetable 
which  they  had  eaten. 

[Frequent  cases  of  poisoning  from  eating  the  flesh  of  the  pheasant 
(Tetrao  umbellus)  have  occurred  in  the  United  States.  This  bird, 
during  the  winter  season,  has  sometimes  caused  dangerous  symptoms 
in  persons  who  have  eaten  it.  These  have  generally  been  attributed 
to  the  fact  of  the  bird  having  fed  upon  the  leaves  and  buds  of  the 
laurel  (kahnia),  and  many  facts  have  here  been  adduced  which  are 
considered  as  corroborating  this  opinion,  the  most  striking  of  which 
is  the  occurrence  of  the  leaves  of  the  plant  in  the  crops  of  the  birds. 
Notwithstanding  this  almost  universal  belief,  Dr.  Griffith,  in  the 
former  edition  of  this  work,  is  not  satisfied  with  this  explanation, 
but  is  inclined  to  attribute  it  to  some  change  in  the  flesh  analogous 
to  that  noticed  above,  as  taking  place  in  other  meats,  since  the  symp- 
toms are  almost  identical,  and  these  cases  are  rare,  whilst  nearly  all 
these  birds  feed  on  the  laurel,  when  the  ground  is  covered  with  snow 
and  other  food  cannot  be  readily  obtained. — H.] 


SYMPTOMS    OF    POISONING    WITH    OPIUM.  165 


NEUROTIC    POISONS. 

(NARCOTIC  OR  CEREBRAL  POISONS.) 


CHAPTEE   XVI. 

Opium. — symptoms.  —  appearances.  —  its  action  on  infants. — 
poisoning  with  opiate  compounds. — morphia  and  its  salts. — 
process  for  detecting  opium  in  organic  mixtures. 

Opium. 

Symptoms. — The  symptoms  which  manifest  themselves  when  a 
large  dose  of  opium  or  its  tincture  has  been  taken,  are  in  general  of 
a  uniform  character.  They  are — giddiness,  drowsiness,  a  strong 
tendency  to  sleep,  stupor,  succeeded  by  perfect  insensibility,  the 
person  lying  motionless,  with  the  eyes  closed  as  if  in  a  sound  sleep. 
In  this  state  he  may  be  easily  roused  by  a  loud  noise,  and  made  to 
answer  a  question:  but  he  speedily  relapses  into  stupor.  In  a  later 
stage,  when  coma  has  supervened  with  stertorous  breathing,  it  will 
be  difficult,  if  not  impossible  to  rouse  him.  The  pulse  is  at  first 
small,  quick,  and  irregular,  the  respiration  hurried,  and  the  skin 
warm  and  bathed  in  perspiration,  sometimes  livid:  but  when  the 
person  becomes  comatose,  the  breathing  is  slow  and  stertorous ;  the 
pulse  slow  and  full.  The  skin  is  occasionally  cold  and  pallid.  The 
pupils,  in  the  early  stage,  are  contracted;  in  the  later  stage,  and 
when  progressing  to  a  fatal  termination,  they  may  be  found  dilated. 
In  a  case  referred  to  me  in  1846,  one  pupil  was  contracted  and  the 
other  dilated.  In  infants  and  children  they  are  generally  much  con- 
tracted. They  are  commonly  insensible  to  light.  The  expression 
of  the  countenance  is  placid,  pale,  and  ghastly:  the  eyes  are  heavy, 
and  the  lips  are  livid.  Sometimes  there  is  vomiting,  or  even 
purging;  and,  if  vomiting  takes  place  freely  before  stupor  sets  in, 
there  is  great  hope  of  recovery.  This  symptom  is  chiefly  observed 
when  a  large  dose  of  opium  has  been  taken;  and  it  may  then  be, 
perhaps,  ascribed  to  the  mechanical  effect  of  the  poison  on  the 
stomach.  The  peculiar  odor  of  opium  is  occasionally  perceptible  in 
the  breath.  Nausea,  and  vomiting,  with  headache,  loss  of  appetite 
and  lassitude,  often  follow  on  recovery.  In  cases  likely  to  prove 
fatal,  the  muscles  of  the  limbs  feel  flabby  and  relaxed,  the  lower 
jaw  drops,  the  pulse  is  feeble  and  imperceptible,  the  sphincters  are 
in  a  state  of  relaxation,  the  pupils  are  unaffected  by  light,  the  tern- 


166  POISONING    WITH    OPIUM. 

perature  of  the  body  is  low,  there  is  a  loud  mucous  rattle  in  breath- 
ing, and  convulsions  are  sometimes  observed  before  death,  but  more 
commonly  in  children  than  in  adults.  One  of  the  marked  effects  of 
this  poison  is  to  suspend  all  the  secretions  except  that  of  the  skin. 
Even  during  the  lethargic  state,  the  skin,  although  cold,  is  often 
copiously  bathed  in  perspiration.  It  is  a  question  yet  to  be  deter- 
mined, whether  this  may  not  be  a  medium  by  which  the  poison  is 
principally  eliminated.  The  contracted  state  of  the  pupils  has  been 
hitherto  considered  to  furnish  a  valuable  distinctive  sign  of  poison- 
ing with  opium  or  the  salts  of  morphia.  In  relying  upon  it,  it  is 
necessary  to  bear  in  mind  the  fact  pointed  out  by  Dr.  Wilks,  that, 
in  apoplexy,  which  is  seated  in  the  pons  Varolii,  the  pupils  are  also 
contracted.  He  describes  two  cases  of  this  form  of  apoplexy  which 
were  mistaken  for  poisoning  by  opium  in  consequence  of  this  con- 
dition of  the  pupils.  ("Med.  Times  and  Gaz.,"  1863,  1,  p.  214.)  The 
symptoms  above  described  usually  commence  in  from  half  an  hour  to 
an  hour  after  the  poison  has  been  swallowed.  Sometimes  they  come 
on  in  a  few  minutes,  especially  in  children;  and  at  other  times  their 
appearance  is  protracted  for  a  long  period. 

Appearances. — In  a  case  which  proved  fatal  in  fifteen  hours,  the 
vessels  of  the  head  Avere  found  unusually  congested  throughout.  On 
the  surface  of  the  fore  part  of  the  left  hemisphere,  there  was  an 
ecchymosis,  apparently  produced  by  the  effusion  of  a  few  drops  of 
blood.  There  were  numerous  bloody  points  on  the  cut  surface  of 
the  brain: — there  was  no  serum  collected  in  the  ventricles.  The 
stomach  was  quite  healthy.  Fluidity  of  the  blood  is  mentioned  as  a 
common  appearance  in  cases  of  poisoning  by  opium.  There  is  also 
engorgement  of  the  lungs:  most  frequently  observed,  according  to 
Dr.  Christison,  in  those  cases  which  have  been  preceded  by  convul- 
sions. (Op.  cit.,  p.  732.)  Among  the  external  appearances  there  is 
often  great  lividity  of  the  skin.  Extravasation  of  blood  on  the 
brain  is  rarely  seen;  serous  effusions  in  the  ventricles,  or  between 
the  membranes,  are  sometimes  met  with.  The  stomach  is  so  seldom 
found  otherwise  than  in  a  healthy  state,  that  the  inflammatory  red- 
ness said  to  have  been  occasionally  seen,  may  have  been  due  to  acci- 
dental causes.  From  this  account  of  the  appearances  in  the  dead 
body,  it  will  be  seen  that  there  is  nothing  but  a  fulness  of  the  ves- 
sels of  the  brain,  which  can  be  looked  upon  as  specially  indicative 
of  poisoning  by  opium,  and  even  this  is  not  always  present. 

The  medicinal  dose  of  opium,  in  extract  or  powder  for  a  healthy 
adult,  varies  from  half  a  grain  to  two  grains.  Five  grains  would  be 
a  very  full  dose.  The  medicinal  dose  of  the  tincture  (laudanum)  is 
from  ten  minims  to  one  drachm — as  an  average,  from  thirty  to  forty 
minims.  The  smallest  dose  of  solid  opium  which  has  been  known  to 
prove  fatal  to  an  adult,  was  in  a  case  reported  by  Dr.  Sharkey,  of 
Jersey.  A  man,  set.  32,  died  very  speedily  in  a  convulsive  lit.  after 
having  taken  two  pills,  each  containing  about  one  grain  and  a  quar- 
ter of  extract  of  opium.  This  quantity  is  equivalent  to  four  7 
of  crude  opium.  ("Med.  da/.,"'  vol.  37,  p.  236.)  The  smallest  fatal 
do,  (  of  llit  tincture  in  an  adult,  which  I  have  found  recorded,  is  tico 


POISONING    WITH    MORPHIA.  167 

drachms.  ("Ed.  Med.  and  Surg.  Journ.,"  July,  1840.)  In  connection 
with  this  subject,  it  is  important  for  a  medical  jurist  to  bear  in  mind 
that  infants  and  young  persons  are  liable  to  be  killed  by  very  small 
doses  of  opium;  they  appear  to  be  peculiarly  susceptible  of  the 
effects  of  this  poison.  The  syrup  of  poppies,  paregoric  elixir,  God- 
frey's cordial,  and  Dalby's  carminative,  owe  their  narcotic  effects  to 
the  presence  of  opium.  The  symptoms  and  appearances  which  they 
produce  when  taken  in  a  large  dose  are  similar  to  those  caused  by 
opium  or  its  tincture. 

It  has  been  remarked,  that  most  cases  of  poisoning  by  opium  prove 
fatal  in  from  about  six  to  twelve  hours.  They  who  recover  from  the 
stupor,  and  survive  longer  than  this  period,  generally  do  well ;  but 
there  may  be  a  partial  recovery,  or  a  remission  of  the  symptoms, 
and  afterwards  a  fatal  relapse.  The  symptoms,  however,  generally 
progress  steadily  to  a  fatal  termination,  or  the  stupor  suddenly  dis- 
appears, vomiting  ensues,  and  the  person  recovers.  Several  instances 
are  recorded  of  this  poison  having  destroyed  life  in  from  seven  to 
nine  hours.  One  has  occurred  within  my  knowledge,  in  which  an 
adult  died  in  five  hours  after  taking  the  drug  prescribed  for  him 
by  a  quack.  Dr.  Christison  met  with  a  case  which  could  not  have 
lasted  above  five,  and  another  is  mentioned  by  him  which  lasted  only 
three  hours.  Mr.  Barwis,  of  Melton,  communicated  to  me  the  case 
of  an  adult  (November,  1863)  which  proved  fatal  in  three  hours  and 
a  half. 

Morphia  audits  Salts. — Morphia  is  the  poisonous  alkaloid  of  opium, 
of  which  it  forms  from  five  to  ten  per  cent.  The  two  principal  salts 
of  this  alkaloid  are  the  hydrochlorate  and  the  acetate.  Opium  owes 
its  narcotic  properties  chiefly  to  the  presence  of  morphia  in  combi- 
nation with  meconic  acid.  A  dose  of  one  grain  of  a  salt  of  morphia 
has  destroyed  life. 

Chemical  Analysis.  Opium. — There  are  no  means  of  detecting 
opium  itself,  either  in  its  solid  or  liquid  state,  except  by  its  smell 
and  other  physical  properties,  or  by  giving  a  portion  of  the  suspected 
substance  to  an  animal,  and  observing  whether  any  narcotic  effects 
are  produced.  The  smell  is  said  to  be  peculiar,  but  a  similar  smell 
is  possessed  by  lactucarium,  which  contains  neither  meconic  acid  nor 
morphia.  The  odor  is  a  good  concomitant  test  of  the  presence  of  the 
drug,  whether  it  be  in  a  free  state,  or  dissolved  in  alcohol  or  water, 
but  it  is  not  perceptible  when  the  solution  is  much  diluted.  The 
analysis  in  cases  of  poisoning  by  opium,  is  therefore  limited  to  the 
detection  of  morphia  and  the  acid  with  which  it  is  combined,  meco- 
nic acid. 

Morphia. — Morphia  may  be  identified  by  the  following  properties: 
1.  It  crystallizes  in  small  prisms,  which  are  white  and  perfect,  ac- 
cording to  their  degree  of  purity.  These  crystals  may  be  obtained 
by  adding  weak  ammonia  to  a  solution  of  morphia  in  hydrochloric 
acid.  (See  the  illustration,  Fig.  18.)  2.  When  heated  on  platinum, 
the  crystals  melt,  become  dark-colored,  and  burn  like  a  resin  with  a 
yellow  smoky  flame,  leaving  a  carbonaceous  residue.     If  this  ex- 


168  OPIUM.      CHEMICAL    ANALYSIS. 

periment  is  performed  in  a  small  reduction-tube,  it  will  be  found,  by 
employing  test-paper,  that  ammonia  is  one  of  the  products  of  decom- 
position. 3.  It  is  scarcely  soluble  in  cold 
water,  as  it  requires  1000  parts  to  dissolve 
it ;  it  is  soluble  in  100  parts  boiling  wa- 
ter, and  the  hot  solution  has  a  faint  alka- 
line reaction.  By  its  insolubility  in  wa- 
ter, it  is  readily  known  from  its  salts.  It 
is  not  very  soluble  in  ether,  thus  differ- 
ing from  narcotina ;  but  it  is  dissolved  by 
forty  parts  of  cold,  and  rather  less  than 
this  quantity  of  boiling  alcohol.  It  is 
dissolved  by  a  solution  of  potash  or  soda, 
from  which  it  cannot  be  removed  by 
Crystals  of  MorpWa  obtained  by  add-  ether.  It  is  very  soluble  in  acetic  ether, 
ing  ammonia  to  a  solution  of  the    ant|  this  liquid  has  been  employed  as  a 

hydrochlorate,  magnified  121  diam-      substitute  for  ether  in  procuring  morphia 

from  organic  liquids.  4.  It  is  easily  dis- 
solved by  a  very  small  quantity  of  all  diluted  acids,  mineral  and 
vegetable.  5.  Morphia  and  its  solutions  have  a  bitter  taste.  6.  The 
salts  of  morphia  are  not  precipitated  in  a  crystalline  form  by  solutions 
of  sulphocyanide  of  potassium,  ferric yanide  of  potassium,  nor  chro- 
mate  of  potash.  In  this  respect  they  are  strikingly  distinguished  from 
the  salts  of  strychnia,  which  give  well-marked  crystalline  precipitates 
with  these  three  reagents.  Like  all  alkaloids,  the  morphia  in  solution 
is  thrown  down  white  by  the  chloriodide  of  potassium  and  mercury 
(made  by  dissolving  sixteen  grains  of  corrosive  sublimate  and  sixty 
grains  of  iodide  of  potassium  in  four  ounces  of  water).  This  liquid 
precipitates  albumen,  hence  this  substance,  if  present,  should  be  sepa- 
rated by  boiling  before  applying  the  test. 

Tests. — In  order  to  apply  the  chemical  tests  for  morphia,  the  alka- 
loid may  be  dissolved  in  a  few  drops  of  a  diluted  acid,  either  the 
acetic  or  the  hydrochloric.  If  the  hydrochlorate  or  the  acetate  of 
morphia  is  presented  for  analysis,  the  salt  may  be  at  once  dissolved 
in  a  small  quantity  of  boiling  water.  The  tests  for  this  alkaloid  are 
the  following :  1.  Nitric  acid.  This,  when  added  to  a  moderately 
strong  solution  of  a  salt  of  morphia,  produces  slowly  a  deep  orange- 
red  color.  If  added  to  the  crystals  of  morphia  or  its  salts,  deutoxide 
of  nitrogen  is  evolved;  the  morphia  is  entirely  dissolved,  and  the 
solution  acquires  instantly  the  deep  red  color  above  described;  be- 
coming, however,  lighter  by  standing.  In  order  that  this  effect  should 
follow,  the  solution  of  morphia  must  not  be  too  much  diluted,  and 
the  acid  must  be  strong  and  added  in  pretty  large  quantity.  The 
color  is  rendered  much  lighter  by  boiling;  therefore  the  test  should 
never  be  added  to  a  hot  solution.  2.  Perchhride  of  iron  (sesqui- 
chloride),  or  colorless  persulphate.  Either  of  these  solutions,  when 
saturated  and  neutralized  (by  a  small  quantity  of  potash,  if  necessa- 
ry), produces  an  inky-blue  color  in  a  solution  of  morphia.  If  the 
quantity  of  morphia  is  small,  or  the  test  has  a  deep  red  or  yellow 
tint,  the  color  is  greenish.     The  blue  color  is  entirely  destroyed  by 


TESTS    FOR    MORPHIA    AND    MECONIC    ACID.  169 

acids,  and  is  also  destroyed  by  heat ;  thus  the  iron-test  should  never 
be  employed  with  a  very  acid  or  a  very  hot  solution  of  a  salt  of  mor- 
phia. It  may  be  observed,  that  the  blue  given  by  the  test  in  a  solution 
of  morphia,  is  entirely  destroyed  by  nitric  acid  and  replaced  by  an 
orange-red  color,  so  that  the  nitric  acid  will  act  through  the  iron-test, 
but  not  vice  versa.  In  this  way  two  tests  may  be  applied  to  one 
quantity  of  liquid.  3.  Iodic  acid.  Morphia  in  the  solid  state  or  in 
solution,  decomposes  this  acid,  taking  its  oxygen,  and  setting  free 
iodine.  In  order  to  make  this  evident,  the  iodic  acid  should  be  first 
mixed  with  starch ;  and  a  part  of  this  mixture  only,  added  to  the 
suspected  solution — part  being  reserved,  to  allow  of  a  comparison. 
(If  the  iodic  acid  be  added  to  a  solution  of  morphia  without  starch, 
the  liquid  becomes  brown  and  smells  of  iodine.)  When  the  quant  it  y 
is  very  small,  there  is  only  a  reddish  or  purple  tint  slowly  produced  : 
when  large,  the  dark-blue  iodide  of  farina  is  formed  in  a  few  seconds. 
The  color  being  destroyed  by  heat,  the  test  must  not  be  added  to  a 
hot  solution.  The  test  succeeds  equally  well  with  morphia  or  its 
salts,  when  unmixed  with  organic  matter.  4.  Sulphuric  acid  and 
bichromate  of  yjotash.  When  strong  sulphuric  acid  is  poured  on  pure 
morphia  in  a  solid  state,  there  is  either  no  effect,  or  the  alkaloid 
acquires  a  light  pinkish  color.  On  adding  to  this  a  drop  of  solution 
of  bichromate  of  potash,  or  a  small  fragment  of  a  crystal,  it  imme- 
diately becomes  green  (from  oxide  of  chromium),  and  retains  this 
color  for  some  time. 

Meconic  Acid. — This  is  a  solid  crystalline  acid,  seen  commonly  in 
scaly  crystals  of  a  pale  reddish  color.  It  is  combined  with  morphia 
in  opium,  of  which,  according  to  Mulder,  it  forms  on  an  average  six 
per  cent. ;  and  it  serves  to  render  this  alkaloid  soluble  in  water  and 
other  menstrua.  Tests. — Many  tests  have  been  proposed  for  meconic 
acid ;  but  there  is  only  one  upon  which  any  reliance  can  be  placed, 
namely,  the  perchloride  or  persulphate  of  iron.  This  test  produces, 
even  in  a  diluted  solution  of  meconic  acid,  a  deep  red  color ;  and  it 
is  owing  to  the  presence  of  this  acid  that  a  salt  of  iron  strikes  a  red 
color  in  tincture  and  infusion  of  opium,  as  well  as  in  all  liquids  con- 
taining traces  of  meconate  of  morphia,  the  effects  of  the  iron-test 
with  morphia  being  counteracted  by  the  presence  of  meconic  acid. 
The  red  color  of,  the  meconate  of  iron  is  not  easily  destroyed  by 
diluted  mineral  acids,  by  a  solution  of  corrosive  sublimate,  or  by 
chloride  of  gold,  but  it  is  by  sulphurous  acid  and  chloride  of  tin. 
In  liquids  containing  tannic  acid,  e.  g.,  tea  or  beer,  the  action  of  this 
test  is  obscured. 

Detection  of  Opium  in  Organic  Mixtures. — Opium  itself  may  be 
regarded  as  an  organic  solid,  containing  the  poisonous  salt  which  Ave 
wish  to  extract.  It  is  not  often  that,  in  fatal  cases  of  poisoning  by 
opium  or  its  tincture,  even  when  these  are  taken  in  large  quantity 
and  death  is  speedy,  we  can  succeed  in  detecting  meconate  of  morphia 
in  the  stomach.  The  poison  is  probably  removed  by  vomiting  or 
absorption.  If  the  matter  is  solid,  it  should  be  cut  into  small  slices; 
if  liquid,  evaporated  to  an  extract ;  and,  in  either  case,  digested  with 
a  large  quantity  of  rectified  spirit  slightly  acidulated  with  acetic 


170  PRUSSIC    ACID.      SYMPTOMS. 

acid.  The  residue  should  be  well  pressed  in  linen;  the  alcoholic 
liquid  should  then  be  evaporated  in  a  water-bath  until  it  is  almost 
dry.  The  residue  should  be  digested  in  water  filtered  and  treated 
with  acetate  of  lead,  until  there  is  no  further  precipitation.  This 
liquid  should  be  boiled  and  filtered :  meconate  of  lead  is  left  on  the 
filter,  while  any  morphia  passes  through  under  the  form  of  acetate. 
The  surplus  acetate  of  lead,  dissolved  in  the  filtered  liquid  (containing 
the  morphia)  should  now  be  precipitated  by  a  current  of  sulphuretted 
hydrogen— the  black  sulphide  of  lead  separated  by  filtration,  and 
the  filtered  liquid  evaporated  at  a  very  gentle  heat  to  an  extract,  so 
that  any  sulphuretted  hydrogen  may  be  entirel}*  expelled.  On  treat- 
ing this  extract  with  alcohol,  the  acetate  of  morphia,  if  present  in 
sufficient  quantity,  may  be  dissolved  out  and  tested.  If  the  alcoholic 
liquid  is  still  much  colored,  it  may  be  again  evaporated  and  taken 
up  by  water.  Animal  charcoal  deprives  it  of  color,  but  at  the  same 
time  removes  the  morphia  if  this  is  in  small  quantity.  If  there  is  a 
sufficient  quantity  of  pure  acetate  present,  the  addition  of  a  drop  of 
solution  of  ammonia  to  a  portion  of  the  liquid  on  a  slide,  will  pro- 
duce crystals  of  the  form  of  slender  prisms  which  are  somewhat  deli- 
quescent (see  Fig.  18).  The  remainder  may  be  tested  by  the  nitric 
and  iodic  acids.  The  meconate  of  lead  left  on  the  filter  is  readily 
decomposed  by  boiling  it  with  a  small  quantity  of  diluted  sulphuric 
acid  ;  and  in  the  filtered  liquid,  neutralized  if  necessary  by  an  alkali, 
the  meconic  acid  is  easily  detected  by  the  iron-test. 


CHAPTER    XVII. 

prussic  acid. — symptoms  and  appearances. — tests  for  the  acid 
— process  for  organic  mixtures. — cyanide  of  potassium. — 
essential  oil  of  bitter  almonds. — xitrobenzole. 

Hydrocyanic  or  Peussic  Acid. 

Symptoms. — This  acid  has  a  hot  bitter  taste  and  an  odor  resem- 
bling that  of  bitter  almonds  diluted.  The  time  at  which  the  symp- 
toms of  poisoning  commence  varies,  but  it  is  generally  within  a  few 
minutes  after  the  poison  has  been  swallowed.  When  a  large  dose 
has  been  taken,  as  from  half  an  ounce  to  an  ounce  of  diluted  acid, 
the  symptoms  usually  commence  in  the  act  of  swallowing,  or  within 
a  few  seconds.  It  is  rare  that  their  appearance  is  delayed  beyond 
one  or  two  minutes.  When  the  patient  has  been  seen  at  this  period, 
he  has  been  perfectly  insensible,  the  eyes  fixed  and  glistening,  the 
pupils  dilated  and  unaffected  by  light,  the  limbs  flaccid,  the  skin  cold 
and  covered  with  a  clammy  perspiration  ;  there  is  convulsive  breath- 
ing at  long  intervals,  and  the  patient  appears  dead  in  the  intermedi- 
ate period;  the  pulse  is  imperceptible,  and  involuntary  evacuations 


PRUSSIC    ACID.      FATAL    DOSE.  171 

are  occasional^  passed.  The  respiration  is  slow,  deep,  gasping,  and 
occasionally  heaving,  or  sobbing.  It  is  generally  convulsive,  but 
when  the  coma  or  insensibility  is  profound,  it  may  be  stertorous. 
This  was  observed  in  a  case  which  occurred  to  Dr.  Christison.  ("  Ed- 
inburgh Monthly  Journal,"  February,  1850,  p.  97.)  Convulsions  of 
the  limbs  and  body  with  a  spasmodic  closure  of  the  jaw  are  some- 
times noticed  among  the  symptoms. 

Appearances. — The  body  when  seen  soon  after  death  often  exhales 
the  odor  of  prussic  acid  ;  but  if  it  has  remained  exposed  before  it  is 
seen,  and  if  it  has  been  exposed  to  the  open  air  or  in  a  shower  of 
rain,  the  odor  may  not  be  perceptible ;  again  the  odor  may  be  con- 
cealed by  tobacco-smoke,  peppermint,  copaiba,  or  other  powerful 
odors. 

Externally,  the  skin  is  commonly  livid,  or  is  tinged  of  a  violet 
color ;  the  nails  are  blue,  the  fingers  clenched,  and  the  toes  con- 
tracted; the  jaws  firmly  closed,  with  foam  or  froth  about  the  mouth, 
the  face  often  pale,  but  sometimes  bloated  and  swollen,  and  the  eyes 
have  been  observed  to  be  wide  open,  fixed,  glassy,  very  prominent 
and  glistening  with  the  pupils  dilated;  but  a  similar  condition  of  the 
eyes  has  been  observed  in  other  kinds  of  violent  death.  Internally, 
the  venous  s}rstem  is  gorged  with  dark-colored  liquid  blood;  the 
stomach  and  intestines  may  be  in  their  natural  state  ;  but  in  several 
instances  they  have  been  found  more  or  less  congested.  The  mucous 
membrane  of  the  stomach  of  a  dog  which  died  in  a  few  minutes  from 
a  dose  of  three  drachms  of  Scheele's  acid,  was  intensely  reddened 
throughout,  presenting  the  appearance  met  with  in  arsenical  poison- 

The  smallest  dose  of  this  acid  which  is  reported  to  have  caused 
death,  was  in  a  case  which  occurred  to  Mr.  Hicks.  ("  Med.  Graz." 
vol.  35,  p.  896.)  A  healthy  adult  woman,  died  in  twenty  minutes 
from  a  dose  equivalent  to  nine-tentJis  of  a  grain  of  anhydrous  prussic 
acid.  This  corresponds  to  about  twenty  grains  of  Scheele's  acid.  In 
a  case  reported  by  Mr.  T.  Taylor  ("Med.  Gaz."  vol.  36,  p.  104),  a 
stout  healthy  man  swallowed  this  dose,  i.  e.  nine-tenths  of  a  grain, 
by  mistake,  and  remained  insensible  for  four  hours,  when  he  vomited 
and  began  to  recover.  From  the  facts  hitherto  observed,  we  shall 
not  be  wrong  in  assuming  that  a  quantity  of  Scheele's  acid  (at  five 
per  cent.)  above  twenty  grains  (i.  e.  one  grain  of  anhydrous  acid),  or 
an  equivalent  portion  of  any  other  acid,  would  commonly  suffice  to 
destroy  the  life  of  an  adult.  This  I  believe  to  be  the  nearest  ap- 
proach that  we  can  make  to  the  smallest  fatal  dose. 

When  a  dose  of  two  drachms  and  upwards  has  been  taken,  we 
may  probably  take  the  average  period  for  death  at  from  two  to  ten 
minutes.  In  Mr.  Hicks'  case,  twenty  grains  of  Scheele's  acid  de- 
stroyed life  in  twenty  minutes.  It  is  only  when  a  dose  is  just  in  a 
fatal  proportion,  that  we  find  a  person  to  survive  from  half  an  hour 
to  an  hour.  In  this  respect,  death  by  prussic  acid  is  like  death  by 
lightning,  the  person  in  general  either  dies  speedily  or  recovers 
altogether. 

Chemical  Analysis. — Prussic  acid  is  limpid  like  water;  it  possesses 


172 


CHEMICAL    ANALYSIS. 


a  faint  acid  reaction,  and  its  vapor  lias  a  peculiar  odor,  which  when 
the  acid  is  concentrated,  although  not  at  first  perceptible,  is  sufficient 
to  produce  giddiness,  insensibility,  and  other  alarming  symptoms. 
The  tests  which  are  best  adapted  for  the  detection  of  this  poison, 
either  in  liquid  or  vapor,  are  equally  applicable  whether  the  acid  is 
concentrated  or  diluted,  and,  so  far  as  the  detection  of  the  vapor  is 
concerned,  whether  the  acid  is  pure  or  mixed.  In  the  simple  state, 
the  tests  are  three  in  number  :  the  /Silver,  the  Iron,  and  the  Sulphur 
tests.  1.  The  Silver  Test.  Nitrate  of  Silver. — This  yields,  with  prussic 
acid,  a  dense  white  precipitate,  speedly  subsiding  in  heavy  clots  to 
the  bottom  of  the  vessel,  and  leaving  the  liquid  almost  clear.  The 
precipitate  is  identified  as  cyanide  of  silver  by  the  following  proper- 
ties :  a.  It  is  insoluble  in  cold  nitric  acid  ;  but  when  drained  of  water, 
and  a  sufficient  quantity  of  strong  acid  is  added,  it  is  easily  dissolved 
on  boiling,  b.  It  evolves  prussic  acid  when  digested  in  hydrochloric 
acid.  c.  The  precipitate,  when  well  dried,  and  heated  in  a  small  re- 
duction-tube, yields  cyanogen,  which  may  be  burnt  as  it  issues,  pro- 
ducing a  rose-red  flame  with  a  blue  halo.  This  is  a  well-marked 
character,  and  at  once  identifies  the  acid  which  yielded  the  precipi- 
tate as  prussic  acid.  For  the  detection  of  prussic  acid  in  vapor,  hold 
over  the  liquid  a  watch-glass  moistened  in  the  centre  with  a  drop  of 
a  solution  of  nitrate  of  silver.  Cyanide  of  silver,  indicated  by  the 
formation  of  an  opaque  white  film  in  the  solution  is  immediately 
produced,  if  only  in  a  moderate  state  of  concentration.     One  drop 

of  a  diluted  acid  containing  less  thanl-50th 
of  a  grain  of  the  anhydrous  acid  produces 
speedily  a  visible  effect.  When  the  prussic 
acid  is  more  diluted,  a  few  minutes  are  re- 
quired ;  and  the  opaque  film  begins  to 
show  itself  at  the  edges  of  the  silver  solu- 
tion. In  this  case  the  action  may  be  ac- 
celerated by  the  heat  of  the  hand.  If  the 
vapor  is  allowed  to  reach  the  nitrate  of  sil- 
ver gradually  and  much  diluted  with  air, 
then  instead  of  an  opaque  film  of  cyanide 
of  silver,  crystals  well  defined  under  the 
microscope  will  be  slowly  produced,  and 
these  will  constitute  an  additional  proof  of 
the  presence  of  the  acid  in  a  state  of  vapor. 
As  shown  in  the  illustration,  Fig.  19,  these 
crystals  have  the  form  of  slender  prisms  with  oblique  terminations. 
They  often  hang  together  in  groups,  and  generally  require  a  high 
magnifying  power  to  render  them  visible.  2.  The  Iron-Test. — The 
object  of  the  application  of  this  test,  is  the  production  of  Prussian 
Blue.  Add  to  a  small  quantity  of  the  suspected  poisonous  liquid  a 
few  drops  of  potash  and  of  a  solution  of  green  sulphate  of  iron.  A 
dirty  green  or  brownish  precipitate  falls;  on  shaking  this  for  a  few- 
minutes,  and  then  adding  dilute  hydrochloric  or  sulphuric  acid,  the 
liquid  becomes  blue;  and  Prussian  blue,  of  its  well-known  color, 
unaffected  by  diluted  acids,  subsides,     o.  The  Sulphur  Test. — Some 


Crystals  of  Cyanide  of  Silver  from 
the  vapor  of  prussic  acid,  magnified 
124  diameters. 


PEUSSIC    ACID    IN    ORGANIC    LIQUIDS.  173 

years  since  Liebig  proposed  the  following  process  for  detecting  prussic 
acid  as  a  liquid.  ("  Oesterreichische  Med.  Wochenschrift,"  Marz  27, 
1847,  p.  396.)  If  a  small  quantity  of  the  bisulphide  of  ammonia  is 
added  to  a  few  drops  of  a  solution  of  prussic  acid,  and  the  mixture 
is  gently  warmed,  it  becomes  colorless,  and,  on  evaporation,  leaves 
crystals  of  sulphocyanate  of  ammonia — the  sulphocyanic  acid  being 
indicated  by  the  intense  blood-red  color  produced  on  adding  to  the 
dry  residue  a  solution  of  a  nearly  neutral  persalt  of  iron :  this  red 
color  immediately  disappears  on  adding  a  few  drops  of  a  solution  of 
corrosive  sublimate. 

The  great  utility  of  the  sulphur-test,  however,  is  in  its  application 
to  the  detection  of  the  minutes  portion  of  prussic  acid  when  in  a 
state  of  vapor.  In  this  respect  it  surpasses  any  other  process  yet 
discovered.  In  order  to  apply  it,  we  place  the  diluted  prussic  acid 
in  a  watch-glass,  and  invert  over  it  another  watch-glass,  having  in  its 
centre  one  drop  of  the  bisulphide  of  ammonium.  No  change  appa- 
rently takes  place  in  the  sulphide ;  but  if  the  upper  watch-glass  is 
removed  after  the  lapse  of  from  half  a  minute  to  ten  minutes,  ac- 
cording to  the  quantity  and  strength  of  the  prussic  acid  present, 
crystallized  sulphocyanate  of  ammonia  will  be  obtained  on  gently 
evaporating  the  drop  of  liquid  to  dryness.  With  an  acid  of  from 
three  to  five  per  cent,  the  action  is  completed  in  ten  seconds.  The 
addition  of  one  drop  of  the  neutral  persulphate  of  iron  (free  from 
nitric  acid),  to  the  dried  residue,  brings  out  the  blood-red  color  in- 
stantly, which  is  intense  in  proportion  to  the  quantity  of  sulphoc}^a- 
nate  present.  I  have  elsewhere  made  some  remarks  on  the  applica- 
tion of  this  process  for  the  detection  of  prussic  acid.  (See  "  Med. 
Gaz."  1847,  vol.  39,  p.  765.) 

Prussic  Acid  in  Organic  Liquids.  Detection  by  vapor  without  distilla- 
tion.— The  organic  liquid  may  be  placed  in  a  wide-mouthed  bottle,  to 
which  a  watch-glass  has  been  previously  fitted  as  a  cover.  The  ca- 
pacity of  the  bottle  may  be  such  as  to  allow  the  surface  of  the  liquid 
to  be  within  one  or  two  inches  of  the  concave  surface  of  the  watch- 
glass.  The  solution  of  Nitrate  of  silver  is  then  used  as  a  trial-test 
for  the  vapor  in  the  manner  above  described.  If  the  l-200th  of  a 
grain  of  prussic  acid  is  present,  and  not  too  largely  diluted,  it  will 
be  detected  (at  a  temperature  of  60°)  by  the  drop  of  nitrate  of  silver 
being  converted  into  an  opaque  white  or  crystalline  film  of  cyanide 
of  silver,  the  chemical  change  commencing  at  the  margin.  We  may 
then  substitute  for  the  nitrate  of  silver  the  bisulphide  of  ammonium 
and  proceed  in  the  manner  above  described.  It  may  be  sometimes 
necessary  to  place  the  bottle  in  a  basin  of  warm  water.  If  the  solu- 
tion of  silver  is  tarnished  by  sulphuretted  hydrogen,  as  a  result  of 
putrefaction,  the  sulphur-test  alone  should  be  used.  By  this  process 
I  have  detected  prussic  acid  in  the  stomach  of  a  person  poisoned  by 
it,  as  late  as  twelve  days  after  death.  After  the  stomach  had  been 
exposed  for  a  few  days  longer,  the  acid  had  entirely  disappeared. 

If  traces  of  the  poison  are  found  then  the  organic  liquid  should 
be  distilled  in  a  water-bath,  at  ^12°,  and  about  one-sixth  or  one- 


174  POISONING    WITH    CYANIDE    OF    POTASSIUM. 

eighth  of  the  contents  of  the  retort,  collected  in  a  receiver  kept  cool 
by  water.     The  test  may  now  be  applied  to  the  distilled  liquid. 

In  the  Tissues. — Soon  after  death  the  poison  may  be  easily  detected 
in  the  blood,  secretions,  or  any  of  the  soft  organs,  by  placing  them 
in  a  bottle,  and  collecting  the  vapor  in  the  manner  already  described. 
This  will  be  found  to  be  far  more  convenient  and  satisfactory  than 
the  process  by  distillation.  In  the  case  of  a  dog  poisoned  by  a  large 
dose  of  prussic  acid,  Mr.  Hicks  brought  to  me  the  stomach  after  it 
had  been  exposed  twenty-four  hours,  and  thoroughly  washed  under 
a  current  of  water,  and  yet  the  poison  was  really  detected  by  placing 
the  whole  organ  in  a  bottle,  and  absorbing  the  vapor  by  nitrate  of 
silver.  This  shows  how  completely  the  animal  tissues  at  death  are 
penetrated  by  prussic  acid,  and  how  firmly  for  a  time  it  is  retained 
by  them.  The  poison  has  been  thus  discovered,  in  experiments  on 
animals,  in  the  blood  and  in  the  serous  exhalation  of  the  chest. 

If  the  body  is  in  a  putrefied  state  the  prussic  acid  may  have  been 
converted  into  fixed  sulphocyanide  of  ammonium.  In  order  to  de- 
tect this  salt  in  the  stomach  or  its  contents,  we  should  digest  the 
parts  finely  cut  up  in  hot  alcohol,  filter  the  alcoholic  liquid,  evapo 
rate  to  dryness,  and  take  up  any  crystalline  residue  with  water.  A 
solution  of  a  persalt  of  iron  added  to  this  will  indicate  the  presence 
of  a  sulphocyanide  bv  imparting  to  it  an  intenselv  red  color.  (See 
p.  173.) 

Cyanide  of  Potassium. 

Symptoms. — This  salt  has  a  bitter  taste,  producing  first  a  sense  of 
coldness  on  the  tongue,  followed  by  a  feeling  of  constriction,  and 
burning  heat  in  the  throat.  It  is  one  of  the  most  formidable  poisons 
known  to  chemists.  It  has  destroyed  life  in  a  quarter  of  an  hour. 
A  dose  of  five  grains  has  proved  fatal  in  three  instances.  In  one 
case  the  person  died  in  two  hours.  ("  Chem.  News,"  Sept.  5,  1863.) 
The  symptoms  which  the  cyanide  produces  are  similar  to  those  occa- 
sioned by  prussic  acid;  insensibility,  spasmodic  respiration,  convul- 
sions, with  tetanic  stiffness  of  the  jaws  and  body.  They  appear  in 
a  few  seconds  or  minutes,  and  run  through  their  course  with  great 
rapidity. 

Appearances. — In  a  case  in  which  an  inspection  of  the  body  was 
made  two  days  after  death,  there  was  no  remarkable  odor;  the  mus- 
cles were  rigid ;  the  face  and  fore  part  of  the  trunk,  pale ;  the  back 
part  livid,  except  those  portions  which  had  sustained  pressure.  The 
fingers  and  toes  were  convulsively  bent  inward-,  the  nails  blue,  eye- 
lids half-closed,  lips  pale,  the  vessels  of  the  brain  filled  with  bluish- 
red  (blaurothem)  blood.  On  making  a  section  of  the  brain  and  spinal 
marrow,  bloody  points  were  observed.  The  lungs  were  congested 
posteriorly,  and  on  cutting  into  them,  a  strong  odor  of  bitter  almonds 
was  perceived;  a  yellowish  mucus  was  found  in  the  stomach,  which 
yielded  on  analysis  cyanide  of  potassium.  The  mucous  membrane 
was  reddened  near  the  intestinal  end.  The  poison  was  not  detected 
in  any  part  of  the  body  except  the  contents  of  the  stomach  and  in- 
testines.    ("Casper's  Wochenschrift."  Oct.  4.  1845,  657.) 


ESSENTIAL    OIL    OF    BITTER    ALMONDS.  175 

Cyanide  of  potassium  has  a  local  chemical  action  upon  the  skin; 
and  if  this  is  abraded  or  wounded,  it  may  be  absorbed  and  produce 
serious  effects.  Some  accidents  of  this  kind  have  occurred  in  the 
practice  of  photography.     ("  Ann.  d'Hyg."  1863,  vol.  1,  p.  454.) 

Analysis. — This  substance  is  usually  seen  in  hard  white  masses. 
It  is  deliquescent,  and  very  soluble  in  water ;  the  solution,  when 
pure,  is  colorless,  and  has  a  strong  alkaline  reaction,  a  soapy  feel,  and 
a  powerful  odor  of  prussic  acid.  It  is  not  very  soluble  in  cold  alco- 
hol. 1.  It  is  decomposed  by  all  acids,  and  prussic  acid  is  set  free. 
2.  The  potash  is  precipitated  by  tartaric  acid  and  chloride  of  plati- 
num. 3.  It  gives  a  white  precipitate  with  nitrate  of  silver,  which, 
when  dried  and  heated,  possesses  all  the  properties  of  cyanide  of 
silver  (ante,  p.  172).  This  precipitate  is  easily  redissolved  by  a  slight 
excess  of  the  solution  of  cyanide  of  potassium.  4.  If  a  solution  of 
proto-sulphate  of  iron  is  added  to  a  solution  of  the  cyanide  of  potas- 
sium, and  after  agitation,  diluted  sulphuric  acid,  Prussian  blue  will 
result. 

Essential  Oil  of  Bitter  Almonds. 

This  liquid,  which  is  used  for  the  purpose  of  giving  flavor  and 
odor  to  confectionery,  owes  its  poisonous  properties  chiefly  to  the 
presence  of  prussic  acid.  It  contains  a  variable  quantity  of  this 
poison,  which  has  been  found  in  it  in  a  proportion  of  from  eight 
to  twelve  per  cent.  Almond  flavor  or  essence  of  peach  kernels  con- 
tains one  drachm  of  the  essential  oil  to  seven  drachms  of  rectified 
spirit. 

Symptoms. — The  following  may  be  taken  as  a  summary :  lividity 
of  the  face ;  eyes  glassy,  prominent,  fixed  and  staring ;  pupils  di- 
lated and  insensible  to  light ;  jaws  spasmodically  closed ;  frothy 
mucus  about  the  mouth ;  in  some  cases,  vomiting  of  food ;  coldness 
of  the  skin ;  heaving  and  intermittent  respiration,  in  some  instances 
stertorous;  absence  of  the  pulse;  head  spasmodically  drawn  back- 
wards, and  sometimes  the  trn  nk ;  general  relaxation  of  the  limbs ; 
an  odor  of  bitter  almonds  about  the  mouth. 

Appearances. — In  one  fatal  case  nine  hours  after  death  no  odor  of 
almonds  was  perceptible  in  the  chest,  head,  or  heart,  nor  in  the  blood. 
The  lungs  and  heart  were  healthy ;  the  vessels  of  the  brain  were 
congested,  and  there  was  a  general  effusion  of  serum  on  the  hemi- 
spheres. The  lining  membrane  of  the  stomach  was  much  congested. 
On  opening  it  the  odor  of  bitter  almonds  was  quite  perceptible.  (See 
"  Prov.  Med.  Jour."  Sept.  11,  1844,  p.  364.)  The  blood  with  which 
the  venous  system  is  gorged,  is  generally  liquid  and  of  a  dark  color. 

Analysis. — The  essential  oil,  which  is  often  called  peach-nut  oil,  is 
colorless  when  pure,  but  it  commonly  has  a  pale  yellow  color,  and  a 
strong  odor  of  bitter  almonds,  by  which  it  may  be  at  onceidentilh'd. 
It  has  a  hot  burning  taste,  and  a  feebly  acid  reaction.  The  smell  and 
taste  are  generally  sufficient  for  its  identification ;  but  nitrobenzole 
possesses  the  same  odor,  and  has  been  mistaken  for  it.  It  produces 
when  dropped  on  paper,  a  greasy  stain  which  does  not  entirely  disap- 
pear by  the  application  of  heat.     It  has  a  sp.  gr.  of  1.043  ;  hence  it 


176        NOXIOUS  EFFECTS  OF  NITROBENZOLE. 

sinks  in  water,  which  dissolves  about  one-thirtieth  part.  It  is  solu- 
ble in  alcohol  and  ether  in  all  proportions.  When  mixed  with  a  few 
drops  of  strong  sulphuric  acid,  it  forms  a  rich  crimson-red  liquid 
which,  if  exposed  to  air,  acquires  a  yellow  color.  Prussic  acid  may 
be  detected  in  it  by  dissolving  the  oil  in  alcohol  and  adding  a  solu- 
tion of  potash  and  green  sulphate  of  iron.  On  the  addition  of  a 
diluted  acid  Prussian  blue  remains. 

NITROBENZOLE. 

This  liquid,  which  is  largely  employed  as  a  substitute  for  the 
essential  oil  of  bitter  almonds  in  perfumery  and  confectionery,  has 
now  taken  its  place  among  narcotic  poisons.  It  has  been  mistaken 
for  essential  oil  of  bitter  almonds,  but  its  mode  of  operation  is  differ- 
ent. In  1859,  the  late  Professor  Casper,  of  Berlin,  published  an 
account  of  this  liquid  under  the  name  of  "  A  new  Poison."  ("  Viertel- 
jahrschrift,"  B.  16,  p.  1.)  Its  effects  on  a  rabbit  and  a  dog  are  here 
described.  Two  drachms  of  it  were  given  to  a  rabbit  without  any 
symptoms  being  produced ;  two  drachms  were  then  given  to  the 
animal  at  intervals  of  ten  minutes  or  a  quarter  of  an  hour  until  the 
rabbit  had  taken  one  ounce.  In  a  minute  and  a  half  after  the  last 
dose,  the  animal  fell  suddenly  on  its  left  side.  The  pupils  were  dila- 
ted, while  the  limbs  and  tail  were  strongly  convulsed.  The  animal 
died  in  a  minute.  The  dose  was  probably  unnecessarily  large,  but 
the  result  shows  that  nitrobenzole  in  a  large  dose  destroys  life  rapidly. 
On  opening  the  body,  the  powerful  odor  of  the  liquid  was  every- 
where perceptible,  even  in  the  blood.  This  odor  remained  strongly 
in  the  body  when  it  was  again  examined  fourteen  days  after  death. 
Twenty  cubic  centimeters  (about  five  drachms)  given  to  a  middle- 
sized  dog  produced  no  remarkable  symptoms.  After  some  hours  the 
animal  was  observed  to  be  dull  and  languid;  in  twelve  hours  there 
was  profound  coma  with  slow  breathing  and  coldness  of  the  skin : 
but  there  were  no  convulsions.  The  animal  was  then  killed.  All 
the  solids  and  liquids  of  the  body,  including  the  blood,  had  a  strong 
odor  of  nitrobenzole  and  some  drops  of  the  oily  liquid  were  separated 
from  the  contents  of  the  stomach.  The  fluid  on  which  it  floated  had 
an  alkaline  reaction.     The  blood  retained  the  odor  for  several  days. 

In  reference  to  the  symptoms  produced  in  man,  the  cases  which 
have  yet  occurred  show  that  it  is  an  insidious  poison  both  in  liquid 
and  vapor.  There  is  a  burning  taste  in  the  mouth,  followed  by  a 
sensation  of  numbness  and  tingling  in  the  tongue  and  lips.  There 
is  no  immediate  insensibility,  as  in  poisoning  by  prussic  acid,  and 
there  are  no  convulsions.  The  eyes  are  bright  and  glassy,  the  fea- 
tures pale  and  ghastly,  the  lips  and  nails  purple,  as  if  stained  by 
blackberries,  the  skin  clammy  and  the  pulse  feeble.  The  mind  may 
be  clear  for  an  hour,  or  several  hours  after  the  poison  has  been  swal- 
lowed. The  patient  then  becomes  suddenly  unconscious — the  jaws 
fixed — the  hands  clenched  and  blue,  and  the  muscles  rigid  and  r<>n- 
vulsed.  In  one  case  there  was  vomiting  of  a  liquid  having  the  odor 
of  nitrobenzole.     The  breathing  was  slow  and  the  pulse  scarcely 


NITROBENZOLE.      SYMPTOMS    AND    APPEARANCES.      177 

perceptible.  Eeaction  set  in  in  about  eleven  hours,  and  recovery- 
took  place.  ("Guy's  Hospital  Eeports,  Oct.  1864,  p.  192.)  In  a  case 
examined  by  Dr.  Letheby,  the  appearances  were  as  follows:  the 
superficial  vessels  were  much  gorged  with  blood,  which  was  black 
and  fluid.  The  lungs  were  congested,  the  cavities  of  the  heart  were 
full  of  blood,  the  liver  was  of  a  purple  color,  the  brain  and  its  mem- 
branes were  congested,  and  there  was  much  bloody  serosity  in  the 
ventricles. 

This  compound  has  a  narcotic  action,  but  it  differs  from  the  ordi- 
nary narcotics  in  its  powerful  and  persistent  odor,  which  would  ren- 
der it  difficult  for  a  person  to  administer  it,  either  in  liquid  or  vapor, 
unknowingly  to  another ;  i  n  the  production  of  profound  coma  at  an 
uncertain  interval  after  the  stupor ;  and  in  the  rapidly-fatal  effects 
when  coma  has  followed.  It  operates  powerfully  as  a  poison  in 
vapor  as  well  as  in  a  liquid  state ;  but  so  far  as  cases  have  been  yet 
observed  in  the  human  subject,  the  symptoms  resembling  those  of 
the  first  stage  of  narcotic  poisoning  have  very  soon  appeared.  The 
rapidly -fatal  cases  only  would  be  likely  to  be  mistaken  for  apoplexy, 
but  in  these  the  poison  would  be  detected  by  its  odor. 

Analysis. — Nitrobenzole,  or  Essence  of  Mirbane,  is  a  pale,  lemon- 
colored  liquid  of  a  strong  odor  resembling  that  of  bitter  almonds. 
It  has  a  pungent  hot  disagreeable  taste.  It  gives  to  confectionery 
the  smell  but  not  the  pleasant  taste  of  oil  of  bitter  almonds.  It  de- 
stroys the  color  of  litmus,  and  gives  a  greasy  stain  to  paper,  leaving 
a  yellow  mark  when  the  stain  disappears.  It  sinks  in  water,  and  is 
partly  dissolved,  giving  to  it  a  yellowish  color.  It  is  soluble  in 
alcohol,  ether,  and  chloroform,  but  when  agitated  with  water  it  is  in 
great  part  separated  from  its  ethereal  and  chloroformic  solutions.  It 
has  no  basic  qualities ;  its  aqueous  solution  is  not  precipitated  either 
by  tannic  acid  or  the  chloriodide  of  mercury  and  potassium.  It  is 
highly  combustible,  burning  with  a  yellow  smoky  flame.  It  yields 
no  Prussian  blue  when  mixed  with  sulphate  of  iron,  alcohol,  and 
potash,  and  its  vapor  produces  no  cyanide  of  silver  in  a  solution  of 
the  nitrate.  It  is  distinguished  from  all  other  liquids,  excepting  the 
essential  oil  of  almonds,  by  its  odor,  and  from  this  oil  by  the  follow- 
ing test :  Pour  a  few  drops  of  each  on  a  plate  and  add  a  drop  of 
strong  sulphuric  acid.  The  oil  of  almonds  acquires  a  rich  crimson 
color  with  a  yellow  border,  the  nitrobenzole  produces  no  color.  In 
order  to  separate  it  from  organic  liquids,  they  may  be  acidulated 
with  sulphuric  acid,  and  submitted  to  distillation. 


12 


178  POISONING    WITH    ALCOHOL. 


CHAPTER  XVIII. 

alcohol.— ether.— chloroform  — camphor.— tobacco— nicotina. 
— cocculus  indicus. — picrotoxine. — fungi. — henbane. 

Alcohol. 

Symptoms. — In  general,  the  symptoms  produced  by  alcohol  come 
on  in  the  course  of  a  few  minutes.  There  is  confusion  of  thought, 
with  inability  to  stand  or  walk,  a  tottering  gait  and  giddiness,  fol- 
lowed by  stupor  and  coma.  Should  the  person  recover  from  this 
stage,  vomiting  supervenes.  The  insensibility  produced  by  alcohol 
may  not  come  on  until  after  a  certain  period  and  then  suddenly.  Dr. 
Christison  met  with  an  instance  in  which  a  person  fell  suddenly  into 
a  deep  stupor,  some  time  after  he  had  swallowed  sixteen  ounces  of 
whisky — there  were  none  of  the  usual  premonitory  symptoms.  In 
another  instance,  a  person  may  apparently  recover  from  the  first 
effects — then  suddenly  become  insensible  and  die  convulsed.  There 
is  a  ghastly  or  vacant  expression  on  the  features,  which  are  some- 
times suffused  and  bloated,  the  lips  are  livid,  and  the  pupils  are  di- 
lated and  fixed;  if  they  possess  the  power  of  contracting  under  the 
influence  of  light,  it  is  a  favorable  sign.  The  conjunctivas  or  whites 
of  the  eyes  are  generally  much  suffused.  The  breath  has  an  alcoholic 
odor.  The  more  concentrated  the  alcohol,  the  more  rapidly  are  the 
symptoms  induced,  and  they  are  also  more  severe  in  their  character. 
Diluted  alcohol  commonly  produces  a  stage  of  excitement  before 
stupor,  while  in  the  action  of  concentrated  alcohol  there  may  be 
profound  coma  in  a  few  minutes.  The  cause  of  death  may  be  gen- 
erally traced  to  congestion  of  the  brain  or  lungs  or  both.  Alcohol 
may  act  as  a  poison  by  its  vapor.  If  the  concentrated  vapor  be  res- 
pired, it  will  produce  the  usual  effects  of  intoxication.  There  is  a 
case  on  record  in  which  a  child  two  years  of  age  was  thrown  into 
an  apoplectic  stupor  by  the  alcoholic  vapor  of  eau  de  Cologne.  In 
this  manner  a  child  might  be  destroyed,  and  no  trace  of  the  poison 
found  in  the  stomach. 

Appearances. — The  stomach  has  been  found  intensely  congested  or 
inflamed,  the  mucous  membrane  presenting  in  one  case  a  bright  red, 
and  in  another  a  dark  red-brown  color.  When  death  has  taken  place 
rapidly,  there  may  be  a  peculiar  odor  of  spirits  in  the  contents;  but 
this  will  not  be  perceived  if  the  quantity  taken  was  small,  or  many 
hours  have  elapsed  before  the  inspection  is  made.  The  brain  and 
its  membranes  are  found  congested,  and,  in  some  instances,  there  is 
effusion  of  blood  or  serum  beneath  the  inner  membrane. 

Analysis. — When  a  large  dose  has  been  taken  and  the  case  has 


EFFECTS  PRODUCED  BY  ETHER  AND  CHLOROFORM.   179 

proved  rapidly  fatal,  the  contents  of  the  stomach  may  have  the  odor 
of  alcohol,  or  of  the  alcoholic  liquid  taken.  The  odor  is  not  always 
perceptible,  or  it  may  be  concealed  by  other  odors.  In  a  case  of 
poisoning  by  gin,  the  liquid  drawn  from  the  stomach  by  the  pump 
in  seven  hours  had  no  odor.  The  smell  of  brandy  has  entirely  dis- 
appeared in  twelve  hours.  The  whole  of  the  contents  or  of  the  sus- 
pected liquid  should  be  distilled  in  a  water-bath,  with  a  proper 
condensing  apparatus  attached.  If  the  liquid  has  an  acid  reaction, 
it  should  be  first  neutralized  either  by  a  solution  of  carbonate  of 
potash,  or  soda.  The  watery  distillate  obtained  should  be  mixed 
with  chloride  of  calcicum  or  anhydrous  sulphate  of  copper  in  suffi- 
cient quantity,  and  submitted  to  a  second  distillation  in  a  smaller 
retort,  by  a  water-bath.  The  liquid  obtained  by  the  second  distilla- 
tion should  be  agitated  with  rather  more  carbonate  of  potash  than 
it  will  dissolve,  in  a  small  tube  provided  with  a  stopper,  and  allowed 
to  stand.  A  stratum  of  alcohol,  if  present,  will,  after  a  time,  float 
on  the  surface,  and  may  be  drawn  off  by  a  pipette  and  examined. 
It  may  be  identified  by  its  odor,  taste  and  inflammability. 

Ether. 

Symptoms  and  Effects. — Ether,  in  moderate  doses,  has  a  hot  burn- 
ing taste,  and  produces  during  swallowing  a  sense  of  heat  and  con- 
striction in  the  throat.  It  causes,  like  alcohol,  great  excitement  and 
exhilaration,  with,  subsequently,  intoxication,  but  persons  may  be- 
come habituated  to  it,  and  thus  after  a  time  it  may  be  taken  in  large 
quantities  with  comparative  impunity.  The  effects  produced  on  the 
system  when  a  large  dose  has  been  taken  are  similar  to  those  occa- 
sioned by  alcohol.  In  the  body  of  a  dog  poisoned  by  ether,  the 
whole  of  the  mucous  membrane  of  the  stomach  was  found  of  a 
blackish-red  color,  and  with  the  other  coats  intensely  inflamed. 
There  was  slight  inflammation  of  the  duodenum ;  but  the  rest  of  the 
alimentary  canal  was  in  a  healthy  condition.  The  heart  contained 
black  blood  partly  coagulated:  the  lungs  were  gorged  with  fluid 
blood.  (Orfila,  op.  cit.  ii.  531.)  Ether  as  a  liquid  has  not,  so  far  as 
I  know,  destroyed  the  life  of  a  human  being;  but  when  its  vapor  has 
been  breathed,  it  has  caused  death  in  several  instances.  (See  "On 
Poisons,"  2d  Ed.,  p.  731.) 

Analysis. — When  ether  has  been  taken  as  a  liquid  it  may  be  sepa- 
rated from  the  contents  of  the  stomach  by  the  process  described  for 
alcohol.     It  is  well  known  by  its  odor  and  and  inflammability. 

Chloroform. 

Symptoms. — Chloroform,  when  taken  in  a  large  dose,  appears  to 
affect  the  system  like  alcohol :  but  as  a  liquid  it  cannot  be  regarded 
as  an  active  poison.  A  man  swallowed  four  ounces  of  chloroform. 
He  was  able  to  walk  for  a  considerable  distance  after  taking  this 
dose,  but  he  subsequently  fell  into  a  state  of  coma — the  pupils  were 
dilated,  the  breathing  was  stertorous,  the  skin  cold,  the  pulse  im- 


180        EFFECTS  PRODUCED  BY  CHLOROFORM. 

perceptible,  and  there  were  general  convulsions.  He  recovered  in  five 
days.  ("Med.  Gaz.."  vol.  47,  p.  675.)  A  boy,  set.  4.  was  found  by 
Lis  lather  in  a  state  of  total  insensibility.  It  appeared  that  he  had 
swallowed  a  drachm  of  chloroform,  and  soon  afterwards  laid  his  head 
on  his  mother's  lap,  and  then  lost  all  consciousness.  In  about  twenty 
minutes  he  was  insensible,  cold,  and  pulseless.  Mustard  plasters 
were  applied  to  his  legs;  they  acted  well,  but  produced  no  impres- 
sion on  the  sensibility.  His  breathing  varied;  it  was  sometimes 
natural,  at  other  times  stertorous.  He  became  warmer,  his  pulse 
full  and  regular:  and  he  continued  three  hours  in  this  state,  when  he 
died  quite  calmlv  without  a  struggle,  in  spite  of  every  effort  made 
for  his  recovery.  This  is  the  smallest  dose  of  liquid  chloroform 
that  has  destroyed  life. 

'oro/orm  Vapor. — The  vapor  when  respired  in  a  concentrated 
form,  is  speedily  fatal  to  life.  If  it  is  diluted  with  a  certain  propor- 
tion of  air.  it  produces  insensibility,  with  entire  loss  of  muscular 

er,  in  from  eight  to  ten  minutes,  and  the  patient  rapidly  recovers 
after  the  vapor  is  withdrawn.  Cases  of  death  from  the  inhalation 
of  the  vapor  for  surgical  purposes  are  numerous,  and  the  symptoms 
and  post-mortem  appearances  are  well-marked.  ("  Ox  Poisons." 
2d  Edit.  p.  738;  also  "Lancet,"  April,  1859,  p.  400,  and  April  23, 
p.  425.)  In  some  instances  death  has  taken  place  within  two  minutes 
from  the  commencement  of  inhalation.  In  one  in  which  only  thirty 
drops  had  been  taken  in  vapor,  the  patient  died  in  one  minute,  and 
in  another  so  small  a  quantity  as  fifteen  or  twenty  drops  proved 
speedily  fatal.  ("Table  of  Fatal  Cases,"  by  Dr.  Warren,  U.  S.  p.  23.) 
Its  fatal  effects  do  not  depend  so  much  on  the  absolute  quantity  as 
on  the  proportion  in  which  it  is  breathed  in  a  state  of  mixture  with 
atmospheric  air.  It  has  been  stated  that  the  average  proportion  of 
this  vapor  for  medicinal  purposes,  should  not  exceed  3^  per  cent., 
and  that  4^  is  a  maximum  quantity  to  be  taken  with  safety.  The 
proportion  should  be  only  slowly  increased.  The  vapor  should  not 
be  given  after  a  long  fast,  after  a  full  meal,  or  'while  the  person  is 
sitting  or  erect  posture.  ("Ed.  Monthly  Jour.,"  Aug.  1864.) 
The  vapor  of  this  liquid  operating  through  the  lungs,  has  destroyed 
life  more  rapidly,  and  in  a  smaller  dose  than  any  other  poison 
known.  Its  fatal  operation  is  sometimes  suddenly  manifested  appa- 
rently by  an  accumulative  effect  on  the  blood  after  the  withdrawal 
of  the  vapor.    In  one  case  witnessed  by  a  friend,  the  heart  suddenly 

sed  to  beat  four  minutes  alter  the  vapor  had  been  withdrawn. 
The  digital  arteries  which  had  been  divided  in  the  operation,  ceased 
to  bleed.  The  man  was  dead.  The  fatal  effects  are  generally  ascribed 
to  idiosyncrasy  or  to  the  unforeseen  condition  of  a  fatty  or  flabby 
heart.  Assuming  this  to  be  to  some  extent  the  true  cause  of  the 
fatality,  it  must  be  admitted  that  tatty  and  flabby  hearts  have  become 
very  common  since  the  introduction  of  chloroform  vapor  for  surgi- 
cal and  other  purposes.  The  theory  of  a  flabby  heart  is  quite  un- 
necessary to  explain  the  fatal  results  occasionally  produced  by 
chloroform  vapor,  even  when  administered  by  experienced  persons. 
In  January,  1866,  a  healthy  man  died  in  three  minutes  from  the 


CAMPHOR.      TOB  A.CCO  181 

effects  of  only  two  drachms  of  chloroform  in  vapor.     This  occurred 
on  the  operating  table  of  a  London  hospital — the  vapoT  having  been 

administered  by  a  gentleman  who  had  given  it  previously  T 
400  patients.  Death  was  sudden,  and  took  place  alter  some  deep 
inspirations  and  expirations  had  been  made.  It  was  on  this  occasion 
candidly  admitted  that  the  body  was  quite  healthy.  In  this  and 
similar  cases  either  the  chloroform  had  been  taken  in  too  concen- 
trated a  form,  or  there  may  have  been  an  idiosyncrasy  in  the  patient 
to  its  narcotic  poisonous  action.  In  cases  of  alleged  robbery  and 
rape,  it  has  been  sometimes  stated  that  the  person  assaulted  was  ren- 
dered suddenly  insensible  by  chloroform  :  but  chloroform  vapor  does 
not  produce  immediate  insensibility,  unless  it  also  produces  asphyxia 
and  death. 

Chloroform  is  a  heavy  colorless  liquid,  sp.  gr.  1.484,  neutral  in  its 
reaction,  sinking  in  water  in  globules,  and  only  to  a  slight  extent 
dissolving  in  this  liquid.  It  has  a  fragrant  odor,  like  that  of  apples. 
It  is  very  volatile,  but  not  combustible,  and.  like  alcohol,  dissolves 
camphor. 

Camphor. 

Symptoms  and  Appearan  \es. — Camphor  operates  on  the  brain  and 
nervous  system.  In  one  case  which  occurred  to  Mr.  Hallet,  a  woman 
swallowed  in  the  morning  about  twenty  grains  dissolved  in  rectified 
spirits  of  wine  and  mixed  with  tincture  of  myrrh.  In  half  an  hour 
she  was  suddenly  seized  with  languor,  giddiness,  0  >  sional  loss 
sight,  delirium,  numbness,  tingling  and  coldness  of  the  extremities, 
so  that  she  could  hardly  walk.  The  pulse  was  quick  and  respiration 
difficult,  but  she  suffered  no  pain  in  any  part.  On  the  administra- 
tion of  an  emetic,  she  vomited  a  yellowish  liquid  smelling  strongly 
of  camphor.  In  the  evening,  the  symptoms  were  much  diminished, 
but  she  had  slight  convulsive  fits  during  the  night.  The  next  day 
she  was  convalescent :  the  difficulty  of  breathing,  however,  continued 
more  or  less  for  several  weeks.  This  is  the  smallest  dose  of  camphor 
which  appears  to  have  been  attended  with  serious  symptoms  in  an 
adult.  It  has  proved  fatal  to  infants  and  children,  the  symptoms 
being  chiefly  vomiting  and  purging,  with  violent  convulsions. 

A  case  ol  poisoning  by  camphor  would  be  re  agnized  by  the  odor 
of  the  breath,  a  symptom  which  would  attract  the  attention  of  a  non- 
professional person.  The  presence  of  this  substance  in  the  stomach 
would  be  at  once  indicated  by  its  odor. 

Tobacco. 

S  mptoms. — The  effects  which  tobacco  produces,  when  taken  in 
a  large  dose,  either  in  the  form  of  powder  or  infusion,  are  well- 
marked.  The  symptoms  are  faintness.  nausea,  vomiting,  giddiness, 
delirium,  loss  o\'  power  in  the  limbs,  general  relaxation  of  the  mus- 
cular system,  trembling,  complete  prostration  of  strength,  cold 
o\'  the  surface  with  cold  clammy  perspiration,  convulsive  m 
ments,  paralysis,  and  death.     In  some  cases  there  is  purging,  with 


182  POISONING    WITH    COCCULUS    INDICUS. 

violent  pain  in  the  abdomen ;  in  others  there  is  rather  a  sense  of 
sinking  or  depression  in  the  region  of  the  heart  passing  into  syncope, 
or  creating  a  feeling  of  impending  dissolution.  With  the  above- 
mentioned  symptoms  there  is  dilatation  of  the  pupils  with  insensi- 
bility to  light,  dimness  of  sight  with  confusion  of  ideas,  a  small, 
weak,  and  scarcely  perceptible  pulse,  difficulty  of  breathing  and 
involuntary  discharge  of  urine.  Tobacco  owes  its  poisonous  pro- 
perties to  the  presence  of  a  liquid  volatile  alkaloid,  Nicotina. 

Nicotina. — This  is  a  deadly  poison,  and  like  prussic  acid  it  destroys 
life  in  small  doses  with  great  rapidity.  I  found  that  a  rabbit  was 
killed  by  a  single  drop  in  three  minutes  and  a  half.  In  fifteen  seconds 
the  animal  lost  all  power  of  standing,  was  violently  convulsed  in  its 
fore  and  hind  legs,  and  its  back  was  arched  convulsively  (opistho- 
tonos). A  frothy  alkaline  macus  escaped  from  its  mouth  having  the 
odor  of  nicotina.  ("  Guy's  Hospital  Eeports,"  Oct.  1858,  p.  355.)  A 
case  of  poisoning  by  this  alkaloid  which  occurred  in  Belgium  in 
1851,  was  the  subject  of  a  trial  for  murder.  ("Ann.  d'Hyg.,"  1851, 
2,  pp.  167  and  117.)  In  another  case  which  proved  fatal  in  from 
three  to  five  minutes,  the  appearances  observed  were  a  general  relaxa- 
tion of  the  muscles,  prominent  and  staring  eyes,  bloated  features, 
great  fulness,  with  lividity  about  the  neck.  There  was  no  odor 
resembling  nicotina  or  tobacco  perceptible  about  the  body.  When 
the  body  was  examined  between  two  and  three  days  after  death, 
putrefaction  had  occurred.  The  swelling  of  the  neck  was  found  to 
arise  from  an  effusion  of  dark  liquid  blood,  especially  in  the  course 
of  the  veins.  The  scalp  and  the  membranes  of  the  brain,  were  filled 
with  dark-colored  blood.  The  lungs  were  engorged,  and  of  a  dark 
purple  color.  The  cavities  of  the  heart  were  empty,  with  the  ex- 
ception of  the  left  auricle,  which  contained  two  drachms  of  dark- 
colored  blood.  The  stomach  contained  a  chocolate-colored  fluid,  in 
which  nicotina  was  detected :  the  mucous  membrane  was  of  a  dark 
crimson  red  color  from  the  most  intense  congestion.  There  was  no 
odor  excepting  that  of  putrefaction.  The  liver  was  congested  and 
of  a  purple  black  color.  The  blood  throughout  the  body  was  black 
and  liquid,  but  in  some  parts  it  had  the  consistency  of  treacle. 

Levant  Nut.    (Cocculus  Indicus.) 

Symptoms  and  Effects. — This  is  the  fruit  or  berry  of  the  Anamirta 
Cocculus  {Levant  Nut),  imported  from  the  East  Indies.     The  berry 

contains  from  one  to  two  per  cent, 
of  a  poisonous  principle  (Picrotoxine). 
The  shell  or  husk  contains  no  picro- 
toxine  but  a  non-poisonous  principle 
called  menispermine.  The  seeds,  in 
powder  or  decoction,  give  rise  to 
nausea,  vomiting,  and  griping  pains, 

a  Berry  of  Cocculus  Indicus,  natural  size.  f0Uowec1  fty  Stupor  and  intoxication. 
b  The  same  seen  in  section   with  one-halt      „,,  #•  -r  1 

of  ,he  semi-iunar  kemei.  There  are,  so  far  as  I  am  aware,  only 

c  The  kernel,  containing  picrotoxine.  tWO      Well-ailthenticated     instances     of 


POISONING    WITH    MUSHROOMS.  183 

this  substance  having  proved  fatal  to  man.  Several  men  suffered  from 
this  poison  in  1829,  near  Liverpool :  each  had  a  glass  of  rum  strongly- 
impregnated  with  cocculus  indicus.  One  died  that  evening;  the  rest 
recovered.  ("  Traill's  Outlines,"  146.)  Of  the  second  case,  the  following 
details  have  been  published.  A  boy,  set.  12,  was  persuaded  by  his  com- 
panions to  swallow  two  scruples  of  the  composition  used  for  poisoning 
fish.  It  contained  cocculus  indicus.  In  a  few  minutes  he  perceived 
an  unpleasant  taste,  with  burning  pain  in  the  gullet  and  stomach,  not 
relieved  by  frequent  vomiting — as  well  as  pain  extending  over  the 
whole  of  the  abdomen.  In  spite  of  treatment,  a  violent  attack  of 
gastro- enteritis  supervened,  and  there  was  much  febrile  excitement, 
followed  by  delirium  and  purging,  under  which  the  patient  sank  on 
the  nineteenth  day  after  taking  the  poison.  On  inspection,  the  ves- 
sels of  the  pia  mater  were  congested  with  dark-colored  liquid  blood. 
There  was  serous  effusion  in  the  ventricles  of  the  brain,  and  the 
right  lung  was  congested.  In  the  abdomen  there  were  all  the  marks 
of  peritonitis  in  an  advanced  stage.  The  stomach  was  discolored, 
and  its  coats  were  thinner  and  softer  than  natural.  (Canstatt,  "  Jahres- 
bericht,"  1844,  5,  298.)  Porter,  ale,  and  beer  owe  their  intoxicating 
properties  in  some  instances  to  a  decoction,  or  extract  of  these  ber- 
ries. For  some  remarks  on  this  adulteration  of  beer  and  other 
liquids,  and  a  process  for  separating  the  poisonous  principle,  picro- 
toxine,  by  amylic  alcohol,  see  "  Chemical  News,"  March  12,  1864, 
p.  123.  Cocculus  indicus  operates  readily  as  a  poison  on  animals, 
and  it  has  thus  been  frequently  used  for  the  malicious  destruction  of 
fish  and  game.  In  one  instance  referred  to  me,  there  was  reason  to 
believe  that  270  young  pheasants  had  been  poisoned  by  grain  soaked 
in  a  decoction  of  this  substance.  Barber's  poisoned  ivheat  for  the  de- 
struction of  birds  owes  its  poisonous  properties  to  cocculus  indicus. 
(Horsley.) 

The  poisonous  principle  of  the  berry  of  cocculus  indicus  is  called 
picrotoxine.     It  has  a  remarkably  bitter  taste. 

Poisonous  Mushrooms  (Fungi). 

Symptoms  and  Effects. — The  noxious  species  of  mushrooms  act 
sometimes  as  narcotics,  and  on  other  occasions  as  irritants.  It  would 
appear  from  the  reports  of  several  cases,  that  when  the  narcotic 
symptoms  are  excited,  they  come  on  soon  after  the  meal  at  which 
the  mushrooms  have  been  eaten,  and  they  are  chiefly  manifested  by 
drowsiness,  giddiness,  dimness  of  sight,  and  debility.  The  person 
appears  as  if  intoxicated,  and  there  are  sometimes  singular  illusions 
of  sense.  The  pupils  are  dilated.  Spasms  and  convulsions  have 
been  occasionally  witnessed  among  the  symptoms,  chiefly  in  fatal 
cases.  When  the  drowsiness  passes  off,  there  is  generally  nausea 
and  vomiting ;  but  sometimes  vomiting  and  purging  precede  the 
stupor.  If  the  symptoms  do  not  occur  until  many  hours  after  the 
meal,  they  partake  more  of  the  characters  of  irritation  ;  indicated 
by  pain  and  swelling  of  the  abdomen,  vomiting  and  purging.  In  a 
recent  case  of  poisoning  by  mushrooms,  there  was  slight  vomiting 
about  an  hour  and  a  half  after  the  meal-,  but  no  violent  symptoms 


184  POISONING    WITH    HENBANE. 

until  after  the  lapse  of  ten  hours.  Several  cases,  in  which  the  symp- 
toms did  not  appear  for  fourteen  hours,  are  reported  in  the  "  Medi- 
cal Gazette"  (vol.  25,  p.  110).  In  some  instances  the  symptoms  of 
poisoning  have  not  commenced  until  thirty  hours  after  the  meal ;  and 
in  these,  narcotism  followed  the  symptoms  of  irritation.  It  might 
be  supposed  that  these  variable  effects  were  due  to  different  proper- 
ties in  the  mushrooms ;  but  the  same  fungi  have  acted  on  members 
of  the  same  family,  in  one  case  like  irritants,  and  in  another  like 
narcotics.  In  most  cases  recovery  takes  place,  especially  if  there  is 
early  vomiting.  In  the  instances  which  have  proved  fatal,  there  has 
been  greater  or  less  inflammation  of  the  stomach  and  bowels,  with 
congestion  of  the  vessels  of  the  brain.  (See  "Med.  Gaz."  vol.  46, 
p.  307;  vol.  47,  p.  673  ;  and  "  Journ.  de  Chimie  Med."  1853,  p.  694.) 

In  the  Guy's  Hospital  Reports  for  October,  1865,  p.  382,  I  have 
recorded  two  fatal  cases — a  mother  and  daughter,  who  died  from  the 
effects  of  the  Amanita  citrina;  a  yellow-colored  fungus,  gathered  in 
mistake  for  mushrooms.  The  woman  fried  the  fungi,  and  they  were 
eaten  for  supper.  No  symptoms  appeared  for  seven  hours.  The 
child  when  seen  by  a  medical  man  was  feverish  and  thirsty,  and  the 
pupils  were  strongly  dilated.  There  was  severe  pain  in  the  stomach, 
and  a  sense  of  constriction  in  the  throat.  The  child  became  con- 
vulsed and  insensible,  and  died  forty-one  hours  after  eating  the  fungi. 
The  mother  and  another  child  suffered  from  similar  symptoms ;  the 
mother  partially  recovered,  but  had  a  relapse,  and  died  on  the  fifth 
day.     No  inspection  of  the  bodies  was  made. 

These  fungi  can  only  be  recognized  by  their  botanical  characters. 
Portions  of  them  may  be  found  in  the  food,  or  in  the  contents  of  the 
stomach,  but  if  there  has  been  vomiting  and  purging,  it  is  probable 
that  the  whole  of  the  substance  will  be  expelled.  Fungi  contain  but 
little  solid  matter. 

HEXBANE.      (HyOSCYAMUS  NIGER.) 

Symptoms  and  Appearances. — The  seeds,  roots,  and  leaves  of  this 
plant  are  poisonous.     AYhen  the  dose  is  not  sufficient  to  destroy  life, 
the  symptoms  are :  general  excitement,  fulness  of  the  pulse,  flushing 
of  the  face,  weight  in  the  head,  giddiness,  loss  of  power 
and  tremulous  motion  of  the  limbs,  somnolency,  dilata- 
tion of  the  pupils,  double  vision,  nausea,  and  vomiting. 
After  a  time  these  symptoms  pass  off,  leaving  the  pa- 
tient merely  languid.     When  a  large  quantity  of  the 
root  or  leaves  has  been  eaten,  an  accident  which  has  oc- 
curred from  the  plant  having  been  mistaken  for  other 
vegetables,  more  serious  effects  are  manifested.     In  ad- 
dition to  the  above  symptoms  in  an  aggravated  form, 
there  will  be  loss  or  incoherency  of  speech,  delirium, 
°  ^  ^  confusion  of  thought,   insensibility,    coma,   and  some- 

«eeds  of  Hen-    t™6-^  a  state  resembling  insanity  :  the  pupils  are  dilated 
bane.  ~  and  insensible  to  light,  there  is  coldness  of  the  surface, 

n  xaturaisize.    cold  perspirati< >n.  loss  of  power  in  the  legs,  alternating 
b  Magnified  30    -^h  tetanic  rigidity  and  convulsive  movements  of  the 

diameters.  *-*  J 


NUX    VOMICA    AND    STRYCHNIA.  185 

muscles,  the  pulse  small,  frequent,  and  irregular,  the  respiration  deep 
and  laborious.  (See  "Med.  Graz."  vol.  47,  p.  640.)  Occasionally  there 
is  nausea  with  vomiting  and  purging.  Death  may  take  place  in  a 
few  hours  or  days,  according  to  the  severity  of  the  symptoms.  The 
special  effect  of  this  poisonous  plant  is  manifested  in  its  tendency  to 
produce  a  general  paralysis  of  the  nervous  system. 


(SPINAL  POISONS.) 

CHAPTER    XIX. 


NUX  VOMICA. — STRYCHNIA. — SYMPTOMS  AND  APPEARANCES. — CHE- 
MICAL AND  MICROSCOPICAL  ANALYSIS  OF  NUX  VOMICA  AND  STRYCH- 
NIA.— PROCESS  FOR  ORGANIC  MIXTURES. — BRUCIA. 

Nux  Vomica.    Strychnia. 

Symptoms. — At  a  variable  interval  after  taking  either  nux  vomica 
or  strychnia  in  a  poisonous  dose,  the  person  experiences  a  sense  of 
uneasiness  and  restlessness,  accompanied  by  a  feeling  of  impending- 
suffocation.  There  is  a  shuddering  or  a  trembling  of  the  whole  frame, 
with  twitchings  and  jerkings  of  the  head  and  limbs.  Tetanic  con- 
vulsions then  commence  suddenly  with  great  violence,  and  nearly 
all  the  muscles  of  the  body  are  simultaneously  affected.  The  limbs 
are  stretched  out  involuntarily,  the  hands  are  clenched ;  the  head 
after  some  convulsive  jerkings  is  bent  backwards,  and  the  whole  of 
the  body  becomes  as  stiff  as  a  board.  As  the  convulsions  increase 
in  frequency  and  severity,  the  body  assumes  a  bow-like  form  (opis- 
thotonos), being  arched  in  the  back  and  resting  on  the  head  and 
heels.  The  head  is  firmly  bent  backwards,  and  the  soles  of  the  feet 
are  incurvated  or  arched  and  everted,  the  legs  sometimes  separated. 
The  abdomen  is  hard  and  tense,  and  the  chest  spasmodically  fixed, 
so  that  respiration  appears  to  be  arrested.  The  face  assumes  a  dusky, 
livid  or  congested  appearance,  with  a  drawn,  wild  or  anxious  aspect, 
the  eyeballs  are  prominent  and  staring,  and  the  lips  are  livid.  The 
intellect  is  clear,  and  the  sufferings,  during  this  violent  spasm  of  the 
voluntary  muscles,  are  severe.  The  patient  in  vain  seeks  for  relief 
in  gasping  for  air  and  in  requiring  to  be  turned  over,  moved  or  held. 
The  muscles  of  the  lower  jaw,  which  are  the  first  to  be  affected  in 
tetanus  from  disease,  are  generally  the  last  to  be  affected  by  this 
poison.  The  jaw  is  not  always  fixed  during  a  paroxysm.  The 
patient  can  frequently  speak  and  swallow,  and  great  thirst  has  been 
observed  among  the  symptoms.  In  some  cases  of  poisoning  by  nux 
vomica,  the  jaw  has  been  fixed  by  muscular  spasm  ;  but,  unlike  the 
lock-jaw  of  disease,  this  has  come  on  suddenly  in  full  intensity  with 
tetanic  spasms  in  other  muscles,  and  there  have  been  intermissions 
which  are  not  witnessed  in  the  tetanus  of  disease.     The  sudden  and 


186  STRYCHNIA.      SYMPTOMS    AND    APPEARANCES. 

universal  convulsion  affecting  the  voluntary  muscles  has  sometimes 
been  so  violent  that  the  patient  has  been  jerked  off  the  bed.  After 
an  interval  of  half  a  minute  to  one  or  two  minutes,  the  convulsions 
subside,  there  is  an  intermission,  the  patient  feels  exhausted,  and  is 
sometimes  bathed  in  perspiration.  It  has  been  noticed  in  some  of 
these  cases  that  the  pupils  during  the  paroxysm  are  dilated,  while  in 
the  intermission  they  are  contracted.  The  pulse  during  the  spasms 
is  so  quick  that  it  can  scarcely  be  counted.  Slight  causes,  such  as 
an  attempt  to  move,  a  sudden  noise,  or  gently  touching  the  patient, 
will  frequently  bring  on  a  recurrence  of  the  convulsions.  In  cases 
likely  to  prove  fatal,  they  rapidly  succeed  each  other  and  increase 
in  severity  and  duration  until  at  length  the  patient  dies  utterly  ex- 
hausted. The  tetanic  symptoms  produced  by  strychnia,  when  once 
clearly  established,  progress  rapidly  either  to  death  or  recovery. 
The  person  is  conscious,  and  the  mind  is  commonly  clear  to  the  last. 
He  has  a  strong  apprehension  of  death.  The  duration  of  the  case, 
when  the  symptoms  have  set  in,  is  reckoned  by  minutes,  while  in 
the  tetanus  of  disease,  when  fatal,  it  is  reckoned  by  hours,  days,  and 
even  weeks.  As  a  general  statement  of  the  course  of  these  cases  of 
poisoning,  within  two  hours  from  the  commencement  of  the  symp- 
toms the  person  either  dies  or  recovers,  according  to  the  severity  of 
the  paroxysms  and  the  strength  of  his  constitution.  Death  some- 
times takes  place  in  a  paroxysm.  (See  case  by  Mr.  Lawrence, 
"Lancet,"  June,  1861,  p.  572.) 

The  time  at  which  the  symptoma  commence  appears  from  the  recorded 
cases  to  be  subject  to  great  variation.  In  poisoning  by  nux  vomica 
the  symptoms  are  generally  more  slow  in  appearing  than  in  poison- 
ing by  strychnia.  Until  they  set  in  suddenly,  the  patient  is  capable 
of  walking,  talking,  and  going  through  his  or  her  usual  occupations. 
In  a  case  which  occurred  to  Si.  Pellarin,  a  man  swallowed  about  300 
grains  of  nux  vomica  and  no  symptoms  appeared  for  two  hours.  He 
died  speedly  in  a  violent  convulsive  fit.  ("  Ann.  d'Hvg."  1861,  vol. 
2,  p.  431.)  On  an  average  in  poisoning  by  strychnia  the  symptoms 
appear  in  from  five  to  twenty  minutes. 

Appearances  after  Death. — -In  general  the  body  is  relaxed  at  the 
time  of  death,  and  stiffens  afterwards :  but  the  commencement  and 
duration  of  the  rigid  state  depend  on  various  conditions. 

Among  the  internal  appearances  which  have  been  met  with  in 
different  cases,  are  congestion  of  the  membranes  and  substance  of 
the  brain,  as  also  of  the  upper  part  of  the  spinal  marrow,  with  con- 
gestion of  the  lungs.  The  heart  is  contracted  and  empty;  but  its 
right  cavities  in  some  instances  have  been  distended  with  liquid  blood. 
The  blood  has  been  found  black  and  liquid  throughout  the  body. 
The  mucous  membrane  of  the  stomach  has  occasionally  presented 
slight  patches  of  ecchymosis  or  congestion,  probably  depending  on 
extraneous  causes;  such  as  the  process  of  digestion — the  presence  of 
food — or  of  alcoholic  liquids.  In  most  instances  the  stomach  and 
intestines  have  been  found  quite  healthy,  and  it  is  not  in  the  nature 
of  this  poison  either  to  inflame  or  irritate  the  mucous  membrane. 
Of  the  appearances  observed  in  poisoning  by  strychnia,  there  are 


FATAL    DOSE.      VERMIN    KILLERS.  187 

none  which  can  be  considered  strictly  characteristic.  Congestion  of 
the  membranes  of  the  brain  and  spinal  marrow  is  probably  the  most 
common. 

The  sixteenth  part  of  a  grain  of  strychnia  killed  a  child  between 
two  and  three  years  of  age  in  four  hours.  The  smallest  fatal  dose  in 
an  adult  was  in  the  case  of  Dr.  Warner.  Half  a  grain  of  the  sul- 
phate of  strychnia  here  destroyed  life.  ("  On  Poisoning  by  Strych- 
nia," pp.  138,  139.)  So  powerful  are  the  effects  of  this  drug  in 
certain  cases,  that  ordinary  medicinal  doses  can  scarcely  be  borne. 
Symptoms  of  its  poisonous  action  have  frequently  been  unexpectedly 
produced. 

With  respect  to  nux  vomica,  three  grains  of  the  alcoholic  extract 
have  destroyed  life.  The  smallest  fatal  dose  of  nux  vomica  in  pow- 
der was  in  a  case  reported  by  Hoffmann,  and  quoted  by  Christison 
(p.  901),  also  by  Trail  ("  Outlines,"  p.  137).  Thirty  grains  of  the 
powder,  given  in  two  doses  of  fifteen  grains  each,  proved  fatal.  The 
poison  was  given  by  mistake  for  bark  to  a  patient  laboring  under 
quartan  fever.  This  is  about  equivalent  to  the  weight  of  one  full- 
sized  seed,  and  to  only  one-third  of  a  grain  of  strychnia  in  two  doses. 

In  fatal  cases  death  generally  takes  place  within  two  hours  after 
the  taking  of  strychnia.  One  of  the  most  rapidly  fatal  cases  recorded 
is  that  of  Dr.  Warner.  The  symptoms  commenced  in  five  minutes 
and  he  was  dead  in  twenty  minutes.  In  the  case  of  J.  P.  Cook,  the 
symptoms  commenced  in  an  hour  and  a  quarter,  and  he  died  in 
huenty  minutes.  In  poisoning  by  nux  vomica,  death  may  occur  within 
two  hours ;  but  Dr.  Christison  mentions  a  case  in  which  a  man  died 
in  fifteen  minutes  after  taking  a  dose.  This  is  probably  the  shortest 
period  known. 

Vermin  and  Insect  Killers. — Although  it  is  difficult  to  procure 
strychnia  at  a  druggist's  shop,  it  is  extensively  sold  to  the  public  by 
grocers,  oilmen,  and  others,  under  the  name  of  Vermin  Killers,  in 
threepenny  and  sixpenny  packets.  Butler's  Vermin  Killer  consists  of 
a  mixture  of  flour,  soot,  and  strychnia.  I  have  found  the  sixpenny 
packet  to  weigh  about  a  drachm,  and  to  contain  from  two  to  three 
grains  of  strychnia.  As  the  poison  is  mechanically  mixed  with  the 
other  ingredients,  and  is  probably  manufactured  on  a  large  scale,  the 
proportion  of  strychnia  is  liable  to  variation.  The  threepenny 
packet  contains  about  half  the  quantity  of  strychnia,  but  this  is 
quite  sufficient  to  destroy  the  life  of  an  adult.  In  place  of  soot, 
Prussian  blue  is  sometimes  used  as  a  coloring  substance.  Battle's 
Vermin  Killer  is  a  powder  similar  to  that  of  Butler,  containing  a 
fatal  proportion  of  strychnia,  as  it  is  sold  in  packets.  These  pow- 
ders are  a  fertile  source  of  poisoning  either  through  accident  or 
design ;  they  are  openly  sold  by  ignorant  people  to  others  still  more 
ignorant. 

Chemical  Analysis. — Nux  vomica  is  well  known  as  a  flat  round 
kernel,  about  the  size  of  a  shilling,  with  radiating  silken  fibres, 
slightly  raised  in  the  centre.  It  is  of  a  light  brown  color,  and  co- 
vered with  a  fine  silky  down.  (See  Fig.  22.)  It  is  very  hard,  brittle, 
tough,  and  difficult  to  pulverize.     The  powder  is  of  a  gray  brown 


188 


NUX    VOMICA    AND    STRYCHNIA. 


Fig.  22. 


Hairs   of   Nux  Vomica, 
12-1  diameters 


magnified 


color,  like  that  of  liquorice ;  it  is  sometimes  met  with  in  a  coarsely 
rasped  state ;  it  has  an  intensely  bitter  taste ;  it  yields  to  water  and 

alcohol,  strychnia,  brucia,  igasuric,  or 
strychnic  acid,  and  some  common  vegeta- 
ble principles.  Pleated  on  platinum  foil,  it 
burns  with  a  yellow  smoky  flame.  Nitric 
acid  turns  it  of  a  dark  orange-red  color, 
which  is  destroyed  by  chloride  of  tin. 
These  proportions  are  sufficient  to  distin- 
guish it  from  various  medicinal  powders 
which  it  resembles.  The  aqueous  infusion 
or  decoction  is  deeply  reddened  by  nitric 
acid,  and  is  freely  precipitated  by  tincture 
of  galls.  Persulphate  of  iron  gives  with 
it  an  olive-green  tint.  The  fine  silky 
fibres  or  hairs  which  cover  the  surface 
of  the  seed  may  be  obtained  by  washing 
the  residue  of  the  powder  in  the  stomach,  or  the  sediment  of  any 
liquid  with  which  the  vomica  may  have  been  mixed.  As  in  other 
poisonous  seeds  or  roots,  the  strychnia  is  slowly  removed  from  the 
powder  by  the  absorbent  vessels  of  the  stomach,  and  carried  into 
the  blood,  until  that  liquid  is  sufficiently  impregnated  with  the  poison 
to  produce  symptoms.  The  powder  itself  remains,  as  it  is  unalter- 
able by  the  fluids  of  the  stomach. 

Strychnia. — The  alkaloid  may  be  readily  obtained  crystallized 
from  an  alcoholic  solution.  The  crystal  is  very  small,  and  its  form 
is  subject  to  great  variation,  according  to  the  strength  of  the  solution, 
rapidity  or  slowness  of  evaporation,  the  presence  of  foreign  matters, 
&c.  It  is  commonly  seen  in  octahedra,  sometimes  lengthened  into 
prisms  of  a  peculiar  shape,  bevelled  at  the  ends,  and  crossing  each 
other  at  angles  of  60°.  (See  Fig.  23.)  There  are  as  many  as  six  or 
eight  varieties  of  crystals,  so  that  too  much  importance  must  not  be 


Fig.  23. 


Fig.  24. 


Various  forms  of  Crystals  of  Strychuia,  as  they 
were  obtained  from  an  alcoholic  solution. 
Magnified  22t  diameters. 


Crystals  of  strychnia  obtained  by  adding  am- 
monia to  the  sulphate.  Magnified  124  diame- 
ters. 


attached  to  this  branch  of  the  analysis.  As  strychnia  is  procured 
from  the  solutions  of  its  salts  by  the  addition  of  ammonia,  it  is 
usually  deposited  in  long  slender  prisms.     (Fig.  24.) 


CHEMICAL    ANALYSIS. 


189 


Fig.  25. 


1.  Strychnia  is  white,  of  an  intensely  bitter  taste,  even  when  it 
forms  only  1-30, 000th  part  of  a  solution.  2.  When  heated  on  plati- 
num, it  melts  and  burns  like  a  resin,  with  a  black  smoky  flame ;  in 
a  close  tube  it  yields  ammonia.  3.  It  is  not  perceptibly  dissolved 
by  cold  water ;  it  requires  7,000  parts  for  its  solution.  4.  It  is 
easily  dissolved  by  acids,  and  is  precipitated  from  the  concentrated 
solutions  by  potash,  in  which  it  is  insoluble.  5.  Strong  nitric  acid 
imparts  to  it  a  reddish  color,  owing  to  the  presence  of  brucia.  6. 
Sulphuric  acid  produces  no  apparent  change  in  it;  but  when  to  the 
mixture  a  small  crystal  of  bichromate  of  potash,  of  ferricyanide  of 
potassium,  or  a  small  quantity  of  black  oxide  of  manganese  or  of 
peroxide  of  lead,  is  added  a  series  of  beautiful  blue,  purple,  and 
violet  colors  appear,  which  pass  rapidly  to  a  light  flesh-red  tint. 
Among  these  substances  black  oxide  of  manganese  will  be  found 
preferable. 

Mr.  Horsley  has  suggested  that  a  solution  of  strychnia  should  be 
sufficiently  concentrated,  and  then  precipitated  by  chromate  of  pot- 
ash ;  the  crystals  may  be  examined  microscopically ;  they  are  gene- 
rally seen  in  tufts  of  radiated  prisms  of  a  yellow  color.  On  being 
touched  with  strong  sulphuric  acid,  the  color  reactions  of  strychnia 
are  at  once  brought  out. 

In  Organic  mixtures  a  modification  of  the  process  originally  sug- 
gested by  Stas  is  employed  for  the  separation  of  this  poison.     The 

principle  of  its  operation  consists  in  dis- 
solving the  strychnia  by  a  gentle  heat  out 
of  the  tissue  or  organ  finely  cut  up,  by 
means  of  rectified  spirit  mixed  with  a 
small  quantity  of  acetic  acid.  The  liquid 
is  strained,  and  the  residue  well  pressed 
and  washed  with  alcohol ;  the  acid  solu- 
tion of  strychnia  thus  obtained  is  concen- 
trated in  a  water-bath.  The  concentrated 
liquor  is  neutralized  by  potash,  and  a 
slight  excess  of  alkali  is  added.  The  al- 
kalized liquid  is  then  shaken  in  a  long 
stoppered  tube,  with  twice  its  volume  of 
ether,  or  a  mixture,  consisting  of  two 
parts  of  ether  and  one  of  chloroform. 
These  liquids  dissolve  the  strychnia  set  free  by  the  alkali.  The 
ethereal  solution  is  separated  from  the  watery  liquid  by  a  pipette, 
and  submitted  to  spontaneous  evaporation,  when,  if  strychnia  is 
present,  the  alkaloid  will  be  obtained,  but  generally  associated  with 
oily  and  other  organic  matters,  which  interfere  with  the  production 
of  crystals.  The  impure  residue  left  by  the  ether  is  heated  in  a 
water-bath,  with  a  few  drops  of  strong  sulphuric  acid  ;  this  destroys 
the 'organic  matter.  Water  is  added,  and  the  acid  liquid  is  filtered 
through  paper,  neutralized  by  potash,  and  again  treated  with  ether, 
when  strychnia  will  be  obtained  in  small  and  slender  prisms.  The 
crystals,  after  an  examination  by  the  microscope  (see  Fig.  24,  p.  188)j 
are  treated  with  sulphuric  acid  and  peroxide  of  manganese,  and  the 


Crystals  of   Chromate  of    Strychnia 
magnified   124  diameters. 


190  STRYCHNIA    IN    ORGANIC    MIXTURES. 

color-reactions  of  strychnia,  if  the  alkaloid  is  present,  will  appear. 
Mr.  Bloxam  has  recommended  the  use  of  benzole  in  place  of  ether. 
Strychnia  is  freely  soluble  in  benzole,  and  this  liquid  will  remove 
the  alkaloid  from  water,  when  precipitated  by  an  alkali.  The  crys- 
tals of  strychnia  deposited  from  the  benzolic  solution  are  isolated, 
and  in  the  form  of  truncated  octahedra.  When  the  residue  from 
benzole  is  treated  with  sulphuric  acid,  it  requires  a  pinkish  tinge. 
The  color  tests  for  strychnia  added  to  the  mixture  act  but  slowly. 
and  the  only  one  which  acts  satisfactorily  is  the  peroxide  of  man- 
ganese. It  produces  an  intense  blue,  which  is  a  long  time  in  passing 
to  the  purple  and  red  shades.  Benzole  appears  to  be  a  better  solvent 
of  strychnia  than  ether. 

[Influence  of  Morphia  in  disguising  the  usual  Color-test. — Dr.  John 
J.  Eeese,  of  Philadelphia,  called  attention,  at  a  meeting  of  the  College 
of  Physicians  of  Philadelphia,  held  September  4th,  18*31,  to  some 
experiments  with  which  he  had  confirmed  the  fact  noticed  by  Dr.  T. 
G.  Wormley  ("  Ohio  Medical  and  Surgical  Journal,"  September,  1859), 
that  the  presence  of  morphia  masks  the  color-test  of  strychnia.  Dr. 
Eeese  had  been  led  to  undertake  the  investigation  by  his  want  of 
success  in  detecting  strychnia  in  the  stomach  and  a  portion  of  the 
small  intestine  of  a  woman  who  was  proved  by  the  moral  evidence, 
and  the  subsequent  confession  of  the  accused,  to  have  been  poisoned 
with  strychnia  by  her  husband.  The  parts  submitted  to  analysis 
were  sent  to  Dr.  Eeese  eight  weeks  after  death,  the  body  not  having 
been  disinterred  until  the  elapse  of  six  weeks.  The  woman  took 
about  four  grains  of  the  poison,  and  survived  five  or  six  hours. 
Notwithstanding  a  very  careful  examination  of  the  contents  of  the 
stomach,  of  the  contents  of  the  intestine,  and  of  the  tissues  themselves, 
twice  in  each  instance,  by  the  method  of  Stas,  he  failed  to  discover 
either  the  bitter  taste  or  the  play  of  colors.  Nor  was  he  able  to 
obtain  a  frog  at  that  time  of  year  in  order  to  try  the  physiological 
test  of  Marshall  Hall.  Having  ascertained  that  the  woman,  shortly 
before  her  death,  had  taken  by  prescription  a  quarter  of  a  grain  of 
morphia  with  a  little  ipecacuanha,  which  was  not  vomited,  he  sus- 
pected the  agency  of  the  morphia  in  embarrassing  his  search  for  the 
evidence  of  strychnia.  He  immediately  instituted  a  series  of  experi- 
ments by  which  he  ascertained  conclusively  that  "morphia  does 
unquestionably  possess  the  power,  when  present  in  excess,  of  com- 
pletely disguising  the  usual  color-test  of  strychnia ;  and  this  is  em- 
phatically the  case  when  they  are  associated  in  organic  mixtures,  as 
in  the  contents  of  the  stomach.  Consequently  this  fact  should  always 
be  taken  into  account  in  medico-legal  investigations.*'  This  effect  of 
morphia  seems  to  have  escaped  the  observation  of  Dr.  Guy,  who,  in 
a  recent  paper  ("Chemical  News,  July  6,  1861),  as  Dr.  Eeese  remarks, 
has  stated  as  the  result  of  his  experiments  with  a  great  variety  of 
substances  which  would  be  likely  to  remain  mixed  with  strychnia 
when  extracted  from  the  contents  of  the  stomach  or  from  the  fluids 
and  tissues  of  the  body,  "that  the  color-tests  are  little,  if  at  all, 
affected  by  such  admixtures." 

Dr.  Eeese  attaches  great  value  to  the  play  of  colors,  under  &&  oon- 


POISONING    WITH    BEUCIA.  191 

joined  agency  of  certain  oxidizing  bodies  and  sulphuric  arid,,  as  quite 
peculiar  to  strychnia,  this  being  the  result  is  no  other  substance  now 
known.  Other  organic  principles,  including  the  woorara  (curara) 
poison,  do  yield  a  color  with  sulphuric  acid  alone,  but  there  is  not 
one  that  will  strike  the  peculiar  blue  tint  with  the  acid  and  oxidizing 
body  conjointly.  The  curarina  of  the  curara,  which  is  cited  by  Dr. 
Taylor  ("  Poisons,"  2d  Am.  ed.,  1859,  p.  680),  further  differs  from 
strychnia  in  giving  a  rich  carmine  tint  with  sulphuric  acid  alone, 
whereas,  the  acid  by  itself,  causes  no  change  of  color  with  pure 
strychnia.  The  extreme  delicacy  of  the  color-test  is  also  shown  by 
Dr.  Keese.  Another  confirmatory  test  of  value  is  the  excessive  bit- 
terness of  taste,  in  which  he  ascertained  strychnia  to  be  strikingly 
pre-eminent  above  other  well  known  bitter  articles.  Among  these 
he  specified  extract  of  quassia,  carbazotic  acid,  aloes,  extract  of  colo- 
cynth,  sulphate  of  quinia,  picrotoxine,  and  the  salts  of  morphia,  in 
regular  order  of  succession,  as  to  bitterness. 

The  frog-test  was  very  carefully  and  abundantly  investigated  by 
Dr.  Eeese  and  found  to  be  extremely  delicate.  He  considers  it  of 
very  great  importance  as  corroborative  evidence,  and  one  which  never 
ought  to  be  omitted  in  medico-legal  research.  "-Taken  in  conjunc- 
tion with  the  delicate  color-test  already  alluded  to,  and  the  bitter 
taste  of  the  evaporated  extract,  it  affords  such  overwhelming  proof 
of  the  presence  of  strychnia  as  can  admit  of  no  possibility  of  cavil." 

Further  experiment  convinced  him  that  morphia  rather  aggravated 
than  diminished  the  tetanizing  action  of  strychnia  on  frogs ;  so  that 
"the  presence  of  morphia,  although  most  seriously  interfering  with 
one  of  our  means  of  detecting  this  poison,  viz.,  the  color-test,  most 
fortunately  produces  no  impression  on  the  almost  equally  delicate 
frog-testy 

The  microscopy  of  strychnia  also  occupied  Dr.  Reese's  attention,  as 
one  of  great  delicacy  and  beauty,  and  well  worth  employing  in  cor- 
roboration, so  far  as  practicable,  which  is  only  the  case  when  the 
alkaloid  is  in  a  state  of  purity. .  He  has  succeeded  best  "  by  evapo- 
rating a  drop  of  a  solution  in  pure  water  of  known  strength  on  a 
glass  slide,  and  subjecting  it  to  the  field  of  a  good  instrument.  Very 
satisfactory  results  may  be  obtained  by  using  quantities  as  small 
as  the  l-50,000th  to  the  l-500,000th  of  a  grain;  although  even  the 
1-1, 000,000th  may  easily  be  recognized.  The  appearance  presented  to 
the  eye  is  that  of  numerous  crystals ;  some  are  circular  and  others 
stellate  and  scolloped,  intermingled  with  dentated  crosslets,  the 
whole  bearing  a  striking  resemblance  to  the  appearance  presented  by 
the  arborescent  crystals  of  the  triple  phosphate  seen  in  a  drop  of  the 
evaporated  urine." — See,  for  a  full  account  of  the  subject  of  this  note, 
and  a  detailed  account  of  the  experiments  alluded  to,  a  most  inter- 
esting paper  by  Dr.  Reese  in  the  "  Am.  Journ.  of  Med.  Sci.,  Oct. 
1861,  p.  409,  "  On  the  Detection  of  Strychnia  as  a  Poison,  and  the 
Influence  of  Morphia  in  disguising  the  usual  Color-test. — H.] 

Brucia. — Brucia  is  an  alkaloid  generally  associated  with  strychnia 
in  the  seeds  of  nux  vomica,  but  it  is  more  abundantly  contained  in 
the  bark  of  the  tree.     It  is  not  so  powerful  a  poison  as  strychnia,  but 


192 


POISONING    WITH    BRUCIA. 


the  symptoms  "which  it  produces  are  similar.  It  is  considered  to 
have  about  one-sixth  of  the  strength  of  strychnia.  It  is  not  affected 
by  the  color-tests  employed  for  the  detection  of  strychnia,  and  it 
acquires  an  intense  red  color  on  the  addition  of  nitric  acid.  It  is 
much  more  soluble  in  water  than  strychnia,  and  has  a  bitter  taste. 
Its  aqueous  solution  is  strongly  alkaline,  and  by  spontaneous  evapo- 
ration it  yields  groups  of  slender  prismatic  crystals  arranged  in  a 
fan-like  shape.     Unlike  strychnia,  it  cannot  be  crystallized  from  a 

solution  in  benzole,  and  only  imperfectly 
from  a  solution  in  alcohol.  Hydrochloric 
and  iodic  acids  produce  in  it  no  change, 
either  in  the  cold  or  when  heated.  Sul- 
phuric acid  gives  to  it  a  pink  red  color 
without  carbonizing  it.  The  sulphate  of 
brucia  crystallizes  in  well-defined  prisms 
truncated  at  the  ends.  They  are  larger 
and  longer  than  the  prisms  of  strychnia. 
(See  Fig.  26.)  From  a  case  of  poisoning 
with  this  alkaloid  which  has  occurred  to 
Dr.  Edwards  of  Liverpool,  it  is  necessary 
to  give  a  caution  to  medical  men  respect- 
ing the  possible  criminal  use  of  brucia. 
The  symptoms  which  it  causes  so  closely 
resemble  those  of  poisoning  with  strychnia  that  in  the  event  of  death 
the  latter  poison  only  may  be  sought  for  and  not  found.  The  te- 
tanic symptoms  are  more  slowly  produced,  and  the  poison  is  not  so 
rapidly  fatal  as  strychnia,  but  these  conditions  may  be  altered  by 
the  large  quantity  giveu.  When  in  any  suspected  case,  the  color- 
tests  for  strychnia  fail  to  show  the  presence  of  this  alkaloid,  nitric 
acid  should  be  added  to  the  crystalline  residue  obtained,  as  in  the 
process  for  strychnia,  by  the  use  of  ether  or  chloroformic  ether. 
The  intense  reddening  produced  by  this  test,  with  the  other  charac- 
ters above  mentioned,  will  indicate  the  presence  of  brucia. 

[Strychnia  is  largely  consumed  by  the  hunters  and  farmers  in  the 
United  States  as  a  poison  for  dogs,  wolves,  and  other  carnivorous 
animals ;  and  cases  of  unintentional  and  accidental  poisoning  with  it 
are  more  common  in  this  country  than  formerly.  A  committee  of 
the  American  Pharmaceutical  Association  estimated,  in  1853,  that 
between  five  and  six  thousand  ounces  are  annually  manufactured  in 
this  country  from  about  one  hundred  and  twenty  thousand  of  nux 
vomica,  besides  what  is  imported.  "  Proc.  of  the  Am.  Pharmac. 
Assoc."  1853,  p.  11.— H.] 


Crystals  of  Sulphate  of  Brucia, 
magnified  124  diameters. 


POISONING    WITH    HEMLOCK.  193 


(CEREBROSPINAL  POISONS.) 

CHAP TEE    XX. 

conium    maculatum. — hemlock. — conia. — (enanthe    crocata. — 
^ethusa  cynapium. — aconite  or  monkshood. — aconitina. 

Common  or  Spotted  Hemlock.    (Conium  Maculatum.) 

Symptoms  and  Appearances. — The  effects  produced  by  hemlock  have 
not  been  uniform ;  in  some  instances  there  have  been  stupor,  coma, 
and  slight  convulsions :  while  in  other  cases,  the  action  of  the  poison 
has  been  chiefly  manifested  on  the  spinal  marrow — i.  e.  it  has  pro- 
duced paralysis  of  the  muscular  system.  A  man  ate  a  large  quantity 
of  hemlock-plant,  by  mistake  for  parsley.  In  from  fifteen  to  twenty 
minutes  there  was  loss  of  power  in  the  lower  extremities ;  but  he 
apparently  suffered  no  pain.  In  walking,  he  staggered  as  if  he  was 
drunk  ;  at  length  his  limbs  refused  to  support  him,  and  he  fell.  On 
being  raised,  his  legs  dragged  after  him,  and  when  his  arms  were 
lifted,  they  fell  like  inert  masses,  and  remained  immovable.  There 
was  perfect  paralysis  of  the  upper  and  lower  extremities  within  two 
hours  after  he  had  taken  the  poison.  There  was  loss  of  power  of 
swallowing,  and  a  partial  paralysis  of  sensation,  but  no  convulsions, 
only  slight  occasional  motions  of  the  left  leg ;  the  pupils  were  fixed. 
Three  hours  after  eating  the  hemlock,  the  respiratory  movements  had 
ceased.  Death  took  place  in  three  hours  and  a  quarter ;  it  was  evi- 
dently caused  by  gradual  asphyxia  from  paralysis  of  the  muscles  of 
respiration ;  but  the  intellect  was  perfectly  clear  until  shortly  before 
death.  On  inspection,  there  was  slight  serous  effusion  beneath  the 
arachnoid  membrane.  The  substance  of  the  brain  was  soft ;  on  sec- 
tion there  were  numerous  bloody  points,  but  the  organ  was  otherwise 
healthy.  The  lungs  were  gorged  with  dark  fluid  blood ;  the  heart 
was  soft  and  flabby.  The  stomach  contained  a  green-colored  pulpy 
mass  resembling  parsley.  The  mucous  coat  was  much  congested, 
especially  at  its  greater  end.  Here  there  were  numerous  extravasa- 
tions of  dark  blood  below  the  membrane,  over  a  space  of  about 
the  size  of  the  hand.  The  intestines  were  healthy,  here  and  there 
presenting  patches  of  congestion  in  the  mucous  coat.  The  blood 
throughout  the  body  was  fluid,  and  of  a  dark  color. 

In  a  case  which  was  the  subject  of  a  trial  for  murder  {Reg.  v. 
Boiuyer,  IpsAvich  Summer  Assizes,  1848),  the  child  died  in  one  hour 
after  swallowing  part  of  a  teacupful  of  a  decoction  of  hemlock, 
alleged  to  have  been  administered  by  the  mother.  The  child  sipped 
the  decoction,  until  it  lost  the  power  of  holding  the  cup :  it  became 
insensible  and  paralyzed,  and  died  in  the  chair  in  a  sitting"  posture.. 
13 


194  PROPERTIES    OF    CONIA. 

There  were  no  morbid  appearances,  and  no  hemlock  leaves  were  found 
in  the  body,  these  having  subsided  in  the  cup, and  being  left  in  the 
dregs.  The  child  had  been  poisoned  by  the  upper  stratum  of  clear 
liquid.  The  mother  was  acquitted  for  want  of 
proof,  the  death  of  the  child  having  taken 
place  in  secrecy. 

Hemlock  is  known  from  most  other  plants 

which  resemble  it  by  its  large  round  smooth 

stem,  with  dark  purple  spots.     The  leaves  are 

of  a  dark  green  color,  and  smooth  and  shining. 

Every  portion  of  the  plant  has  a  peculiar  and 

disagreeable  smell  when  bruised,  resembling 

cat's  urine,  or,  according  to  some,  the  odor 

of  mice.      It   is    strongly  brought  out  when 

the  stem,  leaves,  or  seeds  are  rubbed  with  a 

a  seed" oTnemiock,  natural     solution    of  caustic    potash.      An  illustration 

size.  of  the  seeds  of  hemlock,  is  annexed  (Fig.  27.) 

b  The    same,   magnified   30    They  are  peculiar  in  their  form,  and  are  easily 

diameters  distinguished  from  the  seeds  of  other  umbelli- 

c  Group  of  seeds.  pi  *  i  •  i 

ferous  plants.  A  person  may  be  poisoned 
by  a  decoction  of  leaves  of  hemlock,  and  no  leaves  be  found  in  the 
stomach  or  bowels  (case  of  Bowyer,  supra.)  In  this  case  the  stomach 
had  been  emptied,  and  the  contents  lost,  before  it  was  sent  to  me ! 
No  trace  of  conia  was  found. 

The  poisonous  alkaloid  of  hemlock  is  known  under  the  names  of 
Conia,  conein,  conicine,  and  conicina.  It  resembles  nicotina  and 
ammonia  in  its  liquidity,  volatile  reaction,  and  in  some  of  its  chemi- 
cal properties.  It  is  a  liquid  of  oily  consistency,  of  a  pale  yellow 
color,  powerfully  alkaline,  and  has,  when  its  vapor  is  diluted,  a 
smell  resembling  that  of  mice,  and  an  acrid  bitter  taste.  It  gives  a 
volatile  greasy  stain  to  paper,  and  burns  with  a  yellow  flame  and 
thick  smoke.  1.  It  is  not  colored  or  affected  by  nitric,  sulphuric, 
or  hydrochloric  acid ;  the  last-mentioned  acid  produces  with  it,  dense 
white  fumes  of  hydrochlorate  of  conia,  and  on  heating  the  mixture, 
this  salt  remains  in  prismatic  crystals.  2.  It  is  not  dissolved  by 
water,  but  floats  on  it  in  oily  globules.  3.  It  is  soluble  in  alcohol 
and  ether,  and  this  last-mentioned  liquid  removes  it  from  its  aqueous 
solution,  and  leaves  it  in  oily  globules  on  evaporation.  In  reference 
to  its  presence  in  organic  mixtures,  it  may  be  detected  by  its  peculiar 
odor,  or  by  distilling  the  liquid  with  a  solution  of  potash  and  exa- 
mining the  distillate. 

The  reactions  produced  by  tests  on  small  quantities  should  be 
distrusted,  unless  there  is  strong  evidence  of  the  action  of  the  poi- 
son on  the  body  from  the  symptoms. 

Water-Hemlock.    (Cicuta  Yirosa.) 

Symptoms  and  Appearances. — The  symptoms  produced  by  the  roots 
of  this  plant  are  giddiness,  dimness  of  sight,  headache,  and  difficulty 
of  breathing.    There  is  burning  pain  in  the  stomach,  with  vomiting, 


POISONING    WITH    CENANTHE    CKOCATA.  195 

and  these  symptoms  are  accompanied  by  heat  and  dryness  of  the 
throat.  Convulsions  have  been  observed  to  precede  death.  In  the 
cases  of  three  children  in  convulsions  from  this  poison,  Mertzdorff 
found  an  injected  state  of  the  mucous  membrane  of  the  stomach, 
with  redness  of  the  air-passages,  as  well  as  of  the  cardia,  and  pylorus ; 
the  vessels  of  the  brain  and  the  sinuses  were  filled  with  dark  liquid 
blood.     (Wibmer,  "  Cicuta,"  119.) 

Hemlock  Water-Dropwort.    (GEnanthe  Crocata.) 

This  umbelliferous  plant  grows  on  the  banks  of  rivers,  streams, 
and  ditches.  It  is  one  of  the  most  poisonous  of  the  order,  and  is 
considered  to  be  one  of  the  most  virulent  of  English  vegetable 
poisons. 

Symjrtoms  and  Appearances. — In  April,  1857,  two  cases  of  poison- 
ing with  this  plant  occurred  at  West  Bolclon  in  Durham.  Two 
laborers  ate  some  of  the  roots  of  the  cenanthe.  They  were  found 
soon  afterwards  lying  insensible  and  speechless,  their  faces  livid, 
tongues  swollen  and  protruded,  and  there  were  convulsive  movements 
of  their  teeth,  frothy  mucus  with  blood  about  their  mouths,  eyes 
full  and  projecting,  pupils  dilated,  breathing  stertorous  and  labored, 
with  occasional  general  convulsions.  They  both  died  in  an  hour 
and  a  half  from  the  time  at  which  they  were  first  discovered.  On 
inspection,  it  was  found  that  there  had  been  bleeding  from  the  ears ; 
the  abdomen  was  livid  and  swollen.  The  stomach  contained  a  gruelly 
liquid  with  some  of  the  partly  digested  roots:  on  removing  this 
liquid,  the  membrane  was  found  congested  and  softened.  The  lungs 
were  engorged  with  dark  liquid  blood,  and  the  blood  contained  in 
the  heart  was  in  a  similar  state.  Mr.  Boyle,  to  whom  these  cases 
occurred,  forwarded  to  me  a  portion  of  the  roots,  and  there  was  no 
doubt  that  they  were  the  roots  of  the  cenanthe  crocata.  (For  other 
cases  see  "  Medical  Gazette,"  vol.  31,  p,  288.) 


Seeds  of  CEnanthe  Crocata.     a  Natural  size,     b  Magnified  30  diameters,     c  One-half  of  a  seed 
magnified,     d  One-half  natural  size,    e  Group  of  seeds. 

It  is  not  often  that  attempts  are  made  to  destroy  others  by  the 
administration  of  these  vegetable  poisons;  but  a  case  occurred  in 
France  in  which  a  woman  attempted  to  poison  her  husband  by  mix- 
ing slices  of  the  root  of  this  plant  with  his  soup.  His  suspicions  were 


196 


POISONING    WITH    .ETHUSA    CYXAPIUM. 


excited  by  the  acrid  taste  of  the  soup.  The  woman  was  tried  for 
the  crime,  and  M.  Toulmouche  deposed  at  the  trial,  that  the  plant 
from  which  the  root  had  been  taken,  was  the  cenanthe  crocata — that 
it  was  a  powerful  poison,  and  might  cause  death  in  two  or  three 
hours.  The  prisoner  was  convicted,  and  condemned  to  ten  years  at 
the  o-alleys.  ("Gaz.  Med.,"  Jan.  3,  1846,  18;  also  "Journ.  de  Chim. 
Med.,"  1845,  533.) 

The  cenanthe  crocata  can  be  identified  only  by  its  botanical  char- 
acters. The  leaves  are  of  a  dark  green  color,  with  a  reddish  colored 
border.  They  have  no  unpleasant  odor  when  rubbed.  The  seeds, 
of  which  an  illustration  is  annexed,  are  peculiar.  The  plant  bears  a 
greater  resemblance  to  celery  than  most  of  the  other  umbelliferae. 
Its  stem  is  channelled,  round,  smooth,  and  branched,  of  a  yellowish 
red  color,  and  growing  to  the  height  of  two  or  three  feet.  The  root 
consists  of  a  series  of  oblong  tubercles,  with  long  slender  fibres.  It 
is  of  a  yellowish-white  color,  and  not  unpleasant  to  the  taste.  It  is 
the  most  active  part  of  the  plant.  The  leaves  yield  much  tannic 
acid  to  water,  but  the  decoction  appears  to  contain  no  alkaloidal  base, 
since  the  chloriodide  of  potassium  and  mercury  produces  no  precipi- 
tate in  it.  The  roots  and  stems  of  this  plant  are  more  frequently 
eaten  than  the  leaves  or  seeds. 


Fool's  Parsley.    (^Ethusa  Cynaphjm.) 

Fool's  Parsley,  or  Lesser  Hemlock,  is  very  common  in  gardens 
and  hedgerows.  The  leaves  so  closely  resemble  those  of  parsley 
that  they  have  often  been  gathered  for  them  by  mistake. 

Symptoms  and  Appearances. — In  May,  1815,  a  girl  aged  five  years, 
in  good  health,  ate  the  bulbs  of  the  asthusa  by  mistake  for  young- 
turnips.    She  was  suddenly  seized  with  pain  in  the  abdomen,  followed 
by  sickness,  but  no  vomiting.     She 'complained  of  feeling  very  ill. 
On  trying  to  eat,  she  could  not  swallow.    She 
Fig.  29.  was  incapable  of  answering  questions,  and 

her  countenance  bore  a  wild  expression. 
The  lower  jaw  became  fixed,  so  as  to  prevent 
anvthing  being  introduced  into  the  mouth. 
She  then  became  insensible,  and  died  in  an 
hour  from  the  commencement  of  the  symp- 
toms :  so  far  as  could  be  ascertained,  there 
were  no  convulsions.  A  second  child,  aged 
three  years,  shortly  after  eating  the  same 
substance,  was  attacked  with  pain  in  the 
stomach,  sickness,  vomiting,  and  profuse  per- 
spiration. She  soon  recovered,  with  the  ex- 
ception of  suffering  severe  griping  pains 
without  purging,  but  these  disappeared  on 
the  following  day.  A  third  child,  of  the 
same  age,  suffered  from  similar  symptoms. 
Recovery  in  the  two  last  cases  was  probably 
due  to  the  plant  having  been  eaten  on  a  full  stomach,  and  to  the 


Seeds  of  Fool's  Parsley. 
a  Natural  si/e. 
b  Magnified  30  diameters, 
c  Group  of  Seeds. 


POISONING    WITH    MONKSHOOD.  197 

effect  of  early  and  copious  vomiting.      ("  Med.  Times,"  Aug.  23, 
1845,  p.  408.) 

This  plant  is  known  from  garden  parsley  by  the  smell  of  its  leaves 
when  rubbed,  which  is  peculiar,  disagreeable,  and  very  different 
from  that  possessed  by  the  leaves  of  parsle}7.  The  leaves  of  Fool's 
parsley  are  finer,  more  acute,  and  of  a  darker  green  color.  The 
seeds  are  also  peculiar.  They  are  represented  in  the  annexed  illus- 
tration. Its  flower-stem,  which  is  striated,  or  slightly  grooved,  is 
easily  known  from  all  other  umbelliferous  plants  by  the  beard,  or 
three  long  pendulous  leaves  of  the  involucrum  under  the  flower. 
The  flowers  are  white,  those  of  the  garden  parsley  of  a  pale  yellow 
color.  The  poisonous  properties  of  the  plant  are  believed  to  be  due 
to  an  alkaloid,  which  has  not  yet  been  isolated. 

Monkshood.    (Aconitum  Napellus.) 

This  well-known  garden  plant  is  in  some  parts  of  the  country  called 
Wolfsbane,  and  in  Ireland  Blue-rocket.  The  roots,  seeds,  and  leaves 
are  highly  poisonous,  owing  to  the  presence  of  the  alkaloid  aconitina  ; 
the  root  is  especially  noxious,  and  when  the  leaves  have  fallen  off  it 
appears  to  possess  its  greatest  virulence.  These  parts  of  the  plant, 
when  masticated,  produce  a  peculiarly  cool  numbing  sensation,  affect- 
ing the  lips,  tongue,  and  interior  of  the  mouth  generally.  At  first 
the  root  appears  to  be  tasteless,  as  the  effects  are  only  manifested 
after  twenty  minutes  or  half  an  hour.  From  tasting  only  a  small 
portion  of  the  dried  root,  I  found  that  this  disagreeable  sensation 
remained  on  the  tongue  and  lips  for  four  hours.  In  larger  quantity 
the  taste  has  been  described  as  burning,  and  it  is  stated  to  have  been 
followed  by  a  hot  acrid  sensation  in  the  throat. 

Symptoms  and  Appearances. — In  from  a  few  minutes  to  an  hour 
after  the  poison  has  been  taken,  the  patient  complains  of  numbness 
and  tingling  in  the  mouth  and  throat,  which  are  parched :  there  is 
giddiness,  with  numbness  and  tingling  in  the  limbs,  a  loss  of  power 
in  the  legs,  sometimes  frothing  at  the  mouth  and  severe  pain  in  the 
abdomen,  followed  by  vomiting  and  purging.  In  some  cases  the 
patient  is  completely  paralyzed  but  retains  his  consciousness ;  in 
others  the  giddiness  is  followed  by  dimness  of  sight,  delirium,  and 
other  cerebral  symptoms,  but  not  amounting  to  the  complete  coma 
produced  by  the  cerebral  or  narcotic  poisons.  The  pupils  are  di- 
lated, the  pulse  sinks,  the  skin  is  cold  and  livid,  and  the  breathing  is 
difficult.  Convulsions  are  not  commonly  observed  in  man,  or  they 
are  indicated  by  general  tremors  or  twitchings  of  the  voluntary 
muscles.  The  poison  produces  convulsions  in  animals.  Poisoning 
by  the  root  of  aconite  is  by  no  means  unfrequent.  In  the  spring  or 
autumn  the  root  is  liable  to  be  mistaken  for  that  of  horseradish.  It 
has  been  thus  accidentally  eaten  on  several  occasions  and  has  caused 
death.  A  mistake  of  this  kind  led  to  fatal  results  in  three  hours  in 
a  case  which  occurred  at  Lambeth  ;  and  another  set  of  cases  occurred 
at  Dingwall,  in  Scotland,  in  January  185(3.  Here  three  persons  were 
poisoned  by  reason  of  their  having  had  sauce  made  with  the  root  of 


198  SYMPTOMS    AXD    APPEAEAXCES. 

aconite  served  at  dinner  with  roast  beef  in  place  of  horseradish  sauce! 
They  were  healthy  adults ;  they  all  died  within  three  hours  and  a 
half.  Mistakes  of  this  kind  show  deplorable  ignorance,  but  there  is 
always  the  risk  of  their  occurrence  when  horseradish  and  aconite  are 
grown  near  to  each  other  in  a  garden  at  that  season  of  the  year  when 
the  leaves  have  fallen. 

The  tincture  of  the  root  is  a  powerful  poison.  In  January,  1853, 
a  woman  took  by  mistake  seventy  minims  of  Fleming 's  tincture  of  the 
root  mixed  with  one  grain  of  acetate  of  morphia.  In  a  few  minutes 
she  became  very  thirsty,  complained  of  a  burning  sensation  and  pain 
in  her  stomach,  to  relieve  which  she  swallowed  a  quantity  of  cold 
water.  In  fifteen  minutes  there  was  violent  vomiting,  which  con- 
tinued for  two  hours.  She  lost  the  power  of  standing,  and  was  very 
restless.  The  pain  in  the  stomach  increased,  and  there  were  con- 
vulsive movements  of  the  muscles.  She  was  conscious  until  shortly 
before  her  death,  which  took  place  in  about  four  hours  after  she  had 
taken  the  poison.  There  were  no  general  convulsions :  the  pain  in 
the  stomach  was  well  marked  throughout.  On  inspection,  the  mem- 
branes of  the  brain  were  congested,  but  the  brain  itself  was  firm 
and  healthy.  The  lungs  were  healthy:  and  the  heart  was  flaccid, 
the  uterus  congested.  The  stomach  contained  some  mucus,  and  the 
membrane  at  the  larger  curvature  was  injected  (reddened)  in  patches, 
but  otherwise  natural.  The  mucous  membrane  of  the  duodenum 
was  in  a  high  state  of  inflammation,  abraded  in  patches,  softened, 
and -broken  down.  Some  spots  were  of  a  very  dark  color,  passing 
into  mortification.  In  October,  1852.  an  excise  officer  lost  his  life 
by  merely  tasting  Fleming's  tincture  of  aconite,  under  the  supposi- 
tion that  it  was  flavored  spirit.  He  was  able  to  walk  from  the  Cus- 
tom House  over  London  Bridge,  but  he  died  in  about  four  hours 
after  taking  the  poison. 

The  case  of  the  man  Hunt,  who,  in  November,  1863,  destroyed 
his  wife  and  children  by  prussic  acid,  presents  some  features  of  in- 
terest in  reference  to  the  symptoms  and  appearances  produced  by 
tincture  of  aconite.  The  quantity  of  tincture  taken  by  him  was  not 
determined ;  but  the  man  was  soon  afterwards  seized  with  violent 
spasmodic  retching,  face  pale,  skin  cold  and  clammy,  pulse  small  and 
hardly  perceptible,  and  the  action  of  the  heart  feeble.  The  pupils 
were  much  dilated,  and  the  eyes  brilliant  and  sparkling:  the  breath- 
ing was  quiet  and  regular,  except  during  the  fits.  He  complained 
of  pain  in  his  heart.  In  attempting  to  walk,  he  staggered,  and  had 
no  power  to  raise  his  arms.  He  was  perfectly  conscious — called  for 
writing  materials,  and  wrote  a  few  lines.  He  then  became  suddenly 
worse,  and  a  quarter  of  an  hour  before  his  death  he  lost  all  power 
and  sensation  in  his  limbs,  the  sharpest  pinches  producing  no  im- 
pression. The  pulse  was  imperceptible.  There  were  no  convulsions, 
but  complete  relaxation  of  the  limbs  at  death,  which  appeared  to 
arise  from  syncope  three  quarters  of  an  hour  after  he  had  taken  the 
poison.  On  inspection  forty-two  hours  after  death,  there  was  great 
rigidity  of  the  muscles.  The  substance  of  the  brain  was  linn  and 
healthy:  the  vessels  on   the  surface  were  tilled  with  blood.     The 


ACONITE    ROOT. 


199 


heart  was  healthy :  the  right  side  was  greatly  distended  with  dark 
fluid  blood :  the  left  side  contracted  and  quite  empty.     The  lungs 


Fig.  30. 


Fig.  31. 


Root  of  Aconite. 


Root  of  Horseradish. 


were  healthy.  In  the  abdomen  the  viscera  were  healthy,  with  the 
exception  of  the  stomach  and  duodenum.  There  was  great  capillary 
congestion  at  the  larger  end  of  the  stomach,  the  mucous  membrane 
having  a  bright  red  color.  There  were  marks  of  irritation,  with 
vsoftening  and  separation  of  the  mucous  lining,  the  whole  of  the  mem- 
brane being  in  a  highly  corrugated  condition.  Traces  of  aconitina 
were  found  in  the  contents  of  the  stomach.  The  deceased  had  pro- 
vided himself  with  an  ounce  of  the  tincture  of  aconite,  and  had 
swallowed  the  greater  part  of  this  mixed  with  water. 

Analysis. — The  botanical  characters  of  the  leaves  and  root,  when 
any  portion  can  be  obtained,  will  enable  a  medical  witness  to  iden- 
tify this  vegetable  poison.  The  root  has  been  frequently  and  fatally 
mistaken  for  horseradish,  but  there  are  these  striking  differences :  1. 
Aconite  root  is  very  short,  conical,  and  tapers  rapidly  to  a  point 
(Fig.  80).  2.  It  is  externally  of  an  earthy-brown  color — internally 
white  and  of  an  earthy  smell — the  cut  surface  is  rapidly  reddened  by- 
exposure  to  air.    It  has  numerous  long  thin  fibres  proceeding  from  it. 


200  ACOXITIXA. 

3.  It  has  at  first  a  bitter  taste,  but  after  a  quarter  of  an  hour  or 
twenty  minutes  it  produces  a  disagreeable  sense  of  tingling  and 
numbness  on  the  lips  and  tongue.  1.  Horseradish  root  is  long,  cy- 
lindrical or  nearly  so,  and  of  the  same  thickness  for  many  inches 
(Fig.  31).  2.  It  is  externally  whitish-yellow,  and  has  a  pungent 
odor  when  scraped.  3.  Its  taste  is  something  bitter,  but  it  produces 
an  immediate  hot  or  pungent  sensation. 

The  leaves  of  aconite  or  monkshood  are  of  a  dark-green  color  and 
of  a  peculiar  shape.  When  masticated  they  slowly  produce  on  the 
lips  and  tongue  the  persistent  sense  of  tingling  and  numbness,  with 
the  sense  of  coolness  observed  in  the  root.     They  are  less  powerful 

than  the  roots  and  seeds.     The  seeds  differ 
Fis-  32-  in  appearance  from  those  of  other  poisonous 

plants  (Fig.  32). 

Aconitina. — The  alkaloidal  base  of  this 
plant,  Aconitina,  is  a  formidable  poison,  ex- 
ceeding all  others  in  its  effects.  In  one  case 
one-fiftieth  part  of  a  grain  nearly  proved 
fatal  to  an  elderly  lady  (Pereira,  "Mat.  Med." 
vol.  2,  pt.  2,  p.  695) ;  and  it  is  probable  that 
one-tenth  part  of  a  grain  of  pure  aconitina 
would  prove  fatal  to  a  human  beinsf.  Some 
aseed  of  Aconite  natural  sue  sampies  of  tbis  alkaloid  are,  however,  much 

o  The  same.magmhed  30  diameters.  i  '  '        . 

less  potent  than  others,  and  the  chemical 
properties  are  also  different.  (See  paper  by  Schroff,  "  Reil's  Journal 
fur  Toxikologie,"  3d  H.  1857,  p.  335),  and  one  by  Liegeois  ("Chem. 
News,"  Oct.  24,  1863,  p.  201).  This  contains  the  account  of  a  simple 
method  for  its  extraction. 

A  sample  of  English  aconitina  possessed  the  following  properties : 
It  was  in  whitish  granular  masses,  without  any  distinctly  crystalline 
structure.  1.  When  heated  it  readily  fused  and  burnt  in  the  air  with 
a  bright  yellow  flame.  2.  Heated  in  a  close  tube,  it  evolved  first  an 
alkaline  and  then  an  acid  vapor.  3.  It  Avas  scarcely  soluble  in  water, 
but  was  dissolved  by  weak  acids  and  alcohol ;  it  did  not  readily 
crystallize.  4.  Nitric  acid  dissolved  it  without  causing  any  change 
of  color.  5.  Sulphuric  acid  gave  to  it  a  yellowish  color,  and  green 
oxide  of  chromium  was  separated  on  adding  to  it  a  crystal  of  bichro- 
mate of  potash.  Aconitina  cannot  be  separated  from  its  solutions  in 
a  crystalline  state  by  the  addition  of  ammonia.  6.  Tannic  acid  and 
the  chloriodide  of  potassium  and  mercury  readily  precipitated  it. 

Aconitina  is  sufficiently  soluble  in 'ether  to  allow  of  its  separation 
from  organic  liquids  by  a  process  similar  to  that  used  for  strychnia. 
Dr.  Headland  recommends  as  a  physiological  test  the  production  of 
an  alcoholic  extract  of  the  contents  of  the  stomach  and  its  applica- 
tion to  animals.  One-twentieth  of  a  grain  will  be  sufficient :  the 
l-300th  of  a  grain  will  poison  a  mouse:  the  l-100th,  a  bird;  and 
l-l<)00th  causes  tingling  and  numbness  of  the  tip  of  the  tongue.  The 
l-100th  of  a  grain  dissolved  in  spirit  and  rubbed  into  the  skin  causes 
loss  of  feeling,  lasting  for  some  time.     ("Lancet,"'  March  29,  1  ; 


POISONING    WITH    BELLADONNA.  201 

p.  343.)  There  is  a  great  difference  in  the  properties  of  this  alka- 
loid according  to  the  mode  in  which  it  is  prepared.  (Bouchardat, 
"  Ann.  de  Therapeutique,"  1864,  pp.  48  and  54 ;  also,  "  Annuaire," 
1863,  p.  41.) 


CHAPTER   XXI. 

atropa  belladonna  or  deadly  nightshade. — poisoning  by 
atropia. lobelia. —  foxglove.  —  digitaline.  —  datura  stra- 
monium, or  thornapple. — daturia. 

Deadly  Nightshade.     (Atropa  Belladonna.) 

Symptoms. — The  symptoms  which  are  produced  by  the  leaves, 
berries,  seeds,  and  root  of  belladonna  are  of  a  uniform  character,  and, 
as  a  summary,  they  may  be  thus  described :  Heat  and  dryness  of 
the  mouth  and  throat,  nausea,  vomiting,  giddiness,  indistinct  or 
double  vision,  delirium,  great  excitement,  convulsions,  followed  by 
stupor  and  lethargy.  The  pupils  are  much  dilated,  and  the  eyes  are 
insensible  to  light.  In  two  cases  which  occurred  to  Mr.  Tufnell,  the 
pupils  were  contracted  during  sleep,  although  dilated  in  the  waking 
state.  ("Dublin  Med.  Press,"  Jan.  5,  1853.  "Journal  de  Chimie 
Medicale,"  1853,  p.  695.)  Several  deaths  from  the  poisonous  effects 
of  the  berries,  occurred  in  London  in  1846.  The  following  case  was 
admitted  into  Guy's  Hospital :  A  boy,  set.  14,  ate,  soon  after  break- 
fast, about  thirty  of  the  berries  of  the  belladonna,  which  he  had 
bought  as  fruit  in  the  streets.  In  about  three  hours,  he  had  the  sen- 
sation of  his  face  being  swollen ;  his  throat  became  hot  and  dry,  his 
vision  was  impaired,  objects  appeared  double,  and  they  seemed  to 
revolve  and  run  backwards.  His  hands  and  face  were  flushed,  and 
his  eyelids  swollen ;  there  were  occasional  flashes  of  light  before  his 
eyes.  He  tried  to  eat,  but  could  not  swallow  on  account  of  the  state 
of  his  throat.  In  endeavoring  to  walk  home  he  stumbled  and  stag- 
gered ;  and  he  felt  giddy  whenever  he  attempted  to  raise  his  head. 
His  parents  thought  him  intoxicated ;  he  was  incoherent ;  frequently 
counted  his  money,  and  did  not  know  the  silver  from  the  copper 
coin.  His  eyes  had  a  fixed,  brilliant,  and  dazzling  gaze ;  he  could 
neither  hear  nor  speak  plainly,  and  there  was  great  thirst ;  he  caught 
at  imaginary  objects  in  the  air,  and  seemed  to  have  lost  all  know- 
ledge of  distance.  His  fingers  were  in  constant  motion ;  there  was 
headache,  but  neither  vomiting  nor  purging.  He  did  not  reach  the 
hospital  until  nine  hours  had  elapsed ;  and  the  symptoms  were  much 
the  same  as  those  above  described.  He  attempted  to  get  out  of  bed 
with  a  reeling,  drunken  motion;  his  speech  was  thick  and  indistinct; 
the  pupils  were  so  strongly  dilated  that  there  was  merely  a  ring  of 
iris,  and  the  eyes  were  quite  insensible  to  light;  the  eyelids  did  not 
close  when  the  hand  was  passed  suddenly  before  them.     He  had  evi- 


202  BELLADONNA.   APPEARANCES. 

dently  lost  the  power  of  vision,  although  he  stared  fixedly  at  objects 
as  if  he  saw  them;  the  nerves  of  common  sensation  were  unaffected. 
When  placed  on  his  legs  he  could  not  stand.  His  pulse  was  90, 
feeble  and  compressible ;  his  mouth  was  in  constant  motion,  as  if  he 
were  eating  something.  His  bladder  was  full  of  urine  on  admission. 
He  continued  in  this  state  for  two  days,  being  occasionally  conscious, 
when  by  a  free  evacuation  of  the  bowels,  some  small  seeds  were 
passed ;  these  were  examined  and  identified  as  the  seeds  of  bella- 
donna. The  boy  gradually  recovered,  and  left  the  hospital  on  the 
sixth  day  after  his  admission ;  the  progress  of  recovery  was  indi- 
cated by  the  state  of  the  pupils,  which  had  then  only  acquired  their 
natural  size  and  power  of  contraction.  In  three  other  cases  which 
occurred  at  the  same  time,  the  berries  having  been  baked  in  a  pie, 
pains  in  the  limbs,  drowsiness,  insensibility,  aud  convulsions,  were 
among  the  symptoms.  In  two  instances  of  poisoning  by  the  berries 
related  by  Dr.  Moll,  the  symptoms  bore  a  strong  resemblance  to 
those  of  delirium  tremens,  but  among  them  were  heat  and  dry- 
ness of  the  throat,  loss  of  power  of  swallowing,  incoherent  speech, 
double  vision,  and  strange  spectral  illusions,  with  occasional  fits  of 
wild  and  ungovernable  laughter.  On  the  following  morning  both 
these  patients  recovered  as  if  from  a  dream ;  but  they  suffered  for 
some  time  from  languor,  thirst  and  dryness  of  the  throat ;  the  pupils 
also  continued  dilated,  (Casper's  "  Wocherischrift,"  10  Jan.  1846.  p. 
26.)  Two  cases,  showing  the  poisonous  effects  of  the  berries  on 
children,  are  quoted  in  the  "Edinburgh  Medical  and  SurgicalJour- 
nal."     (Vol.  29,  p.  452.) 

Appearances. — The  appearances  observed  in  several  cases  of  poi- 
soning with  the  berries  which  proved  fatal  in  London  during  the 
autumn  of  1846,  were  as  follows :  the  vessels  of  the  brain  were  con- 
gested with  liquid  blood ;  the  stomach  and  intestines  were  pale  and 
flaccid ;  there  were  some  red  spots  towards  the  cardiac  end.  In  other 
fatal  cases,  of  which  the  appearances  have  been  reported,  the  vessels 
of  the  brain  and  its  membranes  were  found  distended  with  thick 
black  blood.  Eed  spots  have  also  been  observed  around  the  throat 
and  gullet,  and  congested  patches  of  a  dark  purple  color  on  the  coats 
of  the  stomach.  In  some  instances  the  mucous  membrane  has  been 
completely  dyed  by  the  juice  of  the  berries.  A  boy,  set.  5,  after 
having  eaten  a  quantity  of  the  berries  of  the  belladonna,  went  to 
bed,  was  very  restless,  vomited  once,  and  died  in  convulsions  about 
fifteen  hours  after  having  taken  the  poison.  On  inspection,  the  eyes 
were  half  open,  with  an  intense  lustre:  the  pupils  dilated;  the  mouth 
was  spasmodically  closed  and  the  sphincter  ani  relaxed.  The  cere- 
bral vessels  were  distended  with  dark-colored  blood :  the  substance 
of  the  brain,  cerebellum,  and  medulla  oblongata,  presented  numerous 
bloody  points.  In  the  throat  and  gullet  there  were  several  patches 
of  redness.  In  the  stomach  there  was  some  fluid,  with  three  open 
berries;  the  mucous  membrane  was  of  a  reddish-blue  color  in  vari- 
ous parts.  (Case  of  Dr.  Rosenberger,  Canstatt's  "Jahresb."  1^44,  v. 
295.) 

Analysis. — The  indigestible  nature  of  the  leaves,  fruit,  and  seeds 


PROPERTIES  OF  ATROPIA.  203 

will  commonly  lead  to  their  detection  in  the  matters  vomited  or 
passed  by  the  bowels,  or  in  the  contents  of  the  viscera  after  death. 
The  seeds  of  belladonna  are  very  small — they  can  be  distinguished 
by  the  microscope  from  the  seeds  of  other  poisonous  plants.  They 
are  of  a  somewhat  oval  shape  and  of  a  dark  color.  Under  a  low 
magnifying  power  they  present  a  honey-combed 
surface  (Fig.  33).  In  henbane  the  surface  of  the 
seeds  presents  more  irregular  depressions,  resem- 
bling those  seen  on  certain  corals  or  madrepores. 
The  coloring  matter  of  the  berry  is  of  a  deep  pur- 
ple hue :  it  is  turned  green  by  alkalies,  and  red  by 
acids.  The  leaves  would  be  known  by  their  botani- 
cal characters,  or  decoction  or  infusion  of  them 
by  the  liquid  causing  dilatation  of  the  pupil.  ^  "  o  a 

Atropia. — Atropia    is  the  name  given  to  the 

ni      i     •  -i    i  •        •     -i         f>  i      n     i  • .    •  Seeds  of  Belladonna. 

alkaloidal  principle  of  belladonna  ;  it  is  a  power-  a  Natural  size 
ful  poison.  Some  consider  it  to  be  identical  with  &  Magnified  30  diameters, 
daturia,  the  poisonous  alkaloid  of  thornapple,  but 
this  is  not  yet  satisfactorily  established,  either  chemically  or  phy- 
siologically. Symptoms  of  poisoning  have  been  produced  by  the 
application  of  a  weak  solution  of  atropia  to  the  eyes.  One- eighth 
of  a  grain  injected  beneath  the  skin  for  the  relief  of  sciatica,  caused 
all  the  symptoms  of  poisoning  with  belladonna.  One  grain  used 
endermically  nearly  proved  fatal  at  Guy's  Hospital,  and  in  the  fol- 
lowing case  reported  by  Mr.  Leach  ("  Med.  Times  and  Gaz."  July  6, 
1865,  p.  34) — a  man  who  swallowed,  by  mistake,  a  grain  of  sulphate 
of  atropia  in  solution,  had  a  narrow  escape  of  his  life.  In  an  hour 
afterwards,  the  following  symptoms  were  observed :  the  pupils  were 
enormously  dilated  so  that  the  irides  were  scarcely  visible ;  the  eyes 
moved  restlessly  from  side  to  side.  The  pulse  was  very  quick,  and 
the  patient  appeared  as  if  intoxicated.  In  another  hour  his  hands 
were  cold,  the  pulse  was  weak,  and  there  was  loss  of  power  in  the 
limbs.  He  became  restless,  incoherent,  and  unconscious  of  preced- 
ing events.  There  was  also  delirium.  In  a  later  stage  there  was  a 
morbid  sensitiveness  to  sounds  and  objects,  the  tongue  was  furred 
and  the  skin  was  dry  and  hot.  The  pupils  continued  dilated  for  a 
week,  and  for  several  days  there  was  a  partial  paralysis  of  the  blad- 
der.    He  recovered  in  a  fortnight. 

Atropia  is  a  white  crystalline  substance,  not  very  soluble  in  water, 
but  easily  dissolved  by  alcohol,  ether,  and  diluted  acids.  It  does 
not  readily  crystallize,  but  it  forms  crystallizable  salts.  The  crystals 
melt  at  194°,  and  at  284°  they  are  volatilized,  being  at  the  same  time 
in  great  part  decomposed.  Ammonia  added  to  a  solution  of  sulphate 
of  atropia  does  not  separate  the  alkaloid  in  distinct  crystals.  In  this 
respect  it  differs  from  morphia  and  strychnia.  When  atropia  is 
heated  on  platinum  it  melts,  darkens  in  color,  and  burns  with  a 
yellowish  smoky  flame.  Sulphuric,  hydrochloric,  and 'nitric  acids 
dissolve  it  without  any  change  of  color.  Water  added  to  the  mixture 
of  sulphuric  acid  produces  no  change :  but  a  crystal  of  bichromate 
of  potash  produces  a  green  color  from  the  formation  of  oxide  of 


204  POISONING    WITH    LOBELIA. 

chromium.  Tannic  acid  precipitates  the  alkaloid  from  its  solutions ; 
but  the  most  effectual  precipitant  is  the  chloriodide  of  potassium  and 
mercury,  which  throws  down  a  dense  white  precipitate  even  in  very- 
diluted  solutions.  Atropia  is  also  precipitated  by  chloride  of  gold, 
but  unlike  strychnia,  it  is  not  precipitated  by  sulphocyanide  of  potas- 
sium or  chromate  of  potash.  It  may  be  detected  in,  and  separated 
from,  organic  liquids  by  the  process  of  Stas.     (See  page  189.) 

There  are  no  absolute  or  certain  chemical  tests  for  this  alkaloid 
when  contained  in  an  organic  liquid.  The  only  test  usually  employed 
is  of  a  physiological  nature,  namely,  the  effect  produced  on  the  pupil 
by  small  quantities  of  liquid,  or  extract,  containing  traces  of  atropia. 
The  pupil  is  largely  dilated  and  the  eye  loses  its  insensibility  to  light. 
Datura,  hyoscyamia,  and  digitaline  also  produce  dilatation  of  the 
pupil.  Poisonous  mushrooms  and  other  noxious  organic  matters 
have  a  similar  effect,  so  that  there  is  nothing  conclusive  in  this  result 
unless  there  is  also  strong  evidence  from  symptoms  that  belladonna 
has  been  actually  taken  or  administered. 

At  the  Exeter  Autumn  Assizes  for  1865  {Reg.  v.  Sprague),  a  medi- 
cal man  was  charged  with  attempting  to  poison  his  wife  and  other 
persons  with  atropia,  which  it  was  alleged  had  been  placed  in  a 
rabbit  pie.  The  evidence  failed  to  show  at  the  trial  that  the  prisoner 
or  any  other  person  could  have  mixed  poison  with  the  pie,  much 
less  such  a  poison  as  this,  which  in  the  dose  of  one  or  two  grains, 
either  destroys  life  or  produces  serious  illness  continuing  for  some 
time.  The  symptoms,  as  described,  resembled  those  caused  by  noxi- 
ous food,  and  differed  in  many  respects  from  those  of  poisoning  by 
atropia.  The  only  fact  on  which  this  chemical  theory  seemed  to 
rest  was  that  the  pupils  of  those  who  ate  of  the  pie  and  were  taken 
ill  afterwards,  were  dilated  and  a  portion  of  the  extract  of  the  scrap- 
ings of  the  pie  dish  is  said  to  have  caused  a  dilatation  of  the  pupil 
of  the  analyst.  (See  "Med.  Times  and  Gazette,"  August  12,  1865, 
p.  168;  also  "Chemical  News,"  August  11,  1865,  p.  72.)  It  is  stated 
that  the  supposed  poison  was  separated  from  the  baked  leg  of  a  rabbit 
by  soaking  it  in  dilute  hydrochloric  acid,  but  according  to  those  who 
have  examined  the  properties  of  atropia  this  alkaloid  melts  at  191°, 
is  entirely  volatile  under  300°,  and  is  then  in  great  part  decomposed. 
("  Chemie  der  Organischen  Alkalien,  Schwartzkopf,"  p.  317.)  The 
whole  of  the  scientific  theory  rested  upon  the  dilatation  of  the  pupils, 
and  this,  although  presumptive,  is  not  positive  evidence  of  atropia 
having  been  administered. 

Indian  Tobacco.    (Lobelia  Inflata.) 

The  powdered  leaves  of  Indian  tobacco  contain  an  acrid  principle, 
lobt  lin,  which  is  capable  of  producing  poisonous  effects  on  the  brain 
ami  spinal  marrow,  attended  with  irritation  of  the  stomach  and 
bowels.  When  administered  in  doses  of  from  ten  to  twenty  grains. 
lobelia  operates  as  an  emetic;  but  in  larger  quantity  it  arts  delete- 
riously.  In  one  case  a  man  lost  his  life  by  swallowing  <»/,<  drachm 
of  the  powdered  leaves,  prescribed  by  a  quack.     The  person  was  scon 


POISONING    WITH    FOXGLOVE.  205 

by  a  medical  practitioner  soon  after  he  had  taken  the  poison :  he 
was  evidently  suffering  great  pain,  but  he  was  quite  unconscious ;  the 
pulse  was  small,  and  the  pupils  were  strongly  contracted  and  insen- 
sible to  light.  He  had  vomited  the  greater  part  of  the  poison.  He 
suffered  from  spasmodic  twitchings  of  the  face,  sank  into  a  state  of 
complete  insensibility,  and  died  in  about  thirty-six  hours.  On  inspec- 
tion, some  fluid  was  found  in  the  stomach,  but  none  of  the  powder. 
The  mucous  membrane  was  intensely  inflamed,  and  the  vessels  of  the 
brain  were  strongly  congested.  ("  Pharm.  Times,"  May  1,  1847,  p. 
182.)  The  seeds  of  lobelia  are  equally  poisonous.  In  the  "  Medical 
Times  and  Gazette,"  Nov.  26,  1853,  p.  568,  two  cases  are  reported  in 
which  the  seeds  proved  fatal.  In  one  the  mucous  membrance  of  the 
stomach  was  highly  inflamed.  Another  case  is  referred  to  in  the 
same  journal,  March  12,  1853,  p.  270.  There  have  been  many  in- 
quests and  trials  for  manslaughter  in  this  country  as  the  result  of 
the  improper  administration  of  the  leaves  of  the  Lobelia  inflata  by 
ignorant  quacks,  calling  themselves  medical  botanists  and  dealers  in 
vegetable  medicines.  The  medical  evidence  given  on  these  trials 
has  proved  that  in  large  doses  lobelia  is  a  most  noxious  drug. 

Lobelia  is  seen  in  the  form  of  a  greenish-colored  powder  (frag- 
ments of  leaves.)     This  powder  requires  a  reddish-brown  color  from 
strong  nitric  acid,  and  is  blackened  by  concen- 
trated sulphuric   acid.     Iodine   water  has   no 
effect  upon  the  infusion.     The  proto-and  per- 
sulphate of  iron  produce  with  it  a  dark-green 
color,   the    persulphate    very   rapidly.      The 
leaves  and  seeds  contain  a  resinoid  substance 
called  Lobelin,  which  has  the  smell  and  taste  of 
the  plant.     It  acts   as  a  powerful   emetic  in 
doses  of  from   one  half  to  one   grain.     The 
leaves  of  lobelia  are  generally  seen  in  frag-       <=  «T  --f-  -  °  ~ 
ments  which  do  not  readily  admit  of  identifi- 
cation bv  the  microscope.     The  seeds  are  very       „    Se<"ds  of  Lobeha- 

n  r>  i  i  -i  it  /-n-  o  i\         a  Natural  size. 

small,  ol  a  lengthened  oval  shape  (.big.  34),    &  Magnified  70  diameters, 
reticulated  on  the  surface  with  projecting  hairs 

or  fibres,  and  of  a  light  brown  color.  The  discovery  of  them 
among  the  fragments  of  leaves  would  furnish  a  sufficient  proof  of 
the  presence  of  lobelia. 

Foxglove.    (Digitalis  Purpurea.) 

Symptoms  and  Effects. — Cases  of  poisoning  with  foxglove  are  not 
very  common.  A  boy  who  swallowed  six  ounces  of  a  strong  de- 
coction of  the  leaves  was  soon  attacked  with  vomiting,  purging,  and 
severe  pain  in  the  abdomen.  After  some  time,  he  became  lethargic, 
and  slept  for  several  hours ;  in  the  night  he  was  seized  with  convul- 
sions. The  pupils  were  dilated  and  insensible,  the  pulse  was  slow, 
small,  and  irregular ;  coma  followed,  and  the  boy  died  twenty-two 
hours  after  taking  the  poison.  On  inspection,  the  membranes  of  the 
brain  were  found  much    injected,   and    the   mucous   lining  of  the 


206  POISONING    WITH    FOXGLOVE. 

stomach  was  partially  inflamed.  The  prisoner  was  acquitted  of  the 
charge  because  he  had  only  given  his  fatal  advice  on  the  application 
of  the  friends  of  the  deceased !  ("  Ed.  Med.  and  Surg.  Journ.,"  27, 
223.)  A  young  man  swallowed  a  strong  decoction  of  foxglove  by 
mistake  for  purgative  medicine.  He  was  soon  seized  with  vomiting, 
pain  in  the  abdomen,  and  purging.  In  the  afternoon  he  fell  asleep. 
At  midnight  he  awoke,  was  attacked  with  violent  sickness,  colic, 
and  convulsions ;  the  pupils  were  dilated  and  insensible  to  light ;  the 
pulse  was  slow  and  irregular.  He  died  twenty-two  hours  after  taking 
the  poison.  (Wilmer,  op.  cit.,  Digitalis.)  A  few  grains  of  the 
powdered  leaves  have  been  known  to  produce  giddiness,  languor, 
dimness  of  sight,  and  other  nervous  symptoms.  A  drachm  has, 
however,  been  taken  without  causing  death ;  but  in  this  instance  it 
produced  violent  vomiting.  A  common  effect  of  the  poison  is  to 
produce  great  depression  of  the  heart's  action. 

When  foxglove  has  been  taken  in  substance,  i.  e.  in  the  form  of 
seeds  or  leaves,  or  any  portion  of  these  has 
been  swallowed  in  a  decoction  or  infusion,  frag- 
ments may  be  found  in  the  stomach  and  bowels. 
In  reference  to  the  infusion,  decoction,  tincture, 
or  extract,  except  there  be  sufficient  to  allow  of 
the  separation  of  digitaline,  there  is  no  chemical 
process  known  by  which  the  poison  may  be 
recognized.  If  any  fragments  of  leaves  or 
seeds  are  found  in  the  contents  of  the  stomach 
or  in  food,  they  may  be  identified  by  the  aid  of 
a  Natural  size.  the  microscope.    The  annexed  illustration  (Fig. 

i  Magnified  3"  diameters.  35)  represents  the  seeds  of  foxglove :  they  are 
of  a  reddish-brown  color,  remarkably  small, 
oblong,  and  somewhat  angular  in  shape.  They  have  peculiar  mark- 
ings. By  the  aid  of  the  microscope,  they  may  be  easily  distinguished 
from  the  seeds  of  hyoscyamus,  datura,  belladonna,  and  most  other 
poisonous  plants. 

Digitaline  is  the  active  principle  of  foxglove.  It  constitutes  one 
per  cent,  of  the  dried  leaves.  Its  physiological  properties  have  been 
fully  investigated  by  M.  Homolle  ("Journal  de  Pharmacie,"  Janvier 
1845-57 ;  also,  by  Bouchardat,  "  Ann.  de  Therapeutique,"  186-1,  p. 
155.)  It  is  an  uncrystallizable  substance,  and  has  no  well  defined 
chemical  characters. 

Pure  digitaline  itself  operates  as  a  poison  on  man  and  animals  in 
very  small  doses.  The  l-16th  of  a  grain,  which  is  considered  to  be 
equal  to  eight  grains  of  the  well-prepared  powder  of  the  dried 
leaves,  is  sufficient  to  cause  symptoms  of  poisoning.  Doses  of  from 
1-llth  to  l-32d  part  of  a  grain  have  lowered  the  pulse  and  caused 
nausea,  vomiting,  griping,  purging,  and  an  increased  secretion  of 
urine.  (Pereira,  "  Mat.  Med.,"  vol.  2,  p.  528.)  Doses  of  from  one- 
quarter  to  one-half  of  a  grain  would  probably  prove  fatal  to  life. 
Digitaline  has  acquired  some  notority  by  reason  of  the  trial  of  Dr. 
De  la  Pommerais,  at  Paris,  in  May,  1864,  for  the  murder  of  a  woman 


POISONING    WITH    THOEXAPPLE.  207 

named  Pauw.  (See  "Principles  of  Med.  Jur.,"  p.  364,  also  "Ann. 
d'Hygiene,"  1864,  torn.  2,  p.  105.) 

Thoenapple.    (Datuka  Stkamonium.) 

Symptoms  and  Appearances. — The  symptoms  produced  by  stramo- 
nium whether  the  leaves  or  seeds  are  used,  are  as  follows :  soon 
after  the  poison  has  been  taken  there  is  giddiness,  dimness  of  sight, 
a  sense  of  fainting — insensibility — fixed  and  dilated  pupils,  flushed 
countenance,  and  a  slow  and  full  pulse.  Sometimes  there  is  great 
restlessness,  with  a  hot  and  red  skin,  and  a  wild  and  staring  expres- 
sion in  the  countenance,  the  breathing  hurried  and  gasping,  inces- 
sant talking  without  distinct  articulation,  and  there  are  attempts  to 
drive  away,  or  grasp  at,  imaginary  objects.  There  is  picking  at  the 
bedclothes,  with  paroxysms  of  excessive  laughter,  and  if  the  per- 
son can  walk,  it  is  with  a  staggering  gait  and  he  falls  to  the  ground 
as  if  intoxicated,  or  completely  exhausted.  The  seeds  of  datura 
were  used  by  the  Thugs  of  India  for  rendering  their  victims  power- 
less and  insensible. 

Appearances. —In  a  well-marked  case  of  poisoning  by  stramonium- 
seeds,  in  which  death  took  place  in  less  than  eight  hours,  the  follow- 
ing appearances  were  found :  great  congestion  of  the  vessels  of  the 
brain  and  its  membranes,  the  brain  firm  and  highly  injected,  choroid 
plexus  turgid,  ventricles  containing  serum,  substance  of  the  lungs 
congested,  and  the  heart  flaccid.  The  stomach  contained  about  four 
ounces  of  digested  food  mixed  with  eighty-nine  seeds  of  stramonium. 
There  were  two  patches  of  extravasation  in  the  mucous  coat — one 
on  the  larger  curvature,  and  the  other  near 
the  pylorus.     Many  seeds  and   fragments  FiS-  36- 

were  also  found  in  the  intestines.     ("Lan-         ^s?^-^.  I 
cet,"  Sept.  18,  1847,  p.  298.)     In  another       ;:''■' 
case  there  were  marks  of  diffused  inflam-       $j  ;£:; 

mation    about    the    cardiac    end    of    the 
stomach. 

Analysis. — The  seeds  of  stramonium,  from  "; ^CT        ■-"  h&.W  "' 

which  accidents  have  most  frequently  oc-  ^^m&gz^ 

curred,  are   flattened,  kidney-shaped,   but  ^^    g*a 

half  oval,  rough,  and  of  a  dark-brown  or  ^  ^H? 

black  color.     They  are  liable  to  be  mis-       seeds  of  Datura  stramonium. 

.1  j?        j_i  in  •  A(i    .i  a    Natural  size. 

taken  for  the  seeds  of  capsicum.     Of  the         b  Magnified  so  diameters. 
dry  datura  stramonium,  there  are  about 

eight  seeds  to  a  grain.  They  are  of  an  oblong  kidney-shape,  and  of 
a  dark-brown  or  black  color.  The  illustration  (Fig.  36)  shows  their 
appearance  under  a  low  power  of  the  microscope.  The  leaves  of 
the  common  datura  stramonium  are  well  characterized  by  their 
peculiar  shape. 

Daturia. — The  poisonous  properties  of  thornapple  are  owing  to 
the  presence  of  an  alkaloid,  daturia,  which  forms  about  one  per  cent, 
of  the  dried  vegetable.     Some  have  considered  this  alkaloid  to  be 


208 


PROPERTIES    OF    DATURIA, 


Fig.  37. 


identical  with  atropia,  but  the  physiological  properties  are  different. 

See  Bouchardat,  "Ann.  de  Therapeutique,"  1864,  p.  24.     Daturia 

crystallizes  in  long  colorless  prisms  or 
needles  (Fig.  37);  it  has  a  bitter  taste, 
somewhat  acrid,  and  slightly  resembling 
that  of  tobacco.  It  is  poisonous.  The 
eighth  of  a  grain  killed  a  sparrow  in  three 
hours.  When  placed  on  the  eye  or  intro- 
duced into  the  cellular  membrane  of  an 
animal,  it  is  observed,  like  atropia,  to 
cause  dilatation  of  the  pupil.  When  heated 
in  a  tube  it  is  decomposed,  and  ammonia 
is  evolved  as  with  other  alkaloids.  It  is 
soluble  in  water,  and  the  solution  has  an 
alkaline  reaction.  It  is  precipitated  by 
tannic  acid  and  by  the  chloriodide  of  po- 
tassium and  mercury.  Nitric  and  hydro- 
without  producing  any  change  of  color, 
with  the  crystals,  a  pale  rose-red  color 

which  becomes  paler  when  the  acid  mixture  is  diluted  with  water. 
The  bark,  seeds,  berries  and  leaves  of  the  Laburnum,  Yew,  and 

Privet,  have  in  a  few  cases  given  rise  to  symptoms  of  poisoning. 

These  poisons  affect  the  brain  and  the  alimentary  canal,  producing 

vomiting  and  purging,  followed  by  insensibility  and  convulsions. 


Crystals  of  Daturia,  magnified  30 
diameters. 

chloric  acids  dissolve  it, 
Sulphuric  acid  produces, 


WOUNDS.      MEDICO-LEGAL    DEFINITIONS.  209 


WOUNDS  AND  PERSONAL  INJURIES. 


CHAPTER   XXII. 

Definition  of  a  wound. — danger  to  life. — grievous  bodily 
harm. — examination  of  wounds. — description  of  wounds. — 
characters  of  wounds  inflicted  on  the  living  and  dead 
body. — ecchymosis  on  the  living  and  dead. — effects  of  vio- 
lence on  the  dead  body. — ecchymosis  not  always  a  result 
of  violence. 

Definition. — In  a  medico-legal  sense  a  wound  implies  a  breach  of 
continuity  in  the  structures  of  the  body,  whether  external  or  inter- 
nal, suddenly  occasioned  by  mechanical  violence.  This  definition 
therefore  includes  injuries  to  the  skin  or  mucous  membrane  of  the 
outlets  of  the  body — dislocations  and  fractures,  whether  simple  or 
compound,  as  well  as  ruptures  of  the  viscera.  In  a  medical  point  of 
view  a  wound  is  commonly  restricted  to  those  external  injuries  in 
which  the  skin  is  implicated ;  but  in  legal  medicine  the  term  has  a 
much  wider  signification. 

Danger  to  Life. — When  a  wound  has  been  criminally  inflicted  on 
a  person  by  the  wilful  act  of  another,  one  of  the  first  questions 
which  presents  itself  for  consideration  is  how  far  the  injury  is  dan- 
gerous to  life.  In  order  to  justify  the  detention  of  the  accused,  a 
magistrate  may  require  a  medical  opinion  or  a  written  statement 
from  the  surgeon  in  attendance.  The  meaning  of  the  words  "dan- 
gerous to  life"  is  left  entirely  to  the  professional  knowledge  of  a 
witness.  It  is  not  sufficient  on  these  occasions  that  he  should  make 
a  naked  declaration  of  the  wound  being  dangerous  to  life ;  he  must, 
if  called  upon,  state  to  the  court  satisfactory  reasons  for  this  opinion ; 
and  these  reasons  are  rigorously  inquired  into  by  counsel  for  the  de- 
fence. As  a  general  principle  it  would  not  be  proper  to  consider 
those  wounds  dangerous  to  life,  in  which  the  danger  is  not  imminent. 
A  wound  of  a  great  bloodvessel,  of  any  of  the  viscera,  or  a  com- 
pound fracture  with  depression  of  the  bones  of  the  head,  must  in  all 
instances  be  regarded  as  bodily  injuries  dangerous  to  life ;  because 
in  such  cases  the  danger  is  imminent.  Unless  timely  assistance  be 
rendered,  these  injuries  will  most  probably  prove  fatal,  and,  indeed, 
they  often  destroy  life  in  spite  of  the  best  surgical  treatment.  When, 
however,  the  danger  is  remote,  as  in  a  puncture  or  laceration  of  the 
hand  or  foot,  which  may  be  followed  by  tetanus,  or  in  a  laceration 
14 


210  WOUNDS.      DANGER    TO    LIFE. 

of  the  scalp,  which  may  be  followed  by  erysipelas,  or  in  penetrating 
wounds  of  the  orbit,  which  may  be  attended  by  fatal  inflammation 
of  the  brain  or  its  membranes,  the  case  is  somewhat  different.  Such 
injuries  as  these  are  not  directly  dangerous  to  life — they  are  only 
liable  to  be  attended  with  danger  in  certain  cases,  and  under  certain 
circumstances ;  hence  the  medical  opinion  must  be  qualified.  The 
law,  on  these  occasions,  appears  to  contemplate  the  direct  and  not 
the  future  or  possible  occurrence  of  danger ;  if  the  last  view  were 
adopted,  it  is  clear  that  the  most  trivial  lacerations  and  punctures 
might  be  pronounced  dangerous  to  life ;  since  tetanus  or  erysipelas 
proving  fatal,  has  been  an  occasional  consequence  of  very  slight  in- 
juries. A  difference  of  opinion  will  often  exist  among  medical 
witnesses,  whether  a  particular  wound  is  or  is  not  dangerous  to  life. 
Unanimity  can  only  be  expected  when  the  judgment  and  experience 
of  the  witnesses  are  equal.  The  rules  for  forming  an  opinion  in 
these  cases  will,  perhaps,  be  best  deduced  from  the  results  of  the  ob- 
servations of  good  surgical  authorities  in  relation  to  injuries  of  dif- 
ferent parts  of  the  body.  [In  case  of  application  for  release  on  bail, 
the  medical  atttendant  may  be  called  upon  to  testify  as  to  the  amount 
of  danger  to  life  involved  in  the  injury  inflicted,  and  must  be  gov- 
erned in  his  deposition  by  the  principles  here  laid  down.  The  opinion 
should  be  qualified  in  every  case  of  injury  not  directly  dangerous  to 
life  but  only  incidentally  liable  to  fatal  termination.  Unless  this 
distinction  be  clearly  expressed,  great  injustice  maybe  done  in  with- 
holding a  privilege  which  the  law  expressly  grants  in  cases  of  trifling 
wounds. — H.] 

Wounds  causing  Grievous  Bodily  Harm. — A  wound  may  not  be 
dangerous  to  life,  but  it  may  have  produced  "  grievous  bodily  harm." 
This  question  is  sometimes  put,  although  the  usual  practice  is  to 
leave  it  to  be  drawn  by  the  jury  as  an  inference  from  a  professional 
description  of  the  injury.  These  words  have  a  vague  signification; 
but  it  would  perhaps  be  difficult  to  substitute  for  them  others  less  open 
to  criticism.  They  evidently  refer  to  a  minor  description  of  offence, 
and  are  applied  commonly  to  those  injuries  which,  while  they  do 
not  actually  place  life  in  danger,  may  be  attended  with  considerable 
personal  inconvenience,  or  be  in  some  way  detrimental  to  the  health 
of  the  wounded  party.  It  is  always  a  question  for  a  jury  whether 
the  intent  of  the  prisoner,  in  inflicting  a  wound,  was  or  was  not  to 
produce  grievous  bodily  harm.  In  some  cases  the  nature  or  the 
situation  of  a  wound,  as  well  as  the  kind  of  weapon  used,  will  at 
once  explain  the  intent :  so  far  the  medical  witness  may  assist  the 
court,  by  giving  a  plain  description  of  the  injury,  as  well  as  of  the 
consequences  with  which  it  is  usually  attended.  It  may  happen  either 
that  the  wound  itself  is  not  of  a  serious  nature,  and  yet  the  intention 
of  a  prisoner  may  have  been  to  do  grievous  bodily  harm  to  the 
wounded  person,  or  the  injury  may  be  really  serious,  and  yet  the 
prisoner  may  not  have  intended  to  do  grievous  bodily  harm. 

Let  us  suppose  that  the  wounded  person  is  found  dead,  and  an 
examination  of  the  body  is  required  to  be  made.  The  most  difficult 
jmrt  of  the  duty  of  a  medical  jurist  now  commences.     Among  the 


EXAMINATION    OF    WOUNDS.  211 

numerous  questions  which  here  present  themselves,  the  first  which 
demands  examination,  is  whether  the  wound  was  inflicted  on  the 
body  before  or  after  death. 

Examination  of  Wounds. — In  examining  a  wound  on  a  dead  body, 
it  is  proper  to  observe  its  situation,  extent,  length,  breadth,  depth, 
and  direction:  whether  there  is  about  it  effused  blood,  either  liquid 
or  coagulated,  and  whether  there  is  ecchymosis,  i.  e.  a  livid  discolo- 
ration of  the  skin  from  the  effused  blood.  It  should  also  be  ascer- 
tained whether  the  surrounding  parts  are  swollen,  whether  adhesive 
matter  or  pus  is  effused,  whether  the  edges  of  the  wound  are  gangre- 
nous, or  any  foreign  substances  are  present  in  it.  Care  must  be  taken 
that  putrefaction  is  not  mistaken  for  a  gangrenous  condition  of  the 
wound.  The  wound  may  be  examined  by  gently  introducing  into 
it  a  bougie,  and  carrying  on  the  dissection  around  this  instrument, 
avoiding  as  much  as  possible  any  interference  with  the  external 
appearances.  The  preservation  of  the  external  form  will  allow  of 
a  comparison  being  made  at  any  future  time  between  the  edges  of  a 
wound  and  a  weapon  found  on  a  suspected  person.  Of  all  these 
points  notes  should  be  taken,  either  on  the  spot  or  immediately  after- 
wards. In  the  dissection,  every  muscle,  vessel,  nerve,  or  organ 
involved  in  the  injury  should  be  traced  and  described.  This  will 
enable  a  witness  to  answer  many  collateral  questions  that  may  un- 
expectedly arise  during  the  inquiry.  Another  point  should  be  espe- 
cially attended  to.  A  medical  practitioner  has  frequently  contented 
himself  with  confining  his  dissection  to  the  injured  part,  thinking 
that  on  the  trial  of  the  accused  the  questions  of  counsel  would  be 
limited  to  the  situation  and  extent  of  the  wound  only,  but  this  is  a 
serious  mistake.  If  the  cause  of  death  be  at  all  obscure,  on  no 
account  should  the  inspection  be  abandoned  until  all  the  important 
organs  and  cavities  of  the  body  have  been  closely  examined ;  since 
it  may  be  affirmed  that  a  natural  cause  of  death  might  have  existed 
in  that  organ  or  cavity  which  the  medical  witness  had  neglected  to 
examine.  It  rests  with  the  practitioner  to  disprove  the  probability 
thus  urged  by  counsel,  but  he  is  now  destitute  of  facts  on  which  he 
can  base  an  opinion — legal  ingenuity  will  triumph,  the  witness  will 
be  discomfited,  and  the  prisoner,  of  whose  guilt  there  may  be, 
morally  speaking,  but  little  doubt,  will  have  the  benefit  of  his  inat- 
tention, and  be  acquitted  by  the  jury.  In  the  medical  reports  on 
the  examination  of  the  bodies  of  wounded  persons,  care  should  be 
taken  to  avoid  the  introduction  of  any  remarks  in  the  form  of  infer- 
ences from  the  facts  of  the  case.  The  facts  should  be  simply  re- 
corded, and  the  inferences  or  comments  reserved  for  evidence  at  the 
inquest  or  trial.  In  making  an  inspection  of  the  wounded  body  the 
state  of  the  stomach  should  not  be  overlooked.  Death  may  have 
been  apparently  caused  by  violence,  and  yet  really  be  due  to  poison 
of  which  a  portion  may  be  found  in  the  stomach  or  bowels. 

Characters  of  a  Wound  inflicted  during  Life. — If  we  find  about  a 
wound  marks  of  gangrene,  the  effusion  of  adhesive  or  purulent 
matter,  or  if  the  edges  are  swollen  and  enlarged,  and  cicatrization 
has  commenced,  it  is  not  only  certain  that  the  injury  must  have  been 


212  WOUNDS    ON    THE    LIVING 

inflicted  before  death,  but  that  the  person  must  have  lived  some  time 
after  it  was  inflicted.  Marks  of  this  description  will  not,  however, 
be  commonly  found  when  death  has  taken  place  within  ten  or  twelve 
hours  from  the  infliction  of  the  injury.  A  wound  which  proves 
fatal  within  this  period  of  time  will  present  throughout,  much  the 
same  characters.  Thus,  supposing  it  to  have  been  incised,  there  will 
be  traces  of  more  or  less  bleeding,  the  blood  having  chiefly  an 
arterial  character,  and  it  will  be  found  coagulated  where  it  has  fallen 
on  surrounding  bodies.  The  edges  of  the  wound  are  everted,  and 
the  muscular  and  cellular  tissue  around  is  deeply  reddened  by  effused 
blood.  Coagula  or  clots  are  found  adhering  to  the  wound,  provided 
it  has  not  been  interfered  with.  The  principal  characters  of  a  wound 
inflicted  during  life,  are,  then,  the  following:  1.  Eversion  of  the 
edges  owing  to  vital  elasticity  of  the  skin.  2.  Abundant  hemor- 
rhage or  bleeding,  often  of  an  arterial  character,  with  general  diffu- 
sion of  blood  in  the  surrounding  parts.  3.  The  presence  of  coagula. 
The  wound  may  not  have  involved  any  vessel,  and  there  may  be  no 
appearance  of  bleeding,  still  the  edges  will  be  everted,  and  the 
muscles  and  skin  retracted.  By  an  observation  of  this  kind  made 
on  the  body  of  a  new-born  child  (Case  of  Elphick,  March,  1848).  Mr. 
Prince  was  enabled  to  state  that  the  child  was  living  when  it  was 
inflicted,  an  opinion  afterwards  confirmed  by  the  confession  of  the 
mother. 

Characters  of  a  Wound  made  after  Death. — If  the  wound  on  a  dead 
body  be  not  made  until  twelve  or  fourteen  hours  have  elapsed  from 
the  time  of  death,  it  cannot  be  easily  mistaken  for  one  produced 
during  life.  Either  no  blood  is  effused,  or  it  is  of  a  venous  charac- 
ter, i.  e.,  it  may  have  proceeded  from  some  divided  vein.  The  blood 
is  commonly  liquid,  and  does  not  coagulate  as  it  falls  on  surrounding- 
bodies,  like  that  poured  out  of  a  wound  in  the  living.  The  edges 
are  soft,  yielding,  and  destitute  of  elasticity ;  they  are  therefore  in 
close  approximation.  The  cellular  and  muscular  tissues  around  are 
either  not  infiltrated  with  blood,  or  only  to  a  very  partial  extent. 
There  are  no  coagula  within  the  wound.  In  experimenting  upon 
amputated  limbs,  I  have  found  these  characters  possessed  by  a  wound 
produced  two  or  three  hours  after  death,  although  they  are  best  seen 
when  the  wound  is  not  made  until  after  the  body  has  lost  all  its 
animal  heat.  In  wounds  on  the  dead  body,  divided  arteries  have  no 
marks  of  blood  about  them,  while  in  the  living  body  the  fatal  bleed- 
ing commonly  proceeds  from  these  vessels.  Hence  in  a  wound  on 
the  living,  it  will  be  found  that  the  surrounding  vessels  are  empty. 
The  chief  characters  of  a  wound  after  death  are,  therefore:  1. 
Absence  of  copious  bleeding.  2.  If  there  is  bleeding  it  is  exclu- 
sively venous.  3.  The  edges  of  the  wound  are  close,  not  everted. 
4.  There  is  no  diffusion  of  blood  in  the  cellular  tissue.  5.  There  is 
an  absence  of  coagula.  But  it  may  happen  that  a  wound  has  been 
inflicted  soon  after  the  breath  has  left  the  body,  and  while  it  was 
yet  warm.  The  distinction  between  a  wound  then  made  and  one 
made  during  life,  is  not  so  well  marked  as  in  wounds  inflicted  at  a 
later  period  after  death. 


AND    DEAD    BODY.      ECCHYMOSIS.  213 

In  any  case  in  which  it  is  doubtful  whether  a  wound  was  inflicted 
on  a  living  or  dead  body,  we  should  be  cautious  in  giving  an  opinion : 
since  it  must  be  remembered  there  are  no  decisive  characters  by 
which  wounds  of  the  kind  referred  to  can  be  distinguished ;  and  a 
medical  witness  is  as  likely  to  be  wrong  as  right  in  selecting  either 
hypothesis.  It  is  a  considerable  step  in  evidence,  when  we  are  able  to 
assert  that  a  particular  wound,  found  on  a  dead  body,  must  have  been 
inflicted  either  during  life  or  immediately  after  death ;  for  it  can  scarcely 
be  supposed  that  in  a  case  calling  for  criminal  investigation,  any  one 
but  a  murderer  would  think  of  inflicting  upon  a  body  immediately 
after  death  a  wound  which  would  assuredly  have  produced  fatal 
effects  had  the  same  person  received  it  while  living.  So  soon  as 
such  an  opinion  can  be  safely  expressed  by  a  witness,  circumstantial 
evidence  will  often  make  up  for  that  which  may  be,  medically  speak- 
ing, a  matter  of  uncertainty. 

Wounds  or  Injuries  unattended  ivith  Hemorrhage. — The  copious  effu- 
sion of  blood  has  been  set  down  as  a  well-marked  character  of  a 
severe  wound  received  during  life ;  but  this  observation  applies 
chiefly  to  cuts  and  stabs.  Lacerated  and  contused  wounds  of  a  severe 
kind  are  not  usually  accompanied  by  much  bleeding,  even  when  a 
large  bloodvessel  is  implicated.  It  is  well  known  that  a  whole 
member  has  been  torn  from  the  living  body,  and  that  little  blood 
has  been  lost ;  but  in  such  cases  coagula  or  clots  of  blood  are  com- 
monly found  adhering  to  the  separated  parts,  a  character  which 
indicates  that  the  wound  was  inflicted  either  during  life  or  soon  after 
death,  while  the  blood  was  warm  and  fluid.  When  a  lacerated  or 
contused  wound  involves  a  highly  vascular  part,  although  no  large 
bloodvessel  may  be  implicated,  it  is  liable  to  cause  death  by  loss  of 
blood. 

Ecchymosis  from  Violence. — Contusions  and  contused  wounds  are 
commonly  accompanied  by  a  discoloration  of  the  surrounding  skin, 
to  which  the  term  ecchymosis  (fxa^w,  to  pour  out)  is  applied.  This 
consists  essentially  in  the  extravasation  or  effusion  of  blood  generally 
from  small  ruptured  vessels,  into  the  surrounding  cellular  membrane 
beneath  the  skin.  An  ecchymosis  is  commonly  superficial,  affecting 
only  the  layers  of  the  skin,  and  showing  itself  externally,  either 
immediately  or  in  the  course  of  a  short  time,  in  the  form  of  a  deep 
blue  or  livid  red  patch,  but  the  effusion  may  be  so  deeply  seated  as 
not  to  present  any  external  discoloration  of  the  skin. 

Violence  inflicted  on  a  living  body  may  not  show  itself  under  the 
form  of  ecchymosis  until  after  death.  A  man  received  from  behind 
several  kicks  on  the  lower  part  of  his  abdomen,  which  caused  a  rup- 
ture of  the  bladder,  and  death  by  peritonitis.  He  died  in  about 
thirty-five  hours ;  but  there  was  no  ecchymosis  in  the  seat  of  the 
blows,  i.  e.,  in  the  pubic  and  lumbar  regions,  until  after  death.  Dr. 
Hinze  met  with  a  case  of  suicidal  hanging,  in  which  it  was  observed 
that  ecchymosis  appeared  in  the  course  of  the  cord  only  after  death. 
(See  "  Hanging.")  It  has  been  remarked  by  Devergie  that  ecchy- 
moses  are  often  concealed  on  the  bodies  of  the  drowned,  when  first 
removed  from  water,  owing  to  the  sodden  state  of  the  skin;  they 


214  CONTUSIONS    ON    THE    DEAD    BODY. 

may  become  apparent  only  after  the  body  has  been  exposed  for  some 
days  and  the  water  has  evaporated. 

A  medical  jurist  must  guard  against  the  error  of  supposing  that 
when  a  blow  has  been  inflicted  on  a  living  person,  it  is  necessary 
that  the  individual  who  is  maltreated  should  survive  for  a  long 
period  in  order  that  ecchymosis  should  be  produced.  Among  nu- 
merous instances  proving  the  contrary,  the  case  of  the  Duchess  of 
Praslin  (August,  1847)  may  be  mentioned.  This  lady,  who  was 
assassinated  by  her  husband,  was  attacked  while  asleep  in  bed.  The 
number  of  wounds  on  her  person  (thirty)  showed  that  there  had  been 
a  mortal  struggle,  which,  however,  could  not  have  lasted  more  than 
half  an  hour.  Yet,  on  inspection,  there  were  the  marks  of  numerous 
ecchymoses,  which  had  resulted  from  the  violent  use  of  a  bruising 
instrument.     ("Ann.  d'Hyg."  1847,  t.  2,  p.  377.) 

The  changes  which  take  place  in  the  color  of  an  ecchymosed  spot 
are  worthy  of  attention,  since  they  may  serve  to  aid  the  witness  in 
giving  an  opinion  on  the  probable  time  at  which  a  contusion  has 
been  inflicted.  After  a  certain  period,  commonly  in  eighteen  or 
twenty-four  hours,  the  blue  or  livid  margin  of  the  spot  is  observed 
to  become  lighter ;  it  acquires  a  violet  tint,  and  before  its  final  dis- 
appearance it  passes  successively  through  shades  of  a  green,  yellow, 
and  lemon  color.  During  this  time  the  spot  is  much  increased  in 
extent,  but  the  central  portion  of  the  ecchymosis  which  received  the 
violence  is  always  darker  than  the  circumference. 

Contusions  on  the  Dead. — Dr.  Christison  found  that  blows  inflicted 
on  a  dead  body  not  more  than  two  hours  after  death,  gave  rise  to 
appearances  on  the  skin  similar  to  those  which  resulted  from  blows 
inflicted  on  a  person  recently  before  death.  The  livid  discoloration 
thus  produced  generally  arose  from  an  effusion  of  the  thinnest  pos- 
sible layer  of  the  fluid  part  of  the  blood  on  the  outer  surface  of  the 
true  skin,  but  sometimes  also  from  an  effusion  of  blood  into  a  percep- 
tible stratum  of  the  true  skin  itself.  He  likewise  found  that  dark 
fluid  blood  might  even  be  effused  into  the  cellular  tissue  in  the  seat 
of  the  discolorations,  so  as  to  blacken  or  redden  the  membranous 
partitions  of  the  cells  containing  the  fat ;  but  this  last  effusion  was 
never  extensive.  From  this,  then,  it  follows  that,  by  trusting  to 
external  appearance  only,  contusions  made  soon  after  death  may  be 
easily  confounded  with  those  which  have  been  produced  by  violence 
shortly  before  death.  If  a  contusion  has  been  caused  some  time 
before  death,  there  will  be  swelling  of  the  part,  and  probably  also 
certain  changes  of  color  in  the  ecchymosed  patch,  in  either  of  which 
cases  there  will  be  no  difficulty  in  forming  an  opinion.  Although 
ecchymosis,  or  an  appearance  analogous  to  it,  may  be  produced  on 
a  body  after  death,  the  changes  in  color  are  then  met  with  under 
peculiar  circumstances,  as  where  the  patient  is  laboring  under  general 
dropsy,  and  the  serum  effused  beneath  the  skin  may  lead  to  the  diffu- 
sion of  the  blood.  The  most  satisfactory  mark  of  distinction  between 
the  effects  of  blows  on  the  living  and  dead  body,  in  the  opinion  of 
Dr.  Christison,  is  the  following :  In  a  contusion  inflicted  during  life, 
the  ecchymosed  portion  of  cutis  (true  skin)  is  generally  dark  and 


ECCHYMOSIS    AS    A    RESULT    OF    VIOLENCE.  215 

much  discolored  from  the  infiltration  of  blood  throughout  its  whole 
thickness ;  the  skin  at  the  same  time  is  increased  in  firmness  and 
tenacity.  This  is  not,  however,  a  uniform  consequence  of  a  contu- 
sion during  life ;  for  a  blow  may  cause  effusion  of  blood  beneath  the 
skin  without  affecting  the  cutis  in  the  manner  stated.  The  state  of 
the  skin  here  described  cannot  be  produced  by  a  contusion  on  a  dead 
body,  although  it  is  still  an  open  question  whether  it  might  not  be 
produced  if  the  contusion  were  inflicted  a  few  minutes  after  death. 
As  it  is,  the  value  of  this  sign  is  somewhat  circumscribed — it  is  not 
always  produced  on  the  living — it  might  be  possibly  produced  on 
the  recently  dead ;  so  that  when  it  does  not  exist  we  must  look  for 
other  differential  marks,  and  when  it  does  exist  we  ought  to  satisfy 
ourselves  that  the  contusion  was  not  inflicted  recently  after  death. 

The  practical  inference  from  these  observations  is,  that  discolora- 
tions  of  the  skin  caused  by  blows  inflicted  soon  after  death,  may  be 
sometimes  mistaken  for  marks  of  violence  on  the  living  body.  An 
instance  has  been  communicated  to  me,  on  respectable  authority,  in 
which,  for  the  sake  of  experiment,  blows  with  a  stick  were  inflicted 
on  the  recently  dead  body  of  a  woman,  while  still  warm.  The  body 
was  afterwards  accidentally  seen  by  non-professional  persons,  who 
were  not  aware  of  the  performance  of  these  experiments;  and  so 
strong  was  the  impression  from  the  appearances,  that  the  deceased 
had  been  maltreated  during  life,  that  a  judicial  inquiry  was  actually 
instituted,  when  the  circumstances  were  satisfactorily  explained.  The 
fact,  therefore,  that  severe  blows  after  death  resemble  slight  blows 
during  life,  is,  in  a  practical  view,  unimportant.  It  does  not  aid  our 
diagnosis,  nor  prevent  serious  mistakes  from  occurring. 

Is  Ecchymosis  a  necessary  Result  of  Violence? — This  medico-legal 
question  has  often  created  great  difficulty.  It  has  been  repeatedly 
asserted  in  courts  of  law,  that  no  severe  blow  could  have  been  in- 
flicted on  the  body  of  a  person  found  dead,  in  consequence  of  the 
absence  of  ecchymosis  or  other  indication  of  violence  on  the  part 
struck;  but  this  assertion  is  entirely  opposed  to  well-ascertained 
facts.  However  true  the  statement  may  be  that  severe  contusions 
are  commonly  followed  by  ecchymosis,  it  is  open  to  numerous  ex- 
ceptions ;  and  unless  these  are  known  to  a  practitioner,  his  evidence 
may  mislead  the  court.  The  presence  of  ecchymosis  is  commonly 
presumptive  evidence  of  the  infliction  of  violence,  but  its  absence 
does  not  negative  this  presumption. 

It  was  long  since  remarked  by  Portal,  that  the  spleen  had  been 
found  ruptured  from  blows  or  falls,  without  any  ecchymosis  or 
abrasion  of  the  skin  appearing  in  the  region  struck.  This  has  been 
also  observed  in  respect  to  ruptures  of  the  stomach,  intestines,  and 
urinary  bladder,  from  violence  directly  applied  to  the  abdomen. 
Portal  supposed  that  the  mechanical  impulse  was  simply  transferred 
through  the  supple  parietes  (or  skin)  of  the  abdomen  to  the  viscera 
behind,  as  in  the  striking  of  a  bladder  filled  with  water.  Whether 
this  be  the  true  explanation  or  not,  it  is  quite  certain  that  the  small 
vessels  of  the  skin  often  escape  rupture  from  a  sudden  blow,  so  that 


216  EVIDENCE    OF    THE    USE    OF    A    WEAPON. 

their  contents  are  not  effused.  A  case  is  reported  by  Henke,  in 
which  a  laboring  man  died  some  hours  after  fighting  with  another, 
and  on  an  inspection  of  the  body  the  peritoneum  was  found  exten- 
sively inflamed,  owing  to  an  escape  of  the  contents  of  the  small  in- 
testines, which  had  been  ruptured  to  a  considerable  extent.  There 
was,  however,  no  ecchymosis  or  mark  on  the  skin  externally,  and 
the  medical  inspectors  were  inclined  to  affirm,  contrary  in  this  case 
to  direct  evidence,  that  no  blow  could  have  been  struck ;  but  others 
of  greater  experience  were  appealed  to,  who  at  once  admitted  that 
the  laceration  of  the  intestines  might  have  been  caused  by  a  blow, 
even  although  there  was  no  appearance  of  violence  externally.  Mr. 
Watson  states  that  a  girl,  aged  nine,  received  a  smart  blow  upon  the 
abdomen  from  a  stone.  She  immediately  complained  of  great  pain ; 
collapse  ensued,  and  she  died  in  twenty -one  hours.  On  inspection 
there  was  no  mark  of  injury  externally,  but  the  ileum  (small  intes- 
tines) was  found  ruptured,  its  contents  extravasated,  and  the  perito- 
neum extensively  inflamed.  ("On  Homicide,"  p.  187.)  Dr.  Williamson, 
of  Leith,  met  with  a  case  in  which  a  man  received  a  kick  on  the  ab- 
domen, from  a  horse :  he  died  in  thirty  hours  from  peritonitis.  The 
ileum  was  found  to  have  been  torn  completely  across  in  its  lower 
third.  There  was  not  the  slightest  trace  of  ecchymosis  externally, 
a  fact  which  is  the  more  remarkable,  since  the  blow  was  here  struck 
by  a  somewhat  angular  or  pointed  body — the  hoof  of  a  horse.  ("  Med. 
Gaz.,"  May,  1840.  See  also  Guy's  Hosp.  Eeports,  Oct.  1865,  p.' 285.) 
Many  other  cases  might  be  adduced  in  support  of  the  statement  that 
ecchymosis  is  not  a  necessary  or  constant  result  of  a  severe  blow ; 
but  these  sufficiently  establish  the  fact.  This  medico-legal  question 
frequently  arises  in  cases  in  which  the  bladder  or  liver  is  ruptured, 
as,  owing  to  the  general  absence  of  marks  of  violence,  it  is  often 
alleged  in  defence  that  no  blow  or  kick  could  have  been  inflicted  on 
this  part  of  the  abdomen.  It  is  unnecessary  to  say  that  this  view 
is  not  in  accordance  with  facts. 


CHAPTER  XXIII. 

Evidence  of  the  use  of  a  weapon. — chaeacteks  of  wounds 
caused  by  weapons. — incised,  punctured,  lacerated,  and 
contused  wounds. — stabs  and  cuts. — what  are  weapons? 
examination    of    the    dress.  —  imputed    or    self-inflicted 

WOUNDS. 

Evidence  of  the  Use  of  a  Weapon. — It  is  not  necessary  to  prove 
that  a  weapon  has  been  used  for  the  production  of  a  wound,  for  the 
words  of  the  new  statute  are:  "Whosoever  shall,  by  any  means  what- 
soever, wound  or  cause  any  grievous  bodily  harm  to  a  person,"  &c. ; 
yet  evidence  of  the  use  of  a  weapon  in  cases  of  assault  may  mate- 


CHARACTERS  OF   INCISED  AND  PUNCTURED  WOUNDS.      217 

rially  affect  the  amount  of  punishment  awarded  on  conviction.  "When, 
upon  the  clearest  evidence,  it  is  certain  that  a  weapon  has  been  used, 
it  is  not  unusual  for  prisoners  to  declare  that  no  weapon  was  em- 
ployed by  them,  but  that  the  wound  had  been  occasioned  by  acci- 
dental circumstances.  A  witness  should  remember  that  he  is  seldom 
in  a  position  to  swear  that  a  particular  weapon  produced  at  a  trial, 
must  have  been  used  by  the  prisoner :  he  is  only  justified  in  saying 
that  the  wound  was  caused  either  by  it  or  by  one  similar  to  it. 
Schworer  relates  the  following  case.  A  man  was  stabbed  by  another 
in  the  face,  and  a  knife  with  the  blade  entire  was  brought  forward 
as  circumstantial  evidence  against  him — the  surgeon  having  stated 
that  the  wound  had  been  caused  by  this  knife.  The  wounded  person 
recovered ;  but  a  year  afterwards  an  abscess  formed  in  his  face,  and 
the  broken  point  of  the  real  weapon  was  discharged  from  it.  The 
wound  could  not  therefore  have  been  produced  by  the  knife  which 
was  brought  forward  as  evidence  against  the  prisoner  at  the  trial. 
("Lehre  von  dem  Kindermorde.")  Although  the  criminality  of  an 
act  is  not  affected  by  an  occurrence  of  this  kind,  it  is  advisable  that 
such  mistakes  should  be  avoided  by  the  use  of  proper  caution  on 
the  part  of  a  witness.  (On  this  question,  see  the  case  of  Benaud, 
by  Dr.  Boys  de  Loury,  "Ann.  d'Hyg."  1839,  t.  11,  p.  170.  As  to 
what  is  a  weapon,  see  Henke,  "Zeitschrift  der  S.  A."  1844,  vol.  1, 
p.  67.) 

Characters  of  Wounds  produced  by  Weapons. — Let  us  now  suppose 
that  no  weapon  is  discovered,  and  that  the  opinion  of  a  witness  is  to 
be  founded  only  on  an  examination  of  a  wound.  It  is  right  for  him 
to  know  that  on  all  criminal  trials,  considerable  importance  is  at- 
tached by  the  law  to  the  fact  of  a  wound  having  been  caused  by  the 
use  of  a  weapon ;  since  this  generally  implies  malice,  and  in  most 
cases  a  greater  desire  to  injure  the  party  assailed  than  the  mere  em- 
ployment of  manual  force.  Some  wounds,  such  as  cuts  and  stabs, 
at  once  indicate  that  they  must  have  been  produced  by  weapons. 

1.  Incised  Wounds. — In  incised  wounds,  the  sharpness  of  the  in- 
strument may  be  inferred  from  the  cleanness  and  regularity  with 
which  the  edges  are  cut:  in  stabs,  also,  the  form  and  depth  of  a 
wound  will  often  indicate  the  kind  of  weapon  employed.  Stabs 
sometimes  have  the  characters  of  incised  punctures,  one  or  both 
extremities  of  the  wound  being  cleanly  cut,  according  to  whether 
the  weapon  is  single  or  double-edged.  Dupuytren  has  remarked 
that  such  stabs,  owing  to  the  elasticity  of  the  skin,  are  apparently 
smaller  than  the  weapon — a  point  to  be  remembered  in  instituting  a 
comparison  between  the  size  of  a  wound  and  the  instrument.  A 
lateral  motion  of  the  weapon  may,  however,  cause  a  considerable 
enlargement  of  the  wound.  (See  case  "  Ann.  d'Hyg."  1847,  t.  1,  p. 
400.)  When  a  stab  has  traversed  the  body,  the  entrance  aperture  is 
commonly  larger  than  the  aperture  of  exit ;  and  its  edges,  contrary 
to  what  might  be  supposed,  are  sometimes  everted,  owing  to  the 
rapid  withdrawal  of  the  instrument.  That  facts  of  this  kind  should 
bo  available  as  evidence,  it  is  necessary  that  the  body  should  be  seen 


218  LACERATED    AND    CONTUSED    WOUNDS. 

soon  after  the  infliction  of  a  wound,  and  before  there  has  been  any 
interference  with  it. 

Punctured  Wounds. — It  is  necessary  to  notice  whether  the  edges 
of  a  punctured  wound  are  lacerated  and  irregular,  or  incised ;  because 
it  may  be  alleged  in  defence,  that  the  wound  was  produced  by  a  fall 
on  some  substance  capable  of  causing  an  injury  somewhat  resembling 
it.  In  a  case  that  occurred  to  Mr.  Watson,  a  deeply  penetrating 
wound  on  the  genital  organs  of  the  deceased,  which  had  evidently 
caused  the  woman's  death,  was  ascribed  by  the  prisoners  charged 
with  the  murder,  to  her  having  fallen  on  some  broken  glass;  but  it 
was  proved  that  the  edges  of  the  wound  were  bounded  everywhere 
by  clean  incisions,  which  rendered  this  defence  inconsistent,  if  not 
impossible.  I  have  known  a  similar  defence  made  on  two  other 
occasions,  where  the  cases  came  to  trial.  In  general,  wounds  made 
by  glass  or  earthenware  are  characterized  by  their  great  irregularity 
and  the  unevenness  of  their  edges.  Cases  of  this  kind  show  that  as 
it  is  not  always  possible  to  know  when  this  sort  of  defence  may  be 
raised,  a  medical  witness  should  never  fail  to  make  a  minute  examina- 
tion, of  a  wound  which  is  suspected  to  have  been  criminally  inflicted. 
These  medical  difficulties  are  now  for  the  most  part  removed  by  the 
24th  and  25th  Victoria,  Chapter  100.  This  must  not,  however,  lead 
the  witness  to  suppose  that  a  personal  injury  is  not  to  be  carefully 
examined  with  a  view  to  the  determination  of  this  question. 

2.  Lacerated  and  Contused  Wounds. — Lacerated  wounds  do  not  in 
general  present  greater  difficulty  with  regard  to  their  origin  than 
those  which  are  incised  or  punctured.  The  means  which  produced 
the  laceration  are  commonly  well  indicated  by  the  appearance  of  the 
wound.  These  injuries  are  generally  the  result  of  accident ;  they 
are,  however,  frequently  met  with  on  the  bodies  of  new-born  child- 
ren, in  which  case  they  may  give  rise  to  a  charge  of  infanticide.  If 
it  could  be  proved  that  they  had  arisen  from  the  use  of  a  weapon, 
this  would  of  course,  go  far  to  a  conviction  on  a  charge  of  murder. 
Contused  wounds  and  severe  contusions  present  much  greater  diffi- 
culty to  a  medical  jurist.  It  is  not  often  in  his  power  to  say  whether 
a  contused  wound  has  resulted  from  the  use  of  a  weapon,  from  a 
blow  of  the  fist,  or  a  fall,  by  reason  of  the  deceased  having  acciden- 
tally fallen  against  some  hard  surface.  The  question  is  frequently 
put  to  medical  witnesses,  on  those  trials  for  manslaughter  which 
arise  out  of  the  pugilistic  combats  of  half-drunken  men.  One  of  the 
combatants  is  generally  killed,  either  by  a  blow  on  the  head,  by  a 
fall,  or  by  both  kinds  of  violence  combined.  The  skull  may  or  may 
not  be  fractured;  and  the  person  may  die  of  concussion,  inflamma- 
tion of  the  brain,  or  from  effusion  of  blood.  The  general  defence  is 
that  the  deceased  struck  his  head  against  some  hard  substance  in 
falling  on  the  ground,  and  a  surgeon  is  asked  whether  the  particular 
appearances  might  not  be  explained  on  the  supposition  of  a  fall.  A 
medical  witness  is  rarely  in  a  position  to  swear  with  certainty,  that 
a  contused  wound  of  the  head  must  have  been  produced  by  a  weapon 
and  not  by  a  fall.  Some  circumstances,  however,  may  occasionally 
enable  him  to  form  an  opinion  on  this  point.     If  there  are  contused 


INJURIES    FROM    BLOWS    OR    FALLS.  219 

wounds  on  several  parts  of  the  head,  with  copious  effusion  of  blood 
beneath  the  skin,  the  presumption  is  that  a  weapon  must  have  been 
used.  If  the  marks  of  violence  are  on  the  summit  of  the  head,  it  is 
highly  probable  that  they  have  been  caused  by  a  weapon,  since  this 
is  not  commonly  a  part  which  can  receive  injury  from  a  fall.  So  if 
sand,  gravel,  grass  or  other  substances  be  found  in  a  contused  wound, 
this  will  render  it  highly  probable  that  the  injury  was  really  caused 
by  a  fall. 

It  matters  not,  under  the  new  Statute  on  wounding,  whether  the 
wound  was  produced  directly  by  a  weapon  employed  by  an  assail- 
ant, or  indirectly  by  any  act  of  violence  on  his  part.  A  man  may 
fracture  the  skull  of  another  either  by  striking  him  with  a  brick,  or 
by  striking  him  with  his  fist  and  thus  causing  him  to  fall  against  a 
brick.  Acquittals  formerly  took  place  upon  technicalities  of  this 
kind.  ("  Law  Times,"  March  21, 1846,  p.  501) ;  but  in  Reg.  v.  Dodd 
(Shrewsbury  Summer  Assizes,  1853)  Coleridge  J.  expressed  a  strong 
opinion  against  the  distinction  thus  made.  The  prisoner,  it  was  al- 
leged, threw  a  stone  at  the  deceased,  who  immediately  fell  on  a  stone 
floor.  The  deceased  was  able  to  go  about  for  several  days,  but  he 
died  a  week  after  he  had  sustained  the  violence,  from  inflammation 
of  the  brain,  as  a  result  of  fracture  of  the  skull.  The  medical  wit- 
ness ascribed  the  fracture  to  a  blow  from  a  stone.  In  the  defence  it 
was  urged  that  the  fracture  might  just  as  well  have  arisen  from  a 
fall  on  a  store  floor.  Coleridge  J.  held,  if  the  prisoner  knocked  the 
deceased  down,  that  it  would  make  no  difference  whether  the  deceased 
died  from  a  fall  on  a  stone  floor,  or  from  injury  produced  by  the  stone 
which  was  thrown  at  him. 

A  doubt  may  arise  whether  a  weapon  has  or  has  not  been  used 
in  reference  to  lacerated  or  contused  wounds.  Contused  wounds  on 
bony  surfaces,  as  on  the  head,  sometimes  present  the  appearance  of 
incised  wounds,  the  skin  being  evenly  separated.  When  a  wound 
is  recent,  a  careful  examination  will  generally  enable  a  witness  to 
form  a  correct  opinion,  but  if  some  time  has  elapsed  before  a  wound 
is  examined,  great  caution  will  be  required  in  forming  a  judgment. 

A  surgeon  should  be  cautious  in  listening  to  the  statements  of 
others,  that  a  weapon  has  been  used,  unless  the  wound  itself  bears 
about  it  such  characters  as  to  leave  the  fact  indisputable.  During  a 
scuffle,  the  person  assaulted  may  be  easily  deceived  as  to  the  way  in 
which  an  accused  party  inflicted  a  wound  upon  him ;  and  a  bad  mo- 
tive may  sometimes  exist  for  imputing  to  an  assailant  the  use  of  a 
weapon  during  a  quarrel.  In  such  cases  we  should,  as  medical  wit- 
nesses, rather  trust  to  the  appearance  of  the  wound  for  proof  of  the 
use  of  a  weapon,  than  to  any  account  given  by  interested  parties. 

A  late  learned  judge  suggested  to  me  that  some  means  of  discrimi- 
nation between  the  effects  of  falls  and  blows  affecting  the  same  part 
of  the  body,  would  greatly  aid  the  administration  of  justice.  There 
is  no  doubt  that  it  would,  but  as  no  two  cases  coming  under  this 
class  of  injuries  are  precisely  alike  either  in  the  part  wounded  or 
the  amount  of  force  employed,  it  is  scarcely  possible  to  introduce 
general  rules  or  to  make  statistics  practically  available.     It  is  com- 


220  STABS    AND    CUTS. 

monly  supposed  that  a  mere  fall  is  not  sufficient  to  produce  the  same 
degree  of  injur}^  that  may  be  caused  by  a  blunt  weapon,  applied  sud- 
denly to  the  head  by  human  force ;  but  a  severe  fracture  may  arise 
from  a  simple  accident  of  this  kind,  and  present  nearly  all  the  char- 
acters of  homicidal  violence.  The  difficulties  at  criminal  trials  will, 
I  think,  be  found  to  proceed,  not  so  much  from  want  of  rules  to 
assign  the  violence  to  one  condition  or  the  other,  as  from  a  want  of 
proper  observation  when  the  wounds  are  first  examined.  If  minute 
attention  were  given  to  an  examination  of  these  injuries  soon  after 
their  occurrence,  circumstances  would  be  noticed  which  would  help 
the  medical  witness  to  a  conclusion.  The  defence  that  they  might 
have  been  produced  by  a  fall,  is  not  set  up  until  a  subsequent  period, 
and  the  surgeon  is  then  obliged  to  trust  to  his  memory  for  the  main 
points  of  distinction.  Such  improvised  opinions  usually  fail  in  im- 
pressing a  jury. 

When  it  is  a  question  which  of  two  weapons  produced  certain 
bruised  wounds  found  on  the  head,  the  difficulties  of  medical  evidence 
are  increased.  Under  these  circumstances  the  presence  of  blood, 
hair,  cotton,  or  woollen  fibres  on  one  of  the  weapons  may  render  it 
probable  that  this  weapon  was  used.  In  most  instances  an  accurate 
observation  of  the  form  of  a  contused  wound  and  an  early  comparison 
of  it  with  the  alleged  weapon  or  the  substance  said  to  have  produced 
it,  will  enable  a  witness  to  come  to  a  correct  conclusion  on  the  subject. 
The  situation,  depth,  and  shape  of  the  wound  may  be  such  that  no 
accidental  fall  could  reasonably  account  for  its  production.  In 
assaults  on  women,  it  is  not  unusual  to  find  that  the  complainant 
herself  endeavors  to  exculpate  the  assailant  (her  husband)  by  ascrib- 
ing the  marks  of  violence,  not  to  blows,  but  to  some  accidental  fall. 
In  August,  1864,  a  woman  deposed  before  a  magistrate  that  certain 
severe  injuries  which  she  had  sustained  had  been  caused  by  her  fall- 
ing on  a  fender.  The  medical  man  who  examined  her  found  on  the 
top  of  the  head  three  distinct  wounds  which  were  bleeding.  Two 
appeared  as  if  they  had  been  caused  by  a  blunt  instrument ;  the  third 
on  the  back  part  of  the  head  was  a  clean  cut  wound.  He  considered 
that  they  had  been  produced  by  a  chopper,  and  that  none  of  them 
had  been  caused  by  a  fall  or  a  series  of  falls.  The  prisoner  on  this 
evidence  was  committed  for  trial. 

3.  Stabs  and  Cuts. — It  has  been  remarked  that  the  law  in  some 
cases  attaches  great  importance  to  the  clear  proof  of  the  use  of  a 
.weapon,  and  a  medical  man  has  therefore  a  certain  responsibility 
thrown  upon  him  when,  in  the  absence  of  a  weapon  and  the  denial 
of  its  use,  he  is  called  upon  to  say  whether  one  has  or  has  not  been 
used.  In  reference  to  cuts  and  stabs  there  can  in  general  be  no  diffi- 
culty, for  these  injuries  carry  with  them  distinct  evidence  of  their 
mode  of  production.  Formerly  stabbing  and  cutting  were  treated  as 
distinct  from  wounding,  and  very  nice  legal  distinctions  were  drawn 
between  these  terms,  which  had  the  effect  of  procuring  acquittals  on 
mere  legal  technicalities.  Under  the  new  consolidated  Act,  the 
words  "stab"  and  "cut"  are  properly  omitted,  and  the  word  "wound" 
onlj"  has  been  retained.     Medical  men  would  always  agree  upon  a 


WEAPONS.      EXAMINATION    OF    THE    DRESS.  221 

stab  or  cut  being  a  wound,  but  they  might  reasonably  differ  upon 
the  question  whether  in  a  given  case  a  wound  was  really  a  stab  or 
cut.  It  might  be  punctured,  lacerated,  or  contused,  and  not  fairly 
come  under  the  professional  description  of  a  cut  or  a  stab.  In  the 
meantime  the  only  person  who  derived  benefit  from  this  grammatical 
confusion  was  the  assailant  who  had  inflicted  the  undefined  injury  on 
another.  A  medical  witness  has  now  only  to  prove  that  the  personal 
injury  falls  strictly  within  the  meaning  of  the  term  wound;  he  is  not 
called  upon  to  prove  the  precise  variety  of  wounding  to  which  the 
injury  should  be  assigned.  At  the  same  time  he  will  always  be  pre- 
pared with  a  full  description  of  the  characters  of  an  injury  in  case 
questions  on  the  subject  should  be  put  to  him. 

What  are  Weapons. — The  new  statute  has  removed  those  legal 
doubts  which  formerly  arose  in  reference  to  the  true  signification  of 
the  term  weapon.  Thus  the  teeth,  the  hands  or  feet  uncovered,  were 
formerly  held  by  the  judges  not  to  be  weapons;  and  injuries  produced 
by  them,  however  severe,  were  not  treated  as  wounds  within  the 
meaning  of  the  statute.  Parties  were  tried  on  charges  of  biting  off 
fingers  and  noses,  and  although  the  medical  evidence  proved  that 
wounds  of  a  severe  kind  had  been  inflicted,  and  that  great  disfigure- 
ment and  mischief  had  been  done  to  individuals,  yet  the  nature  of 
the  injury  produced  was  not  so  much  regarded  as  the  actual  method 
by  which  it  was  accomplished.  The  persons  charged  were  acquitted 
under  an  indictment  for  "wounding,"  since  wounds  in  a  legal  sense 
could  be  produced  only  by  weapons,  while  the  teeth,  hands,  and  feet 
were  not  weapons  in  law! 

Examination  of  the  Dress. — This  is  sometimes  a  most  important 
part  of  the  duty  of  a  medical  man.  In  a  case  of  severe  wounding,  of 
whatever  kind,  he  should  always  require  to  see  the  dress  of  the 
wounded  person.  It  may  throw  a  material  light  upon  the  mode  in 
which  a  wound  has  been  produced :  it  may  remove  an  erroneous 
suspicion  of  murder,  and  may  sometimes  serve  to  indicate  that  a 
wound  has  been  self-inflicted  for  the  concealment  of  other  crimes, 
or  falsely  to  impute  its  infliction  to  other  persons.  Marks  of  blood, 
dirt,  grass  or  other  substances  on  the  clothing  may  also  throw  a  light 
upon  the  mode  of  infliction.  So  again  the  use  of  a  weapon,  in  refer- 
ence to  cuts  and  stabs,  may  be  inferred  from  the  dress  presenting 
corresponding  cuts  or  perforations.  Contused  wounds  by  bludgeons, 
may,  however,  be  readily  produced  through  the  dress  without  tearing 
or  injuring  it.  Considerable  laceration  of  the  skin  and  muscles,  and 
even  severe  fractures,  may  be  caused  without  necessarily  penetrating 
the  dress  supposing  it  to  be  of  an  elastic  or  yielding  nature.  In  self- 
inflicted  or  imputed  wounds,  if  of  the  nature  of  cuts  and  stabs,  there 
is  often  a  want  of  correspondence  between  the  perforations  of  the 
dress  and  the  wounds  on  the  person :  this  is  one  of  the  characters  by 
which  the  correctness  of  a  statement  may  be  tested.  A  severe  wound 
may  be  indirectly  produced  by  a  bruising  weapon,  and  medical  wit- 
nesses have  been  often  questioned  on  this  point.  Thus,  the  prose- 
cutor may  at  the  time  have  worn  about  his  person  some  article  of 
dress  which  received  the  blow,  and  this  may  have  actually  caused 


222  IMPUTED    WOUNDS. 

the  wound.  Cases  of  this  kind  must  be  determined  by  the  circum- 
stances which,  accompany  them.  Hence  it  is  obvious  that  a  medical 
practitioner  should  always  make  a  minute  and  careful  examination 
of  wounds  which  are  likely  to  become  the  subject  of  criminal  charges 
as  well  as  of  the  dress  or  clothing  worn  by  the  wounded  person  at 
the  time  of  the  assault.  In  performing  his  duties  as  a  surgeon,  he  is 
bound,  so  far  as  he  consistently  can,  to  notice  as  a  medical  jurist  the 
characters  of  all  personal  injuries,  so  as  to  be  able  to  give  an  opinion 
on  the  mode  in  which  they  were  produced.  A  careful  examination 
of  the  dress  has  served  to  remove  doubts  respecting  the  mode  in 
which  contused  wounds  have  been  inflicted  on  the  body  of  a  person 
found  dead,  while  on  the  other  hand  a  neglect  to  examine  the  dress 
has  led  to  accidental  being  mistaken  for  homicidal  violence. 

If  several  wounds  have  been  inflicted  through  the  dress,  an  exa- 
mination of  this  may  sometimes  suffice  to  show  which  was  first 
received.  A  man,  in  struggling  with  an  assailant,  received  three 
stabs  with  a  knife — two  on  the  left  elbow,  and  the  third  in  the  back. 
The  latter  was  at  about  the  level  of  the  eighth  rib ; — it  was  vertical 
to  the  chest,  and  had  clean  edges.  The  lower  margin  was  obtuse — 
the  upper  acute ;  hence  it  was  evident  that  the  cutting  edge  of  the 
weapon  had  been  directed  upwards.  It  had  traversed  the  left  lung 
and  the  heart,  and  had  caused  immediate  death.  It  was  obvious,  on 
examination,  that  this  mortal  wound  had  been  first  received,  and  the 
stabs  at  the  elbow  inflicted  subsequently.  These  two  stabs,  which 
were  slight,  had  divided  the  cloth  coat  and  shirt,  and  had  only  grazed 
the  skin,  so  that  no  blood  had  been  effused.  But  the  edges  of  the 
cuts'in  the  cloth  coat  and  shirt  were  stained  with  blood;  hence  it 
was  evident  that  they  must  have  been  produced  by  a  weapon  already 
rendered  bloody  by  a  previous  wound.  The  fact  was  of  some  im- 
portance in  the  case,  and  the  correctness  of  the  medical  opinion  was 
confirmed  by  the  evidence  at  the  judicial  inquiry.  (See  "  Ann. 
d'Hygiene,"  1847,  p.  461.) 

Imputed  Self  -  Inflicted  Wounds. — A  man  may  produce  on  himself 
one  or  more  wounds  for  the  purpose  of  simulating  a  homicidal  as- 
sault which  he  may  allege  to  have  been  committed  upon  him.  With 
the  motives  for  the  self-infliction  of  wounds  a  medical  jurist  is  not 
concerned — it  is  of  the  fact  only  that  he  can  take  cognizance.  From 
the  cases  that  have  yet  occurred,  it  would  appear  that  the  object  has 
been  to  extort  money,  to  conceal  murder,  robbery  or  some  other 
crime,  and  to  turn  away  a  suspicion  of  criminality  from  the  wounded 
person  himself,  but  it  is  not  always  easy  to  trace  a  motive  for  the 
self-infliction  of  injuries;  and  when  a  reasonable  motive  is  not  at 
once  forthcoming  persons  are  apt  to  be  misled  and  to  credit  the  story. 
Persons  who  have  been  convicted  of  thus  imputing  violence  to  others, 
have  frequently  borne  respectable  characters  until  the  occurrence, 
and  this  has  contributed  to  give  support  to  their  statements.  When 
a  person  intending  to  commit  suicide  fails  in  the  attempt,  he  has 
sometimes,  under  a  sense  of  shame,  attributed  the  infliction  of  a 
wound  in  his  throat  to  another;  but  facts  of  this  kind  may  without 
difficulty  be  cleared  up  by  circumstantial  evidence.  Imputed  wounds, 


CHARACTERS    OF    IMPUTED    WOUNDS.  223 

if  we  except  the  case  of  an  actual  attempt  at  suicide,  in  which  the 
injury  is  commonly  severe,  are  generally  of  a  superficial  character, 
consisting  of  cuts  or  incisions  not  extending  bplow  the  true  skin ; 
deep  stabs  are  seldom  resorted  to  where  the  purpose  is  not  suicide 
but  merely  to  conceal  other  crimes.  Further,  these  wounds  are  in 
front  of  the  person,  and  may  be  on  the  right  or  left  side,  according 
to  whether  the  person  is  right  or  left-handed.  They  have  also  been 
generally  numerous,  and  widely  scattered ;  sometimes  they  have  had 
a  complete  parallelism,  unlike  those  which  must  have  been  inflicted 
by  an  adversary  during  a  mortal  conflict  with  a  weapon.  The  hands 
are  seldom  wounded,  although  in  the  resistance  to  real  homicidal 
attempts  these  parts  commonly  suffer  most  severely.  The  injuries 
are  not  usually  situated  over  those  parts  of  the  body  in  which  wounds 
are  by  common  repute  considered  mortal,  and  there  is  in  general  an 
entire  want  of  correspondence  between  the  situation  of  the  wounds 
on  the  person,  and  the  cuts  or  other  marks  on  the  dress.  This  is  a 
fact  which  requires  special  attention. 

In  comparing  cuts  on  the  dress  with  wounds  on  the  person,  there 
are  several  circumstances  to  be  attended  to.  What  articles  of  dress 
were  worn  at  the  time  of  the  assault  ?  In  a  case  of  actual  stabbing 
by  another,  all  ought  to  present  marks  of  perforation,  corresponding 
in  direction,  form,  size,  sharpness  of  the  edges  of  the  weapon,  &c. 
In  imputed  wounds,  the  marks  on  several  layers  of  dress  may  not 
correspond  with  each  other  in  the  characters  above  mentioned.  It 
is  very  difficult  for  a  man  simulating  such  injuries  so  to  arrange  his 
clothes  when  off  his  person,  as  to  deceive  a  careful  examiner.  There 
will  be  some  inconsistency  or  want  of  adjustment.  Apart  from  the 
fact  that  several  stabs  or  cuts  cannot  exist  on  the  same  part  of  the 
clothes,  without  one  or  more  being  stained  with  blood  on  the  outside 
or  inside,  an  impostor  may  either  do  too  much  or  too  little,  and  thus 
lead  to  his  detection.  In  a  case  which  excited  much  public  discus- 
sion in  London  many  years  since,  a  simple  circumstance  led  to  the 
inference  that  certain  stabs  or  cuts  through  a  shirt  had  not  been  pro- 
duced while  the  shirt  was  on,  but  while  it  was  off  the  body.  There 
were  two  cuts  in  the  shirt  near  to  each  other,  precisely  similar  in 
size,  form,  and  direction ;  in  fact,  the  knife  or  dagger  producing  them 
must  have  gone  through  a  fold  of  the  shirt,  so  accurate  was  the  cor- 
respondence. Then,  however,  it  followed  that  the  shirt  could  not 
have  been  upon  the  body  of  the  wounded  person,  as  he  alleged,  be- 
cause a  stab  through  a  shirt  when  worn  over  the  skin  must,  in  order 
to  reach  the  body,  traverse  not  only  a  fold  (producing  two  cuts),  but 
another  layer  in  contact  with  the  skin,  and  thus  produce  three  cuts, 
or  in  the  event  of  traversing  two  folds,  five  cuts.  In  simulating  the 
wounds  by  cuts  on  the  shirt,  the  person  is  supposed  to  have  forgotten 
this,  and  have  merely  stabbed  a  fold  of  the  shirt  while  lying  on  a 
table,  or  in  some  situation  convenient  for  the  purpose.  This,  among 
other  facts,  rendered  it  probable  that  the  slight  wounds  on  the  chest 
were  self-inflicted. 

It  has  been  contended  that  no  rules  can  be  laid  down  for  the  de- 
tection of  such  cases ;    each  must  be  decided  by  the  facts  which 


224  IMPUTED    WOUXDS. 

accompany  it.  The  facts  which  a  medical  man  must  endeavor  to 
ascertain  are  the  following  :  1.  The  relative  positions  of  the  assailant 
and  the  assailed  person  at  the  time  of  the  alleged  attack.  2.  The 
situation,  direction,  and  depth  of  the  wound  or  wounds.  3.  The 
situation  or  direction  of  marks  of  blood  or  wounds  on  the  person  or 
dress  of  either,  or  of  both,  the  assailant  and  assailed,  and,  4.  The 
marks  of  blood,  and  the  quantity  effused  at  the  spot  where  the 
mortal  struggle  is  alleged  to  have  taken  place. 

It  is  worthy  of  remark,  that  imputed  wounds  are  generally  cuts  or 
stabs.  They  are  seldom  of  the  contused  kind :  the  impostor  cannot, 
in  reference  to  contusions,  so  easily  calculate  upon  the  amount  of 
mischief  which  is  likely  to  ensue.  Dr.  Bergeret,  however,  has  re- 
lated some  cases  in  which  females  laboring  under  hysterical  attacks 
have  inflicted  upon  themselves  severe  contusions,  and  have  charged 
innocent  persons  with  attempts  to  murder.  ("  Ann.  d'Hyg."  1863, 
vol.  1,  p.  463.)  In  general  the  inconsistency  of  the  story  is  so  palpa- 
ble as  to  betray  the  imposture  at  once ;  but  the  public  are  easily  de- 
ceived, and  much  prejudice  is  often  unjustly  excited  against  those 
who  have  been  falsely  accused.  Slight  excoriations  or  bruises  may 
be  magnified  into  marks  of  murderous  violence ;  and  if  a  medical 
man  can  be  found  to  admit  in  an  unqualified  form  that  a  severe  blow 
can  be  inflicted  and  yet  leave  but  slight  marks  on  the  skin,  the  charge 
will  be  considered  proved  against  the  unfortunate  accused.  The  case 
of  M.  Armand,  a  merchant  of  Montpellier,  who  was  tried  at  the 
Assizes  at  Aix,  in  March,  1864,  for  an  alleged  murderous  assault 
upon  his  servant  Maurice  Koux,  furnishes  a  good  illustration  of  the 
readiness  with  which  the  most  inconsistent  stories  are  accepted  by 
the  public  when  they  are  supported  by  pseudo-medical  evidence. 

Pistol-shot  wounds  are  sometimes  voluntarily  inflicted  for  the 
purpose  of  imputing  murder  or  extorting  charity.  A  man  intending 
to  commit  suicide  by  firearms,  and  failing  in  the  attempt,  may,  from 
shame  and  a  desire  to  conceal  his  act,  attribute  the  wound  to  the  hand 
of  some  assassin.  In  examining  such  imputed  wounds  they  will  not 
be  found  to  involve  vital  parts,  except  in  cases  of  attempted  suicide, 
and  they  will  possess  all  the  characters  of  near- wounds  produced  by 
gunpowder,  wadding,  or  a  bullet.  The  skin  around  will  be  more  or  less 
lacerated  and  bruised  ;  there  will  be  much  ecchvmosis,  and  the  hand 
holding  the  weapon,  as  well  as  the  dress  and  the  wounded  skin,  may 
be  blackened  or  burnt  by  the  exploded  gunpowder.  A  pistol-shot 
wound  from  an  assassin  may  be  produced  from  a  distance,  while  an 
imputed  wound  which  is  inflicted  by  a  person  on  himself,  must  always 
partake  of  the  characters  of  a  near- wound. 


WOUNDS    INDICATIVE    OF    HOMICIDE.  225 


CHAPTER     XXIV. 

Wounds  indicative  of  homicide,  suicide,  or  accident. — evi- 
dence FROM  THE  SITUATION  OF  A  WOUND. — EVIDENCE  FROM  NATURE 
AND  EXTENT. — EVIDENCE  FROM  THE  DIRECTION  OF  A  WOUND. — 
WOUNDS  INFLICTED  BY  THE  RIGHT  OR  LEFT  HAND. — SEVERAL 
WOUNDS. — USE  OF  SEVERAL  WEAPONS. 

Wounds  Indicative  of  Homicide,  Suicide,  or  Accident. — Supposing 
that  the  wound  which  is  found  on  a  dead  body  is  proved  to  have  been 
caused  before  death,  it  may  be  necessary  to  inquire  whether  it  was 
the  result  of  suicide,  homicide,  or  accident.  It  might  at  first  sight  be 
considered  that  the  determination  of  a  question  of  this  nature  was 
wholly  out  of  the  province  of  a  medical  jurist.  In  some  instances 
it  may  be  so,  and  the  settlement  of  it  is  then  properly  left  to  the 
legal  authorities;  but,  in  a  large  number  of  cases,  it  is  so  closely 
dependent  for  its  elucidation  on  medical  facts  and  opinions,  that  juries 
could  never  arrive  at  a  satisfactory  decision  without  medical  evidence. 
Let  us  suppose,  then,  that  a  medical  jurist  is  consulted  in  a  doubtful 
case — What  are  the  points  to  which  he  should  direct  his  attention  ? 
They  are,  with  regard  to  the  wound,  1,  its  sittiation,  2,  its  nature  and 
extent,  and,  3,  its  direction.. 

1.  Evidence  from  the  Situation  of  a  Wound. — It  is  a  general  princi- 
ple in  which  most  medical  jurists  agree,  that  wounds  inflicted  by  a 
suicide,  are  usually  confined  to  the  fore  or  lateral  parts  of  the  body. 
The  throat  and  chest  are  commonly  selected,  when  cutting  instru- 
ments are  employed  ;  while  the  chest,  especially  in  the  region  of  the 
heart,  the  mouth,  the  orbit,  and  the  temples,  are  the  spots  generally 
chosen  for  the  perpetration  of  suicide  by  fire-arms.  But  it  is  obvious, 
that  any  of  these  parts  may  be  also  selected  by  a  murderer,  with  the 
especial  design  of  simulating  a  suicidal  attempt ;  therefore  the  mere 
situation  of  a  wound  does  not  suffice  to  establish  the  fact  of  suicide. 
Some  have  regarded  it  as  fully  established  in  legal  medicine,  that 
when  wounds  exist  at  the  back  part  of  the  body,  it  is  a  positive  proof 
that  they  have  not  been  self-inflicted.  This  situation  is  certainly 
unusual  in  cases  of  suicide ;  but,  as  Orfila  observes,  it  is  not  the  situa- 
tion, so  much  as  the  direction  of  a  wound,  which  here  furnishes 
evidence  against  the  presumption  of  suicide.  A  wound,  traversing 
the  body  from  behind  to  before  in  a  direct  line,  is  not  likely  to  have 
resulted  from  a  suicidal  attempt :  at  least  it  must  be  obvious  that  it 
would  require  more  preparation  and  contrivance  on  the  part  of  a 
self-murderer,  so  to  arrange  matters  that  such  a  wound  should  be 
produced,  than  we  can  believe  him  to  possess  at  the  moment  of  at- 
tempting his  life.  Besides,  his  object  is  to  destroy  himself  as  quickly 
15 


226  EVIDENCE    FROM    SITUATION. 

and  as  surely  as  circumstances  will  permit ;  he  is,  therefore,  not 
likely  to  adopt  complicated  and  uncertain  means  for  carrying  this 
design  into  execution.  Nevertheless,  we  must  not  always  expect  to 
find  suicidal  wounds  in  what  an  anatomist  would  pronounce  to  be, 
the  most  appropriate  situation  to  produce  instant  destruction.  An 
incised  wound  in  a  concealed  or  not  easily  accessible  part  is  presump- 
tive of  murder  :  because  this  kind  of  injury  could  have  resulted  only 
from  a  deliberate  use  of  the  weapon.  Suicidal  wounds,  are,  how- 
ever, sometimes  found  in  unusual  situations.  In  reference  to  this 
subject,  it  has  been  remarked,  that  there  is  no  wound  which  a  suicide 
is  capable  of  inflicting  upon  himself,  which  may  not  be  produced  by 
a  murderer ;  but  there  are  many  wounds  inflicted  by  a  murderer, 
which,  from  their  situation  and  other  circumstances,  a  suicide  would 
be  incapable  of  producing  on  his  own  person.  "We  cannot  always 
obtain  certainty  in  a  question  of  this  kind — the  facts  will  often  allow 
us  to  speak  only  with  different  degrees  of  probability. 

The  situation  of  a  wound  sometimes  serves  to  show  whether  it 
is  of  an  accidental  nature  or  not — a  point  often  insisted  on  in  the  de- 
fence. Accidental  wounds  are  generally  found  on  those  parts  of  the 
body  which  are  exposed.  Some  wounds,  however,  forbid  the  suppo- 
sition of  accident  even  when  exposed ;  as  deeply  incised  wounds  of 
the  throat,  and  gunshot  wounds  of  the  mouth  and  temples.  For  the 
report  of  a  case  in  which  an  accidental  wound  on  the  head,  by  an 
axe,  closely  simulated  a  homicidal  wound,  see  Casper's  "  Wochen- 
schrift,"  May  24,  1845. 

2.  Evidence  from  the  Nature  and  Extent  of  a  Wound. — Contused 
wounds  are  rarely  seen  in  cases  of  suicide,  because  in  producing 
them  there  is  not  that  certainty  of  speedily  destroying  life  to 
which  a  self-murderer  commonly  looks.  There  are,  of  course,  ex- 
ceptions to  this  remark ;  as  where,  for  instance,  a  man  precipitates 
himself  from  a  considerable  height,  and  is  wounded  by  the  fall.  Cir- 
cumstantial evidence  will,  however,  rarely  fail  to  clear  up  a  case  of 
this  description.  Greater  difficulty  may  exist  when  life  is  destroyed 
by  a  contused  wound,  voluntarily  inflicted.  When  persons  laboring 
under  insanity  commit  suicide,  they  often  inflict  upon  themselves 
wounds  of  an  extraordinary  kind — such  as  would,  at  first  view,  lead 
to  a  suspicion  that  they  had  been  produced  by  the  hand  of  a  mur- 
derer ;  and,  therefore,  the  rules  which  are  here  laid  down  to  distin- 
guish homicidal  from  suicidal  wound,  must  be  guardedly  applied  to 
cases  of  this  kind. 

The  extent  of  a  wound,  by  which  we  are  to  understand  the  number 
and  importance  of  the  parts  injured,  must  in  these  cases  be  always 
taken  into  consideration.  It  has  been  somewhat  hastily  laid  down 
as  a  rule,  that  an  extensive  wound  of  the  throat,  involving  all  the 
vessels  and  soft  parts  of  the  neck  to  the  spine,  could  not  be  inflicted 
by  a  suicide.  Although  in  general,  suicidal  wounds  of  this  part  of 
the  body  do  not  reach  far  back,  or  involve  the  vessels  of  more  than 
one  side,  yet  we  find  occasionally  that  all  the  soft  parts  are  thus  com- 
pletely divided.  There  are  cases  in  which,  perhaps,  with  a  firm 
hand,  there  is  a  most  determined  purpose  of  self-destruction.     In  a 


WOUNDS    OF    THE    THROAT.  227 

case  of  suicide,  observed  by  Marc,  the  weapon  bad  divided  all  tbe 
muscles  of  the  neck,  the  windpipe,  and  gullet — had  opened  the  jugu- 
lar veins  and  both  carotid  arteries — and  had  even  grazed  the  anterior 
ligaments  of  the  spine.  A  wound  so  extensive  as  this,  is  rarely 
seen  in  a  case  of  suicide,  but  there  is  no  ground  for  the  assertion, 
that  such  extensive  wounds  in  the  throat  are  incompatible  with  self- 
destruction. 

Incised  wounds  in  the  throat  are  generally  set  down  as  presumptive 
of  suicide,  but  murderers  sometimes  wound  this  part  for  the  more 
effectual  concealment  of  crime.  Circumstances  connected  with  the 
form  and  direction  of  a  wound,  may  in  such  cases  lead  to  detection, 
for,  unless  the  person  attacked  be  asleep  or  intoxicated,  resistance  is 
offered — evidence  of  which  may  be  obtained  by  the  presence  of  great 
irregularity  in  the  wound,  or  the  marks  of  other  wounds  on  the 
hands  and  person  of  the  deceased.  The  peculiar  form  of  a  wound 
on  the  throat  has  sometimes  led  to.  a  justifiable  suspicion  of  homi- 
cide. In  one  instance,  a  man  was  found  dead  with  his  throat  cut  in 
the  manner  in  which  butchers  are  accustomed  to  kill  sheep.  This 
led  the  medical  man  to  believe  that  the  wound  had  been  inflicted  by 
a  butcher.  The  police,  guided  by  this  observation,  arrested  a  butcher, 
who  was  subsequently  tried  and  convicted  of  this  act  of  murder.  In 
some  instances,  however,  it  is  extremely  difficult  to  say  whether  the 
wound  is  homicidal  or  suicidal — the  medical  facts  being  equally  ex- 
plicable on  either  hypothesis.  (See  case  by  Marc,  "  Ann.  d'Hyg." 
1830,  t.  2,  p.  408 ;  another  by  Devergie,  ib.  414 ;  and  a  third  bv 
M.  Ollivier,  "  Ann.  d'Hyg."  1836,  t.  1,  p.  394.)  Regularity  in  a 
wound  of  the  throat  has  been  considered  to  be  presumptive  of  sui- 
cide. This  was  the  publicly-expressed  opinion  of  Sir  Everard  Home 
in  the  well-known  case  of  Sellis.  The  deceased  was  found  lying  on 
a  bed,  with  his  throat  extensively  cut,  and  the  edges  of  the  incision 
were  regular  and  even.  This  condition  of  the  wound,  it  was  inferred, 
repudiated  the  idea  of  homicide,  but  as  a  general  principle,  it  appears 
to  me  to  be  a  fallacious  criterion.  A  murderer,  by  surprising  his 
victim  from  behind — by  having  others  at  hand  to  assist  him,  or  by 
directing  his  attack  against  one  who  is  asleep  or  intoxicated,  or  who 
from  age  or  infirmary  is  incapable  of  offering  resistance,  may  easily 
produce  a  regular  and  clean  incision  on  the  throat. 

3.  Evidence  from  the  Direction  of  a  Wound. — The  direction  of  a 
wound  has  been  considered  by  some  to  afford  presumptive  evidence 
sufficiently  strong  to  guide  a  medical  jurist  in  this  inquiry.  It  has 
been  remarked  that  in  most  suicidal  wounds  which  affect  the  throat, 
the  direction  of  the  cut  is  commonly  from  left  to  right,  either  trans- 
versely or  passing  obliquely  from  above  downwards ;  in  suicidal  stabs 
and  punctured  wounds,  the  direction  is  commonly  from  right  to  left 
and  from  above  downwards.  In  left-handed  persons,  the  direction 
would,  of  course,  be  precisely  the  reverse.  Suicidal  wounds  are, 
however,  subject  to  such  variation  in  extent  and  direction,  that  it  is 
scarcely  possible  to  generalize  with  respect  to  them.  Nevertheless, 
an  attention  to  these  points  may  sometimes  be  of  real  assistance  to 
the  inquirer,  especially  when  the  body  has  not  been  moved  from  its 


228  DIRECTION    OF    WOUNDS. 

position.  It  is  recommended  that  the  instrument  Avith  which  the 
wound  has  beeen  inflicted  should  be  placed  in  either  hand  of  the 
deceased,  and  the  extremity  moved  towards  the  wounded  part,  so 
that  it  may  be  clearly  seen  whether  the  direction  of  the  wound  could 
or  could  not  correspond  to  it  in  any  position.  It  might  happen  that 
neither  arm  would  reach  the  wounded  part,  so  as  to  inflict  a  wound 
of  the  particular  direction  observed;  this  may  be  the  case  in  wounds 
situated  on  the  back.  It  is  obvious  that  if  a  murderer  makes  an  in- 
cised wound  in  the  front  of  the  throat  from  behind,  the  direction 
will  be  the  same  as  that  commonly  observed  in  cases  of  suicide.  (See 
on  this  point  the  case  of  Reg.  v.  Dalmas,  Cent.  Crim.  Court,  May, 
1844.)  Again,  if  the  person  attacked  is  powerless,  the  wound  may 
be  deliberately  made,  so  as  to  simulate  a  suicidal  act ;  indeed  mur- 
derers seldom  attack  the  throat,  but  with  the  design  of  simulating  an 
act  of  suicide.  A  homicidal  stab  may  also  take  the  same  direction 
as  one  which  is  suicidal,  but  this  would  be  confined  to  those  cases  in 
which  the  assailant  was  placed  behind  or  aside.  If  in  front  of  the 
person  whom  he  attacks,  the  direction  would  probably  be  from  left 
to  right ;  but  in  suicide,  when  the  right  hand  is  commonly  used,  it 
is  the  reverse.  Oblique  wounds,  passing  from  above  downwards, 
are  common  to  homicide  and  suicide,  but  those  which  take  an  oblique 
course  from  below  upwards  are  generally  indicative  of  homicide, 
for  it  is  extremely  rare,  that  a  person  bent  on  suicide,  unless  a  luna- 
tic, thus  uses  a  weapon.  Homicidal  incisions,  especially  in  the 
throat,  are  often  prolonged  below  and  behind  the  skin  forming  the 
angles  of  a  wound,  deeply  into  the  soft  parts.  Those  which  are  sui- 
cidal rarely  possess  this  character ;  they  terminate  gradually  in  a 
sharp  angle,  and  the  skin  itself  is  the  furthest  point  wounded ;  the 
weapon  is  not  carried  either  behind,  below,  or  beneath  it.  Exceptions 
to  these  characters  may  exist ;  but  in  a  dark  and  intricate  subject  of  this 
nature,  we  have  only  these  limited  rules  to  guide  us.  The  instrument 
with  which  a  wound  is  supposed  to  have  been  inflicted,  should  be 
adapted  to  the  edges  of  the  incision ;  its  sharpness  compared  with 
the  cleanness  and  evenness  of  the  cut,  and  its  length  with  the  depth 
of  the  incision  or  stab.  It  is  no  uncommon  occurrence  for  a  mur- 
derer to  substitute  some  instrument  belonging  to  the  deceased  or 
another  person,  for  that  which  he  has  actually  employed ;  and  this 
by  its  size,  shape,  bluntness,  or  other  peculiarities,  may  not  account 
for  the  appearances  presented  by  the  wound. 

It  is  not  often  that  any  difficulty  is  experienced  in  distinguishing 
a  suicidal  from  an  accidental  wound.  When  a  wound  has  really  been 
suicidally  inflicted,  there  are  generally  to  be  found  about  it  clear  in- 
dications of  design ;  and  the  whole  of  the  circumstances  are  seldom 
reconcilable  with  the  supposition  of  accident.  But  if  the  position  of 
the  deceased  with  respect  to  surrounding  objects  has  been  disturbed, 
if  the  weapon  has  been  removed,  and  the  body  transported  to  a  dis- 
tance, then  it  will  not  always  be  easy  to  distinguish  a  wound  acci- 
dentally received,  from  one  inflicted  by  a  suicide  or  a  murderer.  The 
evidence  of  those  who  find  the  body  can  alone  clear  up  the  case ;  and 
the  medical  witness  may  be  required  to  state  how  far  this  evidence 


WOUNDS    INFLICTED    BY  THE    RIGHT  OR    LEFT    HAND.      229 

is  consistent  with  the  situation,  extent,  and  direction  of  the  wound 
by  which  the  deceased  has  fallen.  It  is  unnecessary  to  dwell  further 
on  this  subject,  since  the  observations  already  made  will  suggest  to 
a  practitioner  the  course  which  he  should  pursue.  Circumstantial 
evidence  is  commonly  sufficient  to  show  whether  a  wound  has  been 
accidentally  received  or  not ;  but  as  an  accidental  wound  may  some- 
times resemble  one  of  homicidal  or  suicidal  origin,  so  it  follows  that 
it  is  not  always  possible  for  a  medical  jurist  to  decide  the  question 
peremptorily  from  a  mere  inspection  of  the  wound. 

It  would  not  be  difficult  to  produce  instances  in  which  murderers  have 
alleged,  in  defence,  that  the  wounds  observed  on  the  bodies  of  their 
victims  were  of  accidental  origin,  and  the  allegations  have  been 
clearly  refuted  by  medical  evidence.  A  witness  must  be  prepared, 
therefore,  in  all  cases  in  which  death  has  taken  place  in  secrecy,  and 
the  nature  of  the  wound  is  such  as  to  render  its  origin  doubtful,  to 
be  closely  examined  by  counsel  for  a  prisoner  charged  with  felonious 
homicide,  on  a  question  whether  the  wound  might  not  have  been 
accidental.  The  law  requires  that  it  should  be  rendered  evident  to 
a  jury,  before  such  a  charge  can  be  sustained,  that  the  fatal  wound 
could  not  have  had  an  accidental  or  suicidal  origin. 

Wounds  inflicted  by  the  Right  or  Left  Hand. — Some  remarks  have 
been  made  in  reference  to  the  direction  of  a  cut  or  a  stab  varying 
according  to  whether  the  right  or  the  left  hand  has  been  used  by  a 
suicide.  It  is  necessary  for  a  medical  jurist  to  be  aware,  that  there 
are  many  persons  who  are  ambidextrous,  i.  e.,  who  have  equal  facility 
in  the  use  of  the  right  and  the  left  hand.  This  may  not  be  generally 
known  to  the  friends  of  the  deceased :  and  such  persons  are  often 
pronounced,  even  by  those  who  have  associated  with  them,  to  have 
been  right-handed.  A  want  of  attention  to  this  point  is  said  to  have 
been  one  of  the  circumstances  which  led  to  a  suspicion  of  murder  in 
the  case  of  Sellis.  (Wills'  "  Circ.  Evidence,"  p.  97.)  The  man  was 
found  dead  on  his  bed  with  his  throat  cut — the  razor  was  discovered 
on  the  left  side  of  the  bed ;  whereas  it  was  generally  supposed  and 
asserted  that  he  was  right-handed.  The  truth  was,  he  was  ambidex- 
trous— equally  expert  in  the  use  of  the  razor  with  his  left  and  right 
hand;  and  thus  the  apparently  suspicious  circumstance  of  the  razor 
being  found  on  his  left  side,  was  at  once  explained  away.  The  im- 
portance of  making  due  allowance  for  the  characters  presented  by 
wounds  in  the  throat  is  also  illustrated  by  a  case  which  occurred  in 
London  in  November,  1865.  A  publican  and  his  wife  had  been  fre- 
quently in  the  habit  of  quarrelling.  One  night  the  wife  gave  an 
alarm,  and  the  man  was  found  dead  on  the  bed  with  his  throat 
severely  cut.  On  examination,  the  fatal  wound  had  all  the  charac- 
ters of  a  left-handed  cut,  while  the  deceased  was  generally  believed 
to  be  right-handed;  and  there  was  bloody  water  in  a  wash-hand  basin 
in  the  room.  The  wife,  who  had  marks  of  bruises  upon  her,  said 
that  she  left  her  husband  in  the  bedroom  for  a  short  time,  and  on 
her  return  found  him  dead.  The  suspicious  facts  were  explained  at 
the  inquest  by  a  daughter  of  the  deceased  by  a  former  marriage. 
She  stated  that  her  father  had  been  brought  up  as  a  wood-carver,  a 


230  WOUNDS.      THE    USE    OF    SEVERAL    WEAPONS. 

trade  which  requires  a  man  to  use  both  hands  equally  well — that  he 
had  frequently  threatened  to  destroy  himself,  and  that  the  blood  in 
the  wash-hand  basin  was  owing  to  her  having  washed  her  hands  after 
she  had  touched  her  father's  head.  This  satisfactorily  explained  the 
medical  circumstances  which  appeared  at  first  to  point  to  an  act  of 
homicide. 

The  Presence  of  Several  Wounds. — In  suicides,  commonly,  one 
wound  only  is  seen,  namely,  that  which  has  destroyed  life,  and  the 
presence  of  several  wounds  on  the  body,  or  the  marks  of  several 
attempts  around  the  principal  wound,  have  been  considered  to  fur- 
nish presumptive  evidence  of  murder.  But  any  inferences  of  this 
kind  must  be  cautiously  drawn,  since  not  only  may  a  murderer 
destroy  his  victim  by  one  wound,  but  a  suicide  may  inflict  many, 
or  leave  the  marks  of  several  attempts  before  he  succeeds  in  his  pur- 
pose. 

The  Use  of  Several  Weapons. — In  general,  suicides,  when  foiled  in 
a  first  attempt,  continue  to  use  the  same  weapon ;  but  sometimes, 
after  having  made  a  severe  wound  in  the  throat,  they  will  shoot 
themselves,  or  adopt  some  other  method  of  self-destruction.  These 
cases  can  only  appear  complicated  to  those  who  are  unacquainted 
with  the  facts  relative  to  self-murder.  Neither  the  presence  of  several 
wounds  by  the  same  kind  of  weapon,  nor  of  different  wounds  by  dif- 
ferent weapons,  can  be  considered  of  themselves  to  furnish  any  proof 
of  the  act  having  been  homicidal.  In  one  instance  which  is  reported, 
a  lunatic,  in  committing  suicide,  inflicted  thirty  wounds  upon  his 
head.  In  a  case  of  murder,  when  many  wounds  are  found  on  a  dead 
body,  it  may  happen  that  the  situation  or  direction  of  some  will  be 
incompatible  with  the  idea  of  a  suicidal  origin.  Thus  a  stab  or  cut 
may  be  close  to  a  contusion  or  contused  wound,  and  although  a  fall 
or  other  accident  might  account  for  the  latter,  the  former  would  indi- 
cate violence  separately  inflicted. 

Two  or  more  Mortal  Wounds. — When  we  find  several  wounds  on 
the  body  of  a  suicide,  it  generally  happens  that  one  only  bears  about 
it  a  mortal  character,  namely,  that  which  has  caused  death.  On  this 
account  it  has  been  asserted  by  some  medical  jurists,  that  when  two 
mortal  wounds  are  found  upon  a  body,  and  particularly  if  one  of 
them  is  of  a  stunning  or  stupefying  tendency  (i.  e.  affecting  the  head), 
they  must  be  considered  incompatible  with  suicide.  An  inference  of 
this  kind  can  be  applied  to  those  cases  only  in  which  the  two  wounds, 
existing  on  different  parts  of  the  body,  were  likely  to  prove  imme- 
diately fatal.  It  must,  however,  be  borne  in  mind,  that  all  suicides 
do  not  immediately  perish  from  wounds  which  are  commonly  termed 
mortal :  on  the  contrary,  they  have  often  the  power  to  perform  acts 
of  volition  and  locomotion,  which  might  by  some  be  deemed  wholly 
incompatible  with  their  condition.  It  is  difficult  to  say  whether  one 
wound  was  likely  to  destroy  life  so  rapidly  as  to  render  it  impossible 
for  the  person  to  have  inflicted  another  upon  himself;  but  when 
there  are  several  distinct  incisions  on  the  throat,  each  involving  im- 
portant bloodvessels,  there  is  good  reason  to  infer  that  they  have 
resulted  from  an  act  of  murder. 


EVIDENCE    FROM    CIRCUMSTANCES.  281 


CHAPTER    XXV. 

Evidence  from  circumstances. — the  position  of  the  body. — of 
the  weapon. — evidence  from  blood,  hair,  and  other  sub- 
stances on  weapons. — marks  of  blood  on  clothing  and  fur- 
niture, on  the  deceased,  and  on  the  assailant. 

Evidence  from  Circumstances. — In  pursuing  the  examination  of  the 
question  respecting  the  homicidal  or  suicidal  origin  of  wounds,  the 
attention  of  the  reader  may  be  called  to  the  force  of  evidence  which 
is  sometimes  derived  from  the  circumstances  under  which  the  body 
of  a  person,  dead  from  wounds,  is  discovered.  It  may  be  said  that 
this  is  a  subject  wholly  foreign  to  the  duties  of  a  medical  jurist,  but 
I  cannot  agree  to  this  statement.  There  are  few  in  the  profession 
who,  when  summoned  to  aid  justice  by  their  science,  in  the  detection 
of  crime,  do  not  seek  for  circumstances  by  which  to  support  the 
medical  evidence  required  of  them.  A  practitioner  would  certainly 
be  wrong  to  base  his  professional  opinion  on  these  circumstances,  but 
it  is  scarcely  possible  for  him  to  avoid  drawing  an  inference  from 
them  as  they  fall  under  his  observation.  Care  must  be  taken  that 
this  inference  is  not  overstrained.  The  medical  evidence  may  be  of 
itself  weak,  and  insufficient  to  support  the  charge  against  the  accused : 
in  such  a  case,  if  any  suspicious  circumstances  have  come  to  his 
knowledge  he  may  be  often  unconsciously  induced  to  attach  greater 
importance  to  the  medical  facts  than  he  is  justified  in  doing.  In 
short,  he  may,  through  a  feeling  of  prejudice,  which  it  is  not  always 
easy  to  avoid,  give  an  undue  force  to  the  medical  evidence.  But  if 
a  proper  degree  of  caution  is  used  in  drawing  inferences,  and  the 
circumstances  are  not  allowed  to  create  a  prejudice  in  his  mind 
against  the  accused,  a  practitioner  is  bound  to  observe  and  record 
them ;  for,  being  commonly  the  first  person  called  to  the  deceased, 
many  facts  capable  of  throwing  an  important  light  on  the  cause  of 
death,  would  remain  unnoticed  or  unknown,  but  for  his  attention  to 
them.  The  position  of  a  dead  body,  the  suddenness  of  death,  the 
discovery  of  a  deadly  poison,  the  distance  at  which  a  knife  or  pistol 
is  found — the  position  of  the  instrument — whether  situated  to  the 
right  or  left  of  the  deceased — the  marks  of  blood  or  wounds  about 
the  person,  or  of  blood  on  the  clothes  or  furniture  of  the  apartment, 
are  facts  which  must  assist  materially  in  developing  the  real  nature 
of  a  case,  and  in  giving  force  to  the  medical  opinion.  Many  of  these 
circumstances  can  fall  under  the  notice  of  him  only  who  is  first  called 
to  the  deceased ;  and,  indeed,  if  observed  by  another,  no  advantage 
could  be  taken  of  them,  except  from  the  interpretation  of  a  medical 
man. 


282  WOUNDS.      POSITION    OF    THE    BODY. 

At  the  same  time,  a  person  may  have  died  suddenly,  and  a  weapon 
or  poison  be  found  near  the  body,  and  yet  the  death  may  have  taken 
place  from  natural  causes.  Due  allowance  must  be  made  for  coinci- 
dences of  this  kind.  The  purchase  and  possession  of  a  deadly  poison 
shortly  before  a  sudden  death  may  create  suspicion,  but  a  careful 
analysis  may  show  that  there  is  no  poison  in  the  body,  and  further 
that  the  post- mortem  appearances  are  consistent  with  natural  dis- 
ease— -and  unless  treated  as  exceptional  in  character  they  are  not 
consistent  with  death  from  poison.  Mr.  Stedman,  of  Guildford,  met 
with  a  case  in  which  a  woman  was  found  dead  under  very  suspicious 
circumstances.  Within  half  an  hour  of  her  death  she  had  sent  a 
boy  to  a  shop  to  purchase  a  packet  of  Battle's  vermin-killer  (strych- 
nia). He  gave  it  to  her  and  left  the  house.  When  he  returned  at 
the  time  mentioned  he  found  her  leaning  on  the  table,  speechless  and 
motionless.  She  was  then  dead.  There  was  no  rigidity  and  no  evi- 
dence of  convulsions.  Some  fluid  was  found  in  the  stomach,  but  in 
this  there  was  no  strychnia,  and  none  of  the  blue  coloring  matter 
which  had  been  sold  with  the  powder.  No  trace  of  the  powder  could 
be  found  on  the  premises,  and  no  cup,  glass,  or  vessel  in  which  the 
poison  might  have  been  mixed,  could  be  seen.  ("  Med.  Times  and 
Gaz.,"  Jan.  1-1,  1865,  p.  8-i.)  The  absence  of  any  characteristic  symp- 
toms, and  the  non-detection  of  the  poison  and  its  coloring  ingredient 
under  the  circumstances  negatived  the  suspicion  of  poisoning.  The 
purchase,  possession,  and  the  non-discovery  of  the  purchased  packet 
after  the  death  of  the  woman,  were  circumstances  which  created 
suspicion,  but  nothing  more.  The  medical  facts  proved  that  the 
suspicion  was  unfounded.  The  state  of  the  lungs  and  heart  account- 
ed for  sudden  death. 

Among  the  questions  which  present  themselves  on  these  occasions 
are  the  following :  Is  this  the  position  of  a  wounded  body  that 
which  a  suicide  could  have  assumed  ?  Is  the  distance  of  a  weapon 
from  the  body  such  as  to  render  it  improbable  that  it  could  have 
been  placed  there  by  the  deceased  ?  In  answering  either  of  these 
questions,  it  is  necessary  to  take  into  consideration  the  extent  of  the 
wound,  and  the  time  at  which  it  probably  proved  fatal.  Again,  it 
may  be  inquired — Has  the  deceased  bled  in  more  places  than  one? 
Are  the  streams  of  blood  all  connected  ?  Are  there  any  marks  of 
blood  on  his  person  or  clothes,  which  he  could  not  well  have  pro- 
duced himself?  Are  there  any  projecting  nails  or  other  articles 
which  might  account  for  wounds  on  the  body  as  the  result  of  acci- 
dent ?  These  are  questions,  the  answers  to  which  may  materially 
affect  the  case :  hence,  a  practitioner,  in  noticing  and  recording  the 
circumstances  involved  in  them,  ought  to  exercise  due  caution. 

The  rules  for  investigating  a  case  of  alleged  death  from  violence 
have  been  elsewhere  described  (p.  22).  Among  the  additional  circum- 
stances to  which  a  medical  witness  should  especially  direct  his  atten- 
tion on  these  occasions,  are  the  following : — ■ 

1.  The  Position  of  the  Body. — The  body  may  be  found  in  a  position 
which  the  deceased  could  not  have  assumed  on  the  supposition  of 
the  wound  or  injury  having  been  accidental  or  suicidal.     The  posi- 


POSITION    OF    THE    WEAPON.  233 

tion  of  a  dead  wounded  body  is  often  only  compatible  with  homicidal 
interference,  either  at  the  time  of  death  or  immediately  afterwards. 
In  order  to  determine  the  probable  time  of  death,  we  should  always 
notice  whether  there  is  any  warmth  about  the  body — whether  it  is 
rigid,  or  in  a  state  of  decomposition,  and  to  what  degree  this  may 
have  advanced. 

2.  The  Position  of  the  Weapon. — If  a  person  has  died  from  an  acci- 
dental or  self-inflicted  wound,  likely  to  cause  death  either  immedi- 
ately or  within  a  few  minutes,  the  weapon  is  commonly  found  either 
near  to  the  body  or  within  a  short  distance  of  it.  If  found  near,  it 
is  proper  to  notice  on  which  side  of  the  body  it  is  lying;  if  at  a 
short  distance,  we  must  consider  whether  it  might  have  fallen  to  the 
spot,  or  have  been  thrown  or  placed  there  by  the  deceased.  If  there 
has  been  any  interference  with  the  body,  evidence  from  the  relative 
position  of  it  and  the  weapon  will  be  inadmissible.  In  a  case  which 
was  referred  to  me  some  years  since,  a  woman  had  evidently  died 
from  a  severe  wound  in  the  throat,  which  was  homicidally  inflicted; 
the  weapon,  a  razor,  was  found  under  the  left  shoulder,  a  most  unu- 
sual situation,  but  which,  it  appears,  it  had  taken  owing  to  the  body 
having  been  carelessly  turned  over  before  it  was  seen  by  the  surgeon 
who  was  first  called. 

It  is  compatible  with  suicide  that  a  weapon  may  be  found  at  some 
distance,  or  in  a  concealed  situation ;  but  it  is  much  more  frequently 
either  grasped  in  the  hand,  or  lying  by  the  side  of  the  deceased.  In 
one  instance,  it  is  stated  the  deceased  was  discovered  in  bed  with  his 
throat  cut,  and  the  razor  lying  closed  or  shut  by  his  side.  In  another 
case,  the  bloody  razor  closed,  was  found  in  the  deceased's  pocket. 
There  is,  however,  one  circumstance  in  relation  to  the  weapon,  which 
is  strongly  confirmatory  of  suicide.  If  the  instrument  is  firmly 
grasped  in  the  hand  of  the  deceased,  no  better  circumstantial  evidence 
of  suicide  can  be  offered.  It  is  so  common  to  find  knives,  razors, 
and  pistols  grasped  in  the  hands  of  suicides,  that  it  is  quite  unneces- 
sary to  produce  cases  illustrative  of  this  statement.  The  grasping 
of  a  weapon  appears  to  be  owing  to  muscular  spasm  persisting  after 
death,  and  manifesting  itself  under  the  form  of  what  has  been  called 
cadaveric  spasm — a  condition  quite  distinct  from  rigidity,  although 
often  running  into  it.  It  does  not  seem  possible  that  any  murderer 
could  imitate  this  state,  since  the  relaxed  hand  of  a  dead  person 
cannot  be  made  to  grasp  or  retain  a  weapon,  like  the  hand  which  has 
firmly  held  it  by  powerful  muscular  contraction  at  the  last  moment 
of  life.  In  reference  to  the  weapon  being  found  at  a  distance  from 
the  body,  all  the  circumstances  of  the  case  should  be  taken  into  con- 
sideration before  any  opinion  is  expressed.  If  the  weapon  cannot 
be  discovered,  or  it  is  found  concealed  in  a  distant  place,  this  is 
strongly  presumptive  of  homicide,  provided  the  wound  is  of  such  a 
nature  as  to  prove  speedily  fatal.  If  found  near  the  body  it  will  be 
proper  to  notice  whether  the  weapon  is  sharp  or  blunt,  straight  or 
bent,  also  whether  the  edge  is  or  is  not  notched.  These  circumstances 
may  throw  a  light  on  the  question  of  suicide  or  murder. 

3.  Blood  on  Weapons. — The  weapon  with  which  a  wound  has  been 


234  BLOOD    OX    WEAPONS. 

inflicted  is  not  necessarily  covered  with  blood.  The  popular  view 
is  that  if  much  blood  is  found  about  a  dead  body,  the  weapon  ought 
always  to  be  more  or  less  bloody.  In  reference  to  heavy  blunt  in- 
struments applied  with  force  to  the  head,  severe  contusions  and  frac- 
tures may  be  produced  without  immediate  effusion  of  blood.  Unless 
the  bludgeon  is  used  in  a  subsequent  struggle  or  handled  by  a  bloodv 
hand,  no  blood  whatever  may  be  found  on  the  end  which  produced 
the  injuries.  In  reference  to  stabs,  the  knife  is  frequently  without 
any  stains  of  blood  upon  it,  or  there  is  only  a  slight  film,  which,  on 
drying,  gives  to  the  surface  a  yellowish-brown  color.  The  explana- 
tion of  these  facts  appears  to  be  that  in  a  rapid  blow  or  plunge  the 
vessels  are  compressed,  so  that  a  bleeding  takes  place  only  after  the 
sudden  withdrawal,  when  the  pressure  is  removed.  Even  if  blood 
should  be  effused,  the  weapon,  in  being  withdrawn,  is  sometimes 
cleanly  wiped  against  the  edges  of  the  wound,  owing  to  the  elasticity 
of  the  skin.  Thus  the  first  stab  through  the  dress  may  not  present 
any  appearance  of  blood  on  the  outside,  but  in  a  second  stab,  with 
the  same  weapon,  the  outside  of  the  dress  should  present  a  bloody 
mark,  unless  the  weapon  had  previously  been  wiped.  The  blood 
may  have  been  removed  by  washing,  from  the  blade  of  a  knife  or 
dagger;  hence  the  handle  and  inner  portions,  the  notch  for  opening 
the  blade  and  the  indentations  of  any  letters  stamped  upon  it,  should 
be  closely  examined. 

The  blood  on  a  weapon  may  be  in  a  partly  coagulated  state,  and 
not  diffused  as  a  mere  film.  This  would  render  it  probable  that  it 
had  issued  from  the  body  of  a  living  person  or  animal,  or  from  a 
body  recently  dead.  But  the  blood  of  a  dead  animal  dried  in  small 
spots  on  the  blade  of  a  knife  may  sometimes  present  a  similar  ap- 
pearance, and  thus  lead  to  a  mistake  in  evidence. 

4.  Hair  and  other  Substances  on  Weapons. — In  some  instances  no 
blood  may  exist  on  a  weapon,  but  a  few  hairs  or  fibres  may  be  found 
adhering  to  it  if  the  weapon  is  of  a  bruising  or  cutting  kind.  The 
main  questions  may  be,  in  such  a  case,  whether  the  hair  is  that  of  a 
human  being  or  of  an  animal,  and  whether  the  fibres  correspond  in 
their  nature,  form,  and  color  to  articles  of  dress  on  the  deceased  or  the 
accused.  [See  cases  cited  in  former  edition,  p.  214,  where  a  micro- 
scopic examination  of  the  hair  adhering  to  the  alleged  instrument  of 
death  showed  that  it  was  not  human  hair,  and  thus  led  to  the  acquittal 
of  the  accused.  And  to  case  cited  p.  383,  Queen  v.  Mnssett,  where  the 
finding  of  a  single  hair  near  blood  in  a  cellar,  the  presence  of  which  the 
accused  accounted  for  by  saying  she  had  there  killed  a  rabbit,  led  to 
the  conviction  of  the  prisoner,  by  a  microscopic  examination  proving 
that  it  was  a  human  hair. — P.]  Before  any  coagulated  blood  is  re- 
moved from  a  weapon  it  should  be  examined  carefully  by  the  micro- 
scope. Hairs  or  fibres  of  linen,  woollen,  silk,  or  cotton,  may  be 
found  imbedded  in  the  solidified  blood,  either  on  the  edge  or  on  the 
blade  ;  and  evidence  of  this  kind  may  occasionally  be  of  great  im- 
portance. Foreign  substances  are  sometimes  found  in  contused  and 
lacerated  wounds  which  may  throw  a  light  on  the  mode  in  which 
they  were  inflicted.     In  gunshot  wounds  it  is  not  unusual  to  find 


BLOOD    ON"    CLOTHING.  235 

portions  of  paper  or  other  substances  used  as  wadding  for  the  gun 
or  pistol.  The  preservation  of  articles  of  this  description,  or  of  por- 
tions of  the  projectiles  found  under  these  circumstances,  has  proved 
a  means  of  fixing  the  crime  upon  the  guilty  person.  When  a  gun 
or  pistol  is  discharged  near  to  the  body,  a  portion  of  the  wadding  is 
generally  carried  into  the  large  irregular  wound  produced.  In  a 
case  of  stabbing  a  portion  of  the  weapon  may  be  found  in  the 
wound. 

5.  Marks  of  Blood  on  Clothing  or  Furniture. — It  is  proper  to  notice 
all  marks  of  blood  on  the  clothes  of  the  deceased  or  in  the  apart- 
ment, and  to  observe  where  the  greatest  quantity  of  blood  has  been 
effused :  this  is  generally  found  on  the  spot  where  the  deceased  has 
died.  The  deceased  may  have  bled  in  more  places  than  one ;  if  so, 
it  is  proper  to  notice  whether  there  is  any  communication  in  blood 
between  these  different  places.  Blood  on  distant  clothes  or  furniture 
may  show  whether  the  deceased  has  moved  about,  and  whether  he 
has  struggled  much  after  receiving  the  fatal  wound.  Acts  of  loco- 
motion by  a  wounded  person  who  has  died  from  loss  of  blood,  or  by 
a  criminal  whose  hands  and  feet  may  be  bloody,  are  generally  indi- 
cated by  tracks  or  marks  of  blood.  The  observation  of  these  marks, 
if  made  at  the  time  that  a  dead  body  is  found,  is  of  great  importance. 
They  may  be  so  situated  as  to  show  that  the  body  of  the  deceased 
has  been  moved  or  been  interfered  with  after  death,  and  thus  throw 
a  light  upon  the  question  whether  the  act  has  been  one  of  homicide 
or  suicide.  In  reference  to  clothing,  it  is  advisable,  if  it  be  possible, 
to  have  some  clear  proof  that  the  clothes  sent  for  examination  were 
actually  worn  by  the  accused  or  belonged  to  the  deceased.  Serious 
mistakes  are  sometimes  made,  and  medical  opinions  should  therefore 
be  expressed  with  caution.  It  should  be  noticed  on  these  occasions 
whether  the  blood  is  deposited  in  large  patches  on  clothing,  or 
whether  it  is  sprinkled,  and  also  whether  it  is  in  large  or  small 
quantity.  The  sprinkling  may  have  proceeded  from  a  wounded 
artery,  or  from  a  splashing  of  blood  as  a  result  of  continued  vio- 
lence. We  should  likewise  observe  whether,  if  the  wound  is  in  the 
throat  or  chest,  blood  has  flowed  down  in  front  of  the  clothes  or 
person,  or  whether  it  has  flowed  so  as  to  collect  in  the  armpits,  or  on 
each  side  of  the  neck ;  for  these  appearances  will  sometimes  show 
that  the  wound  was  inflicted  when  the  person  was  standing,  sitting, 
or  lying  down.  If  the  throat  is  cut  while  a  person  is  lying  down,  it 
is  obvious  that  the  blood  will  be  found  chiefly  on  either  side  of  the 
neck,  and  not  extending  down  the  front  of  the  body.  Few  suicides 
cut  the  throat  while  in  a  recumbent  posture,  and  the  course  which 
the  blood  has  taken  may,  therefore,  be  sometimes  rendered  subser- 
vient to  the  distinction  of  a  homicidal  from  a  suicidal  wound.  The 
position  in  which  the  body  was  when  a  wound  was  inflicted,  is  a 
frequent  question  on  inquests  and  criminal  trials. 

When  spots  of  blood  are  found  upon  articles  of  dress  or  furniture, 
their  form,  and  direction  may  occasionally  serve  to  furnish  an  indi- 
cation of  the  position  of  the  wounded  person  with  respect  to  them. 
Thus,  if  the  form  of  a  spot  is  oval  and  elongated,  the  presumption 


236  MARKS    OF    VIOLENCE    OX    THE    BODY. 

is  that  the  person  was  placed  obliquely  with  respect  to  the  stained 
furniture  during  the  hemorrhage.  ("Ann.  d'Hyg."  1840,  p.  397.) 
The  force  with  which  the  blood  has  been  thrown  out,  will  be  in 
some  measure  indicated  by  the  degree  of  obliquity  and  length  of  the 
spot.  This  is  in  general  wide  and  rounded  at  the  upper  part,  but 
narrow  and  pointed  below. 

6.  Marks  of  Blood  or  Violence  on  the  Dead  Body. — In  examining  a  dead 
body,  attention  should  be  paid  to  the  state  of  the  mouth  and  throat. 
Assailants  who  make  their  attack  during  sleep,  sometimes  endeavor 
to  close  the  mouth,  or  to  compress  the  throat,  so  as  to  prevent  an 
alarm  being  given.  In  one  instance  there  were  the  marks  of  finger- 
nails around  the  mouth ;  in  another,  ecchymosed  impressions,  as  if 
produced  by  a  hand,  were  found  upon  the  throat  of  the  deceased. 
The  hands  of  a  dead  person  should  always  be  examined ;  many  recent 
cuts,  excoriations,  or  incisions  found  upon  them,  especially  if  on  the 
back  of  the  fingers  or  thumbs,  will  indicate  that  there  has  been  a 
mortal  struggle  with  the  assailant.  In  the  inspection,  the  examina- 
tion of  the  stomach  should  not  be  omitted.  The  presence  or  absence 
of  food,  mucus,  or  blood,  may  furnish  evidence  of  considerable 
importance  in  the  elucidation  of  the  case.  All  marks  or  stains  of 
blood  or  dirt  on  a  dead  body  require  special  observation.  The 
impression  of  a  hand,  or  of  some  of  the  fingers,  may  be  found  on 
the  skin  in  a  situation  where  it  would  have  been  improbable  or  im- 
possible for  the  deceased  to  have  produced  it,  even  supposing  that 
one  or  both  of  his  hands  were  covered  with  blood.  In  one  case  of 
murder  there  was  found  the  bloody  impression  of  a  left  hand  upon 
the  back  of  the  left  hand  of  the  deceased,  in  such  a  position  that  it 
was  quite  impossible  the  deceased  himself  could  have  made  the 
mark  !  In  all  cases  it  should  be  noticed  whether  the  inside  or  outside 
of  the  hand,  or  whether  one  or  both  hands  are  stained  with  blood, 
and  the  size  and  position  of  the  stains  should  be  described.  Marks 
of  blood  on  the  dress  of  a  wounded  person  or  a  dead  body  may  often 
furnish  important  circumstantial  evidence.  If  there  are  several  stabs 
or  cuts  on  the  body  involving  the  dress,  it  should  be  observed 
whether  the  edges  of  one  or  more  of  them  are  stained  with  blood, 
as  if  from  the  wiping  of  a  weapon,  and  whether  the  stain  is  on  the 
outside  or  inside  of  the  article  of  dress.  In  simulated  personal  inju- 
ries, the  stain  of  blood  may  be,  through  inadvertence,  applied  to  the 
outside  of  the  dress — a  fact  which  might,  in  some  instances,  lead  to 
the  detection  of  the  imposture.  (See  case  by  Dr.  Bayard,  "Ann. 
d'Hyg."  1847,  vol.  2,  p.  219.) 

7.  Marks  of  Blood  on  the  Assailant. — It  is  a  very  common  idea  that 
no  person  can  commit  a  murder  in  which  blood  is  effused,  without 
having  his  person  and  clothes  more  or  less  covered  with  blood. 
Nothing  can  be  more  erroneous.  On  several  occasions  I  have  been 
required  to  examine  articles  of  clothing  which  had  been  worn  by 
persons  subsequently  convicted  of  murder  by  wounding,  and  either 
no  blood  has  been  found  on  any  part  of  the  dress,  or  only  small  spots 
wholly  out  of  proportion  to  the  quantity  of  blood  which  must  have 
flowed  from  the  deceased.     {Reg.  v.  Harrington,  Chelmsford  Assizes, 


MARKS    OF    BLOOD    ON    THE    ASSAILANT.  237 

1852.  Reg.  v.  Flack,  Ipswich  Assizes,  1853.  Reg.  v.  Cass,  Carlisle 
Assizes,  1860.  Reg.  v.  Rowlands,  Beaumaris  Assizes,  1861.  Reg. 
v.  Edmonds,  Swansea  Assizes,  1862.)  In  the  case  of  Gardner  (C.  C.  C. 
1862),  in  which  there  had  been  a  large  effusion  of  blood  from  a 
severe  wound  in  the  throat,  no  blood-stains  were  found  on  the 
clothing  of  the  man  who  was  convicted  of  the  murder.  It  is  obvi- 
ous that  the  throat  of  a  person  while  standing,  sitting,  or  kneeling, 
may  be  cut  by  a  murderer  from  behind,  and  thus  in  appearance  simu- 
late suicide.  Under  these  circumstances  the  clothes  of  the  assassin 
would  escape  being  stained  with  blood.  The  flowing  or  spirting  of 
blood  upon  the  clothes  of  the  assailant  will  depend  upon  his  position 
in  relation  to  the  deceased  at  the  time  of  inflicting  the  wound,  and 
this  must  always  be  a  matter  of  pure  speculation.  In  entire  viola- 
tion of  this  simple  principle,  the  fact  of  a  prisoner's  clothes  not  being 
marked  with  blood  has  been  on  more  than  one  occasion  urged  as  a 
proof  of  his  innocence.  (Reg.  v.  Dalmas,  C.  C.  C,  June,  1844.)  In 
this  case  the  counsel  for  the  prisoner  wished  to  impress  the  jury,  in 
what  is  commonly  denominated  a  "powerful"  speech  (in  which  medical 
facts  and  opinions  are  usually  ignored),  that  no  person  could  cut  the 
throat  of  another  without  having  his  clothes  covered  with  blood ; 
and  as  there  was  not  proved  to  be  any  blood  on  his  clothes,  the 
prisoner  could  not  have  been  guilty  of  the  crime.  The  facts  were 
simply  that  the  throat  of  the  woman  was  cut  while  she  was  walking 
across  Battersea  Bridge,  the  prisoner  having  inflicted  the  wound  from 
behind !  Policemen  are  frequently  misled  in  searching  for  criminals 
by  looking  for  blood  on  clothing  as  a  necessary  accompaniment  of 
an  act  of -murder.  This  also  leads  them  to  magnify  stains  of  red 
paint,  iron  rust  and  fruit-stains  on  the  dress  of  an  accused  person 
into  marks  of  blood  I 

The  presence  of  spots  of  blood  on  articles  of  clothing,  knives,  &c, 
taken  from  the  persons  of  those  who  are  accused  of  murder,  may  be 
quite  consistent  with  innocence.  Small  spots  or  stains  have  often  an 
undue  importance  attached  to  them.  I  have  known  minute  spots  of 
blood  on  the  shirt  of  a  man  tried  for  murder  by  wounding,  regarded 
as  furnishing  proof  of  criminality,  until  it- was  explained  that  they 
were  probably  derived  from  flea-bites,  and  that  some  were  on  one 
side  and  some  on  the  other,  showing  that  the  shirt  had  been  worn  on 
the  two  sides.  The  coarse  clothing  worn  by  laborers  may  acquire 
blood-spots  from  a  variety  of  accidental  circumstances,  which  the 
accused  may  not  always  be  able  to  explain.  When  he  knows  the 
stains  are  there,  and  shows  great  anxiety  to  give  some  explanation 
of  their  presence,  as  by  falsely  stating  that  he  had  assisted  in  killing 
a  pig,  a  rabbit,  or  that  he  was  carrying  game  about  him — [or,  as  in 
the  case  of  Christian  Berger,  convicted  of  the  murder  of  Miss  Watts 
in  1866,  that  he  had  kicked  a  piece  of  raw  meat  in  a  butcher  shop, 
and  thus,  made  his  shoe  bloody. — P.] — there  may  be  strong  ground 
for  suspicion ;  but  a  medical  practitioner  should  always  make  due 
allowance  for  the  accidental  presence  of  blood  on  the  clothes  of  work- 
ing men. 


288  CHEMICAL    EXAMINATION 


CHAPTER    XXVI. 

Chemical  examination  of  blood-stains. — stains  of  blood  on 
linen  and  other  stuffs.  —  age  or  date  of  the  stains. — 
other  stains  resembling  blood. blood  on  weapons. — arte- 
rial and  venous  blood.  —  varieties  of  blood.  —  blood  of 
man  and  animals. — microscopical  evidence. 

Examination  of  Blood-stains. — It  may  appear  at  first  sight  an  easy 
matter  to  say  whether  certain  suspected  spots  or  stains  on  articles  of 
clothing,  furniture,  or  weapons  are  or  are  not  owing  to  blood  ;  but 
in  practice,  great  difficulty  is  often  experienced  in  answering  the 
question.  If  the  stains  are  large  and  recent,  most  persons  may  be 
competent  to  form  an  opinion  ;  but  the  physical  characters  of  blood 
are  soon  changed,  even  when  the  stuff  is  white  and  otherwise  favor- 
able for  an  examination.  If  the  stains,  whether  recent  or  of  old 
standing,  are  upon  dark  dyed  woollen  stuffs,  as  blue,  black,  or  brown, 
cloth,  or  if  they  appear  in  the  form  of  small  or  detached  spots,  or  in 
thin  films  on  dark  clothing  or  rusty  weapons,  no  one  but  a  competent 
medical' man  should  be  allowed  to  give  an  opinion. 

Chemical  Analysis. — There  is  no  direct  chemical  process  by  which 
blood  can  be  identified,  but  we  presumptively  establish  its  nature  by 
determining  the  presence  and  properties  of  the  red  coloring  matter, 
or  heematine.  The  chemical  properties  of  the  red  coloring  matter  of 
blood  are  as  follows :  1.  It  readily  combines  with  cold  distilled 
water,  forming,  if  recent,  a  bright  red  solution.  2.  The  red  color  of 
this  solution  is  not  changed  to  a  crimson  or  a  green  tint  by  a  few 
drops  of  a  weak  solution  of  ammonia.  If  the  ammonia  is  concen- 
trated, or  added  in  large  quantity,  the  red  liquid  will  acquire  a  brown- 
ish tint.  3.  The  red  liquid  when  boiled  is  coagulated — the  color  is  en- 
tirely destroyed,  and  a  muddy  brown  flocculent  precipitate  is  formed, 
the  quantity  of  which  will  depend  on  the  quantity  of  coloring  mat- 
tering and  albumen  present.  This  coagulum,  when  collected  on  a 
filter  and  dried,  forms  a  black  resinous-looking  substance,  quite  in- 
soluble in  water,  but  readily  dissolved  by  boiling  caustie potash,  form- 
ing a  solution  which  is  of  a  greenish  color  by  reflected,  and  reddish 
by  transmitted  light.  4.  To  the  above  tests  some  have  added  the 
action  of  strong  nitric  acid,  which  coagulates  the  red  coloring  mat- 
ter, turning  it  of  a  dirty  brown  hue.  Such  are  the  chemical  proper- 
ties of  recent  blood,  whether  derived  from  the  human  body  or  from 
that  of  any  warm  red-blooded  animal. 

Of  the  various  red  coloring  matters  extracted  from  vegetable  and 
animal  substances,  there  are  none  which  to  the  experienced  eve,  pre- 
sent the  peculiar  crimson  red  tint  of  blood,   especially   when  the 


OF    BLOOD-STAINS.  239 

substance  is  examined  in  a  good  light  by  a  low  power  of  the  micro- 
scope. When  solutions  of  these  red  coloring  matters  are  treated 
with  ammonia,  some,  such  as  cochinea],  logwood,  and  the  colors  of 
roots  and  woods,  acquire  a  deep  crimson  tint,  while  others,  such  as 
the  coloring  matter  of  the  rose  and  the  red  colors  of  flowers  and 
fruits,  are  changed  to  a  blue  or  green.  The  red  colors  are  not  de- 
stroyed by  a  boiling  temperature,  and  even  when  mixed  with  albumen 
this  principle  is  coagulated,  but  the  red  coloring  matter  remains  un- 
changed. In  the  case  of  blood,  the  effect  of  heat  is  to  destroy  the 
color  entirely. 

When  these  vegetable  colors  are  found  upon  linen  and  similar 
stuffs,  they  present  under  the  microscope  the  appearance  of  a  uni- 
form stain  or  dye,  unlike  blood  in  color.  There  is  no  coagulum 
to  be  seen,  and  the  stained  stuff  is  not  stiffened  as  it  is  by  the  serum 
of  dried  blood. 

Stains  of  Blood  on  Linen  and  other  Stuffs.  Their  Age  or  Date. — ■ 
Supposing  the  stuff  to  be  white  or  nearly  colorless,  the  spot  of  blood, 
if  recent,  is  of  a  red  color  ;  but  it  sooner  or  later  becomes  of  a  reddish- 
brown,  or  of  a  deep  red-brown  color.  The  change  of  color  to  a  red- 
dish-brown I  have  found  to  take  place  in  warm  weather  in  less  than 
twenty-four  hours.  After  a  period  of  five  or  six  days,  it  is  scarcely 
possible  to  determine,  from  the  appearance,  the  date  of  a  stain  even 
conjecturally.  In  a  large  stain  of  blood  on  linen,  no  change  took 
place  daring  a  period  of  five  years :  it  had  a  reddish-brown  color  at 
the  end  of  six  weeks,  which  it  retained  for  the  long  period  men- 
tioned. Indeed,  it  is  extremely  difficult  in  any  case,  after  the  lapse 
of  a  week,  to  give  an  opinion  as  to  the  actual  date  of  a  stain.  Upon 
colored  stuffs,  or  dirty  clothes,  it  is  of  course  impossible  to  trace  these 
physical  changes  in  stains  of  blood ;  on  red-dyed  stuffs  the  stain  ap- 
pears simply  darker  from  the  first,  and  in  all  cases  the  fibre  of  the 
stuff  is  more  or  less  stiffened,  as  a  result  of  the  drying  of  the  albu- 
men associated  with  the  red-coloring  matter.  In  examining  an  arti- 
cle of  clothing,  attention  should  be  paid  to  the  side  of  the  stuff  which 
has  first  received  the  stain  :  sometimes  both  sides  are  stained.  The 
evidence  derived  from  an  observation  of  this  kind  may  be  occasion- 
ally of  importance. 

The  suspected  stain  should  be  first  examined  in  a  strong  light, 
with  a  low  power  of  the  microscope.  If  caused  by  blood,  it  will 
not  be  a  mere  coloring  of  the  fibres,  but  it  will  have  a  shining  glossy 
appearance,  and  each  fibre  will  be  observed  to  be  invested  with  a 
portion  of  dried  coagulum  or  clot.  In  other  cases,  minute  coagula 
or  clots  presenting  the  appearance  of  dried  jelly  will  be  seen  in  the 
meshes  of  the  stained  article  of  clothing.  In  certain  lights  the  clots 
may  appear  of  a  dark  red  color,  but  by  changing  the  light,  bright 
translucent  portions  of  a  peculiar  crimson  tint  will  come  into  view. 
The  crimson  stain  of  blood  is  unlike  that  of  any  other  red  coloring 
matter,  and  when  the  stained  portion  presents  the  character  of  a 
glossy  dry  coagulum,  the  stain  cannot  be  easily  mistaken  by  a  prac- 
tised eye  for  one  caused  by  any  other  red  coloring  matter.  In  fact, 
the  microscope  puts  the  observer  of  a  small  stain  in  the  same  posi- 


2-40  CHEMICAL    PROCESSES    FOR    THE 

tion  as  a  non-professional  person,  who  unhesitatingly  forms  Ins 
judgment  from  a  large  quantity  of  dried  blood.  Portions  of  kino 
over  a  dress  may  present  occasionally  the  appearance  of  coagulated 
blood ;  but  kino  differs  in  color  and  in  chemical  properties  from 
blood.  The  microscopical  observation  of  a  suspected  stain  on  linen, 
cotton,  or  woollen,  however  small,  is  generally  sufficient  to  enable 
an  expert  to  form  an  opinion  either  in  the  affirmative  or  negative. 
The  application  of  chemical  tests  may  be  resorted  to  for  confirmatory 
evidence  when  there  is  any  doubt  in  the  mind  of  the  observer. 

If  the  stain  is  of  sufficient  size  a  slip  of  the  dress,  with  the  stain 
upon  it,  may  be  removed  and  suspended  by  a  thread  in  a  test-tube 
containing  a  small  quantity  of  distilled  water.  After  a  few  minutes, 
or  a  few  seconds,  should  the  stain  be  recent,  a  red  liquid  will  be  seen 
falling  to  the  bottom  of  the  test-tube,  giving,  when  the  blood  is  fresh, 
a  red  color  to  the  lower  stratum  of  water,  and  when  of  old  standing, 
a  dark  red-brown  color.  Should  the  stuff  be  thick  and  coarse,  or 
not  readily  pervious  to  water,  the  separation  may  not  take  place  in 
less  than  an  hour.  When  the  stain  is  on  thin  silk  or  linen,  I  have 
found  it  to  be  speedily  separated.  Several  slips  of  the  stuff  may  be 
thus  successively  treated,  until  a  liquid  sufficiently  deep  in  color  for 
testing,  is  procured.  If  the  quantity  of  colored  liquid  thus  obtained 
is  small,  the  supernatant  clear  water  may  be  carefully  poured  off  or 
drawn  off  by  a  pipette  ;  but  it  will  be  found  more  convenient  to  use  a 
small  tube  and  a  small  quantity  of  water.  The  colored  liquid  may 
then  be  tested  by  weak  ammonia,  and  by  the  application  of  heat  as 
already  described.  If  ammonia  produces  any  effect  upon  the  solution 
of  blood,  it  is  simply  to  brighten  it ;  this  alkali  never  changes  the  red 
color  of  blood  to  green  or  crimson.  When  the  stain  is  old,  the  solu- 
tion in  water  is  very  slowly  obtained,  and  does  not  present  the  bright 
red  color  of  blood.  In  some  cases  if  the  stain  is  of  very  old  stand- 
ing, and  had  been  much  exposed  to  the  atmosphere,  water  will  have 
scarcely  any  solvent  effect  upon  it,  and  it  may  be  found  impossible 
to  obtain  a  red-colored  liquid  even  after  twenty-four  hours'  macera- 
tion. At  the  most,  the  water  may  acquire  a  pale  brown  or  yellow- 
ish color,  but  wholly  unlike  that  imparted  by  blood.  In  such  a  case 
it  is  useless  to  add  ammonia.  We  may,  however,  generally  form  a 
correct  judgment  by  the  microscopical  appearance  of  the  stain  before 
wetting  it,  and  by  obtaining  crystals  of  haematin  with  the  use  of 
glacial  acetic  acid  (see  p.  24y,  post).  Water  may  dissolve  sufficient 
albumen  (or  serum)  to  become  opaline  by  heat,  or  by  the  addition  of 
nitric  acid,  although  we  may  fail  to  obtain  any  evidence  of  the  pre- 
sence of  corpuscles.  From  the  results  obtained  by  spectral  analysis 
(post  p.  250),  it  appears  probable  that  acid  and  other  vapors  in  the 
atmosphere  affect  blood-stains  and  alter  their  chemical  properties. 
Where  much  coal  is  burnt,  sulphurous  acid  may  operate  in  this  man- 
ner. Under  other  circumstances,  when  the  quantity  of  blood  effused 
is  moderately  large,  it  may  be  detected  by  the  process  above  men- 
tioned, after  the  lapse  of  a  considerable  time.  I  have  thus  detected 
the  blood  of  the  human  body,  and  of  the  bullock,  on  cotton,  linen, 
and  flannel,  after  the  lapse  of  i/tree  years.     If  the  stuff  is  dyed,  we 


DETECTION  OF  BLOOD  ON  CLOTHING.        2-41 

should  proceed  to  examine  the  stains  found  upon  it  by  a  similar 
process.  The  dye  is  commonly  fixed,  and  is  not  soluble  in  water. 
Thus,  then,  in  testing  for  blood,  we  rely  upon :  1.  The  solubility  of 
the  red  coloring  matter  in  water.  2.  The  negative  action  of  ammonia. 
3.  The  positive  effect  of  heat  in  entirely  coagulating  and  destroying 
the  red  coloring  matter. 

Should  the  linen  or  stuff  which  is  stained  with  blood  have  been 
heated  to  a  high  temperature,  the  coloring  matter  may,  as  a  result  of 
coagulation,  be  rendered  insoluble  in  water :  but  this  is  an  excep- 
tional condition.  In  the  case  of  a  body  found  wounded  and  burnt, 
it  would  be  proper  to  allow  for  such  a  change,  and  the  chemical 
evidence  would  fail.  Should  the  blood-stain  be  mixed  with  oil  or 
grease,  this  will  interfere  with  the  solvent  action  of  water.  Should 
it  be  on  a  plaster- wall  or  on  wood  we  must  scrape  or  cut  out  a  por- 
tion, and  digest  it  in  a  small  quantity  of  water  in  a  tube  or  watch- 
glass.  An  unstained  portion  of  the  plaster  or  wood  should  also  be 
examined. 

There  are  red  stains  bearing  a  resemblance  to  blood,  which  are 
insoluble  in  water.  These  may  be  identified  by  their  special  charac- 
ters. Among  them  are:  1.  Certain  red  dyes,  as  madder,  which, 
when  fixed  by  a  mordant,  is  not  readily  affected  by  ammonia.  2. 
Iron-moulds.  These  are  of  a  reddish-brown  color,  sometimes  of  a 
bright  or  orange  red,  they  are  quite  insoluble  in  water,  but  are  easily 
dissolved  by  diluted  hydrochloric  acid,  and  on  adding  ferrocyanide 
of  potassium  to  the  hydrochloric  solution,  the  presence  of  iron  will 
be  at  once  apparent.  Care  should  be  taken  that  the  acid  used  for 
this  purpose  contains  no  iron.  Iron-moulds  are  generally  distin- 
guished by  their  brown  color,  and  by  the  absence  of  all  stiffening  of 
the  fibre,  on  the  stained  spot.  3.  Red  paint.  Stains  made  with  red 
paint  'containing  peroxide  of  iron,  have  been  mistaken  for  blood. 
They  may  be  easily  known  by  digesting  them  in  diluted  hydrochloric 
acid,  and  applying  to  the  solution  the  tests  for  iron.  Like  those  pro- 
duced by  iron-moulds,  they  are  quite  insoluble  in  water,  and  there- 
fore cannot  be  confounded  with  blood-stains.  The  same  may  be  said 
of  spots  of  the  ammonio-nitrate  of  silver  changed  by  light,  which  I 
have  known  to  be  mistaken  for  old  stains  of  blood.  The  stuff  on 
which  the  spots  of  blood  are  found,  may  be  itself  stained  with  a  red 
dye  or  color,  or  it  may  be  dyed  with  iron :  in  this  case  it  will  be 
necessary  to  test  by  the  same  process  a  piece  of  the  colored  or  stained 
portion,  in  order  to  furnish  negative  evidence  that  the  suspected 
stains  are  due  to  blood.  4.  Among  soluble  stains  resembling  those 
of  blood,  are  the  spots  produced  by  the  juices  of  the  mulberry,  cur- 
rant, gooseberry,  and  other  red  fruits.  They  may  be  sometimes  re- 
cognized chemically,  by  dropping  on  them  a  weak  solution  of  am- 
monia— when  the  spot  is  turned  either  of  a  bluish,  olive-green,  or 
green  color.  The  red  of  cochineal  is  changed  to  a  crimson  on  the 
addition  of  weak  ammonia;  but  a  spot  of  blood  thus  treated  under- 
goes no  change  of  color  from  the  addition  of  the  alkali.  Diluted 
acids  brighten  the  red  colors  of  fruit  stains,  but  they  do  not  alter 
the  color  of  blood.  It  is  also  worthy  of  note  that  a  strong  solution 
16 


242  DETECTION    OF    BLOOD    OX    WEAPONS. 

of  chlorine  bleaches  the  red  colors  from  fruit  stains,  but  when  applied 
to  a  stain  of  blood  it  turns  the  red  coloring  matter  of  a  dark  olive- 
green  color  and  does  not  bleach  it.  These  effects  are  only  well  ob- 
served on  white  stuffs. 

If  a  colored  liquid  is  obtained  from  a  piece  of  the  stained  stuff 
suspended  in  water,  it  is  easily  distinguished  from  blood,  by  its  ac- 
quiring a  green  or  crimson  tint  on  the  addition  of  ammonia,  and  by 
the  red  color  not  being  coagulated  or  destroyed  when  the  liquid  is 
boiled.  A  solution  of  chlorine  added  to  the  colored  liquid  also 
presents  a  ready  means  of  distinction.  The  colors  of  fruits  and 
flowers  are  instantly  destroyed — while  the  color  derived  from  blood 
is  altered  to  a  dingy  olive,  and  the  albumen  of  the  serum  is  precipi- 
tated. In  some  red  stuffs,  the  dye  is  often  so  bad,  that  water  will 
dissolve  out  a  portion  of  the  color ;  but  in  this  case,  the  action  of 
ammonia,  heat,  and  chlorine  will  serve  readily  to  distinguish  the 
stains  from  blood.  The  soluble  red  or  brown  stains  given  by  woods 
or  roots,  such  as  Logwood,  Brazil-wood  or  Madder-root,  are  changed  to 
a  crimson  color  by  ammonia.  They  contain  tannic  acid,  and  acquire 
a  dark  olive-green  color  when  touched  with  a  persalt  of  iron.  It 
may  be  generally  remarked  of  these  stains,  whether  they  are  soluble 
or  insoluble  in  water,  that,  although  to  the  naked  eye  they  may  bear 
a  slight  resemblance  to  blood,  they  are  wholly  different  when  exa- 
mined microscopically.  The  distinction  of  color  is  well  marked  and 
there  is  an  absence  of  any  appearance  of  coagulum,  or  of  stiffening 
of  the  fibre.  When  thus  carefully  examined,  it  is  not  probable  that 
they  can  ever  be  mistaken  for  blood. 

Detection  of  Blood  on  Weapons. — When  recent,  and  on  a  polished 
instrument,  stains  of  blood  are  easily  recognized ;  but  when  of  old 
standing,  or  on  a  rusty  piece  of  metal,  it  is  a  matter  of  some  difficulty 
to  distinguish  them  from  the  stains  produced  by  rust  or  other  causes. 
If  the  stain  is  large  and  dry,  a  portion  may  be  easily  scraped  off: 
this  should  be  placed  in  a  watch-glass  with  some  distilled  water — the 
solution  filtered  to  separate  any  oxide  of  iron,  and  then  tested.  If 
the  water  by  simple  maceration  does  not  acquire  a  red  or  red-brown 
color,  the  stain  is  not  due  to  blood.  If  it  acquires  a  red  color,  the 
solution  may  be  tested  by  the  methods  above  described.  Sometimes 
the  stain  appears  on  a  dagger  or  knife  either  in  the  form  of  a  thin 
yellowish  or  reddish  film,  or  in  streaks,  and  is  so  superficial  that  it 
cannot  be  mechanically  detached.  We  should  then  pour  a  thin 
stratum  of  water  on  a  piece  of  plate-glass,  and  lay  the  stained  part 
of  the  weapon  upon  the  surface.  The  water  slowly  dissolves  the 
coloring  matter  of  blood,  and  the  colored  liquid  may  be  examined 
by  the  chemical  processes  above  recommended.  If  the  weapon  has 
been  exposed  to  heat,  this  mode  of  testing  may  fail.  There  is  often 
a  remarkable  resemblance  to  the  stains  of  blood  on  metal,  produced 
by  the  oxide  or  certain  vegetable  salts  of  iron.  If  the  juice  or  pulp  of 
lemon  or  orange  is  spread  upon  a  steel  blade,  and  is  exposed  to  the 
air  for  a  few  days,  the  resemblance  to  blood  produced  by  the  forma- 
tion of  citrate  of  iron  is  occasionally  so  strong  that  I  have  known 
well-informed  surgeons  to  be  completely  deceived  :  they  have  pro- 


ARTERIAL    AND    VENOUS    BLOOD.  243 

nounced  the  spurious  stain  to  be  blood.  These  stains,  which  owe 
their  color  to  citrate  of  iron,  may  be  thus  distinguished:  The  sub- 
stance is  soluble  in  water,  forming,  when  filtered,  a  yellowish-brown 
solution,  totally  different  from  the  red  color  of  blood  under  the  same 
circumstances.  The  solution  undergoes  no  change  of  color  on  the 
addition  of  ammonia.  It  is  unchanged  m  color,  but  may  be  par- 
tially coagulated  at  a  boiling  temperature,  and  it  is  at  once  identified 
as  a  salt  of  iron  by  giving  a  blue  color  with  the  ferrocyanide  of 
potassium. 

It  is  not  always  easy  to  distinguish  by  sight  a  stain  of  blood  on  a 
weapon  from  a  mark  produced  by  iron-rust.  When  suspicion  exists, 
marks  are  pronounced  to  be  due  to  blood,  which,  under  other  circum- 
stances, would  have  passed  unnoticed.  One  source  of  difficulty  is 
this :  the  iron-rust  on  an  old  knife  is  often  mixed  with  some  article 
of  food  or  even  with  blood  itself.  We  must  here  pursue  the  same 
mode  of  examination  as  if  the  stain  were  of  blood ;  we  macerate  the 
weapon,  or  a  portion  of  the  colored  deposit  scraped  from  the  surface, 
in  a  small  quantity  of  distilled  water,  and  filter  the  liquid.  If  the 
stain  is  due  to  iron-rust  alone,  this  will  be  separated  by  filtration, 
and  the  liquid  will  pass  through  colorless.  The  absence  of  blood  is 
thereby  demonstrated.  In  all  old  blood-stains  on  rusty  weapons, 
blood  and  oxide  of  iron  are  usually  intermixed.  The  blood  may  be 
separated  by  digesting  the  compound  in  distilled  water  in  a  small 
tube,  and  decanting  the  solution  from  any  sediment.  The  coloring 
matter  is  dissolved  by  the  water,  while  the  rust  is  left  as  a  sediment. 
Dilute  acetic  acid  will  dissolve  the  blood,  and  leave  the  rust. 

From  the  foregoing  remarks,  we  may  justly  infer  that  the  chemical 
analysis  of  suspected  spots  or  stains  on  weapons  and  clothing,  is  by 
no  means  an  unimportant  duty.  If  we  cannot  always  obtain  from 
these  experiments  affirmative  evidence,  they  often  furnish  good  nega- 
tive proof,  and  thus  tend  to  remove  unjust  suspicions  against  accused 
parties. 

Arterial  and  Venous  Blood. — It  is  not  possible  to  distinguish  arte- 
rial from  venous  blood  by  any  physical  or  chemical  characters,  when 
it  has  been  for  some  days  effused,  and  is  in  a  dry  state  upon  articles 
of  dress  or  furniture ;  but  this,  in  medico-legal  practice,  is  not  often 
a  subject  of  much  importance,  since  there  are  few  cases  of  severe 
wounds,  either  in  the  throat  or  other  parts  of  the  body,  in  which  the 
two  kinds  of  blood  do  not  escape  simultaneously.  The  most  striking 
and  apparent  difference  between  them,  when  recently  effused,  is  the 
color;  the  arterial  being  of  a  bright  scarlet,  while  the  venous  is  of  a 
dark  red  hue ;  but  it  is  well  known  that  the  latter,  when  exposed  to  air 
for  a  short  time,  acquires  a  florid  red  or  arterial  color ;  and  the  kinds  of 
blood,  when  dried,  cannot  be  distinguished  chemically  by  any  known 
criterion.  If  the  coat,  or  other  stuff',  stained  with  blood,  were  of  a 
dark  color,  the  liquid  would  be  absorbed,  and  speedily  lose  its  phy- 
sical characters.  Arterial  blood  contains  more  fibrin  than  venous, 
and  coagulates  more  firmly.  The  microscope  shows  no  appreciable 
difference  in  the  blood-corpuscles,  and  chemistry  does  not  enable  us 
to  apply  any  test  so  as  to  make  a  satisfactory  distinction  between 


244  MICROSCOPICAL    EVIDENCE. 

them.  In  this  deficiency  of  microscopical  and  chemical  evidence,  an 
attempt  has  been  made  to  establish  a  distinction  by  noticing  the 
physical  appearance  of  the  blood-stains.  Thns,  it  is  alleged,  the 
arterial  blood  will  be  indicated  by  its  being  sprinkled  over  surfaces 
upon  which  it  has  fallen,  while  the  venous  blood  is  always  poured 
out  in  a  full  stream.  In  most  wounds  which  prove  fatal  by  hemor- 
rhage, the  blood  is  poured  out  simultaneously  from  arteries  and 
veins.  The  sprinkled  appearance  of  the  blood,  when  it  exists,  will, 
caeteris  paribus,  create  a  strong  presumption  that  it  was  poured  out 
from  a  living  body — for  after  the  heart  has  ceased  to  act,  the  arteries 
lose  the  power  of  throwing  out  the  blood  in  jets.  The  sprinkling  is 
usually  observed  when  the  wounded  artery  is  small,  and  the  blood 
is  effused  at  a  distance.  This  is  a  fact  which  a  medical  jurist  should 
not  overlook,  although,  for  the  reasons  stated  too  great  a  reliance 
must  not  be  placed  on  it.  The  spots  of  blood,  if  thrown  out  from  a 
living  bloodvessel,  speedily  consolidate,  and  the  fibrin,  with  the 
greater  portion  of  the  coloring  matter,  is  found  of  a  deep  red  color 
at  the  lower  part  of  the  spot,  the  upper  portion  being  of  a  pale  red. 
The  lower  and  thicker  part  has  commonly  a  shining  lustre,  as  if 
gummed,  when  the  spot  is  recent,  and  when  it  has  been  effused  upon 
a  non-absorbent  surface. 

When  blood  falls  upon  porous  articles  of  clothing,  as  linen  or 
cotton,  it  is  absorbed,  and  produces  a  dull  stain.  In  dark-colored 
articles  of  dress,  it  is  sometimes  difficult  by  daylight  to  perceive 
these  stains.  The  part  appears  stiffened,  and  has  a  dull  red-brown 
color,  which  is  sometimes  more  perceptible  when  seen  by  the  reflec- 
tion of  the  light  of  a  candle.  In  trusting  to  the  coagulation  of  the 
sprinkled  blood  as  evidence  of  its  escape  from  a  living  vessel,  it 
must  be  remembered  that  three  hours  may  elapse  before  it  coagu- 
lates in  the  healthy  body  after  death.  Hence,  blood  which  has  es- 
caped from  a  recently  dead  body,  athough  it  would  not  be  found 
diffused  as  if  by  spurting,  might,  in  so  far  as  coagulation  is  con- 
cerned, assume  the  appearance  of  having  been  effused  from  a  living 
body.  In  spite  of  the  great  advances  made  in  the  construction  and 
use  of  the  microscope,  there  is  no  method  known  by  which  the  blood 
of  a  man  can  be  distinguished  from  that  of  a  woman,  or  the  blood  of 
a  child  from  that  of  an  adult. 

Microscopical  Evidence.     Blood-eorptiscles. — Hitherto  the  microscope 
has  been  referred  to  as  an  aid  to  the  examiner  in  drawing  a  dis- 
tinction between  the  appearances  presented  by  blood-stains  in  the 
dry  state,  and  those  caused  by  other  substances. 
Fie.  38.  Its  use;  however,  extends  much  beyond  this.    The 

spots  or  stains  may  be  so  small  as  not  to  admit  of 
removal,  for  the  purpose  of  applying  chemical 
tests.  If  an  examination  of  the  dry  stain  with  a 
low  power  (20  or  30  diameters)  justifies  further 
proceedings,  we  may  then  employ  the  micro- 
scope for  the  purpose  of  detecting  those  pecu- 
Biood-corpuscie  highly  liar  bodies  on  which  the  color  of  red  blood  is 
magnified.  known  to  depend.     The  red  coloring  matter  of 


DETECTION"    OF    BLOOD- CORPUSCLES.  245 

blood  consists  of  minute  colored  cells  or  corpuscles,  floating  in  a 
clear  liquid  (serum).  The  engraving  (Fig.  38)  shows  the  form  which 
the  cerpuscle  presents  in  the  class  mammalia,  a  represents  the  cir- 
cular form,  when  seen  in  front,  the  shaded  portion  being  a  depression 
which  under  a  certain  disposition  of  the  light  assumes  the  appear- 
ance of  a  solid  and  opaque  nucleus ;  b  represents  the  corpuscle  seen 
edgewise,  in  which  case  it  presents  somewhat  the  outline  of  a  bicon- 
cave lens.  It  owes  this  form  to  the  central  depression  on  each  face. 
Other  red  coloring  matters,  such  as  madder,  cochineal,  or  lac,  do  not 
owe  their  color  to  independent  cells  or  corpuscles.  Hence,  if  cor- 
puscles, of  the  form  and  size  of  those  found  in  mammalian  blood, 
are  visible  under  the  microscope  there  can  be  no  doubt  that  the 
liquid  is  blood.  Such  evidence,  can,  however,  be  safely  received 
only  from  one  who  has  been  accustomed  to  the  use  of  this  instrument 
and  to  the  examination  of  blood.  In  order  to  examine  the  suspected 
substance  for  corpuscles,  the  best  plan  of  proceeding,  when  the  parti- 
cles of  coagulum  are  very  small,  is  to  breathe  several  times  on  a 
glass  slide,  then  place  the  small  fragments  of  coagulum  on  the 
slide,  and  again  breathe  over  them.  A  slip  of  thin  glass  may 
then  be  laid  upon  them.  If  they  consist  of  blood  a  red  margin  will 
soon  appear,  and  in  the  fluid  portion,  by  the  aid  of  a  magnifying 
power  of  from  300  to  500  diameters,  some  of  the  corpuscles  of  the 
blood  may  be  recognized.  They  are  seldom  so  perfectly  spherical 
as  in  the  fresh  state,  and  they  appear  small,  and  frequently  shrunk 
or  corrugated.  In  some  cases,  only  fragments  of  the  envelopes  can 
be  seen.  The  condensed  moisture  of  the  breath  may  serve  the  pur- 
pose of  water,  in  breaking  up  the  small  portions  of  dried  blood  with- 
out destroying  the  corpuscles  by  too  much  dilution. 

If  the  suspected  clot  is  in  larger  quantity,  it  may  be  removed  from 
the  stuff  and  placed  to  macerate  in  one  or  two  drops  of  water  on  a 
glass  slide.  It  should  be  covered  with  thin  glass,  in  order  to  pre- 
vent rapid  evaporation.  This  method  of  extracting  the  corpuscles 
has  frequently  failed,  owing  to  the  quantity  of  water  employed 
having  been  too  large.  Under  these  circumstances,  the  corpuscles 
are  distended,  become  of  a  globular  form,  paler  and  are  finally  de- 
stroyed, while  the  water  simply  becomes  colored.  It  is  by  no  means 
easy  in  all  cases  to  obtain  from  dry  coagula  -clear  and  distinct  evi- 
dence of  the  presence  of  these  corpuscles,  especially  when  the  blood 
is  old.  In  drying,  the  blood-cells  lose  their  form,  and  they  do  not 
readily  resume  it  when  again  moistened.  Unless  they  are  seen  after 
a  short  maceration  in  a  very  small  quantity  of  water,  it  is  probable 
they  will  not  be  seen  at  all.  To  accelerate  their  separation  various 
chemical  liquids  have  been  recommended.  The  strong  solutions  of 
sulphate  of  soda  and  common  salt,  as  well  as  liquid  albumen  and 
serum,  have  been  employed  as  fluid  media  for  breaking  up  the  dried 
clots  of  blood.  There  are  disadvantages  attending  the  use  of  these ; 
and  after  many  experiments,  I  have  found  that  a  mixture  of  glyce- 
rine and  water  may  be  employed  in  place  of  pure  water.  The  pro- 
portions which  are  most  convenient  are,  one  part  by  measure  of 
glycerine,  to  three  parts  by  measure  of  distilled  water.     A  solution 


246 


CHARACTERS    OF    BLOOD- CORPUSCLES. 


Fig.  39. 


of  arsenious  acid,  in  the  proportion  of  four  grains  to  an  ounce  of 
distilled  water,  as  recommended  by  Dr.  Kunze,  is  also  a  rapid  solvent 
of  the  coagula.  When  this  is  used  the  examination  should  .take 
place  as  soon  as  the  liquid  begins  to  be  colored  at  the  margin,  or  the  cor- 
puscles may  be  destroyed,  and  only  fragments  of  their  envelopes  seen. 
In  reference  to  stains  on  clothing,  if  they  present  any  appearance 
of  dry  coagula,  these  should  be  carefully  scraped  off,  and  treated  in 
the  manner  above  described.  If  no  portions 
of  solid  coagula  can  be  procured,  there  will  be 
but  little  hope  of  obtaining  evidence  of  the 
presence  of  corpuscles  in  the  suspected  stain. 
The  stained  portion  may  be  cut  out  and  mace- 
rated in  a  small  quantity  of  water.  Under 
these  circumstances,  the  corpuscles  may  be 
sometimes  seen  aggregated,  or  in  groups,  in  the 
fibres  of  the  stuff,  as  in  the  subjoined  engraving, 
in  which  the  stain  of  blood  was  on  a  shirt. 
(Briand's  "  Manuel  de  Med.  Leg."  p.  747, 1863.) 
The  subjoined  illustrations  (Figs.  40  and  41)  show  the  appearances 
presented  by  blood-corpuscles,  when  examined  by  a  power  of  about 
300  diameters,  and  under  different  methods  of  treatment.  Fig.  40 
represents  the  appearance  of  a  drop  of  healthy  human  blood.  The 
red  blood-cells  are  partly  detached,  partly  united  in  rolls,  and  partly 
in  irregular  clusters.  In  the  vacant  spaces  between  them  there  are 
delicate  threads  of  fibrin.  The  outlines  of  the  blood-cells  are  ren- 
dered, in  some  instances,  indistinct,  by  reason  of  this  web  of  fibrin 
above  them. 

In  Fig.  41  the  corpuscles  are  seen  free  from  fibrin,  and  in  groups 
as  well  as  singly.  Only  a  small  portion  of  those  which  were  in  the 
field  have  been  engraved.  The  shaded  bodies  are  the  white  corpus- 
cles of  the  blood;  they  are  not  so  well  defined  in  form,  and  present 
an  irregularity  of  surface,  by  which  they  may  be  distinguished  from 
the  colored  blood-cells. 


a.  Corpuscles  of  blood  in 
liuen  fibre  ;  b,  a  group  de- 
tached. 


Fig.  40. 


Fig.  41. 


Human  blood-corpuscles  with  fibrin. 


Human  blood-corpuscles  from  a  dried 
specimeu  magnified  319  diameters. 


Some  practice  in  the  use  of  the  microscope  is  required  to  enable 
a  medical  man  to  arrive  at  a  correct  conclusion  in  these  invest iga- 


BLOOD    OF    MAN    AND    ANIMALS.  247 

tions.  Granules  of  starch  and  the  spores  of  vegetables  might  be 
mistaken  for  blood-corpuscles.  Erdmann  states  that  in  examining 
some  articles  of  clothing  in  a  case  of  suspected  murder,  he  thought 
he  had  found  blood-globules  in  the  liquid  which  he  procured,  but  he 
found  on  further  inspection  that  they  consisted  of  the  red-colored 
spores  of  an  alga  known  as  the  porphyridiwm  cruenlum.  ("  Ed.  Med. 
Journal,"  Oct.  1862,  p.  370.)  The  size  of  the  bodies  as  well  as  their 
shape  will  sometimes  aid  the  observer.  The  blood-corpuscles  have  a 
definite  size ;  the  bodies  seen  under  the  microscope  may  be  either 
too  large  or  too  small  to  fall  within  the  exceptional  range  of  size. 
Hence  the  micrometer  is  a  necessary  adjunct  to  the  instrument. 
Granules  of  starch  would  be  identified  by  the  blue  color  imparted  by 
iodine. 

Blood  of  Man  and  Animals. — When  marks  of  blood  have  been  de- 
tected on  the  dress  of  an  accused  person,  it  is  by  no  means  unusual 
to  find  these  marks  accounted  for  by  his  having  been  engaged  in 
killing  a  pig,  bullock,  or  sheep,  or  in  handling  fish  or  dead  game. 
Of  course  every  allowance  must  be  made  for  a  statement  like  this, 
which  can  be  proved  or  disproved  only  by  circumstances ;  but  the 
question  here  arises  whether  we  possess  any  certain  means  of  dis- 
tinguishing the  blood  of  a  human  being  from  that  of  an  animal. 

There  are  no  chemical  differences  between  the  blood  of  man  and 
animals.  The  red  coloring  matter,  the  albumen  and  fibrin,  are  the 
same,  and  chemical  tests  produce  on  them  precisely  similar  results. 
The  microscopical  differences  refer  to  the  shape  and  size  of  the  cor- 
puscles. 1.  With  respect  to  shape.  ■>  In  all  animals  with  red  blood, 
the  globules  have  a  disk-like  or  flattened  form.  In  the  mammalia, 
excepting  the  camel  tribe,  the  outline  of  the  disk  is  circular  (Fig.  38 
a).  In  this  tribe,  and  in  birds,  fishes,  and  reptiles,  the  corpuscles 
have  the  form  of  a  lengthened  ellipse  or  oval.  In  the  three  last- 
mentioned  classes  of  animals  they  have  a  central  nucleus,  which 
gives  to  them  an  apparent  prominence  in  the  centre.  The  blood 
corpuscles  of  all  the  mammalia,  including  those  of  the  camel  tribe, 
have  no  central  nucleus,  and  they  appear  depressed  in  the  centre. 
The  microscope,  therefore,  enables  an  observer  to  distinguish  the 
blood  of  birds,  fishes,  and  reptiles,  from  that  of  a  human  being ;  and 
this  may  be  of  great  importance  as  evidence. 

The  chief  microscopical  distinction  between  the  blood  of  man  and 
domestic  animals,  consists  in  a  minute  difference  in  the  size  of  the  cor- 
puscles. This,  however,  is  only  an  average  difference;  for  the  corpus- 
cles are  found  of  different  sizes  in  the  blood  of  the  same  animal.  In 
making  use  Of  this  criterion,  it  would  be  necessary  to  rely  upon  the 
size  of  the  majority  of  the  corpuscles  seen  in  a  given  area,  and  under 
the  same  power  of  the  microscope.  It  is  a  curious  fact  that  their 
size  bears  no  relation  to  the  size  of  the  animal.  Thus,  in  the  horse, 
ox,  ass,  cat,  mouse,  pig,  and  bat,  they  are,  on  an  average,  nearly  of 
the  same  size;  the  difference  is  so  slight  as  to  be  practically  inappre- 
ciable. In  these  animals  they  are  smaller  than  in  man,  and  in  several 
of  the  mammalia.  The  corpuscles  in  man,  the  dog,  the  rabbit,  and 
the  hare,  are  of  nearly  the  same  size.     In  the  blood  of  the  sheep 


248  RELATIVE    SIZE    OF    THE    CORPUSCLES. 

and  goat,  they  are  smaller  than  in  other  mammalia.  The  size  of 
the  corpuscles  bears  no  proportion  to  the  age  of  the  animal ;  thus  in 
the  blood  of  the  human  foetus  they  are  to  be  found  as  large  as  in 
that  of  the  adult. 

The  measured  diameter  of  that  of  the  corpuscles  in  human  hlood 
varies,  according  to  Gulliver,  from  l-2000th  l-4000th  of  an  inch,  the 
average  size  in  both  sexes  being  l-3200th  of  an  inch.  From  an 
examination  of  numerous  specimens  of  fresh  human  blood,  I  have 
found  the  average  diameter  of  the  globules  to  be  the  l-3500th  part 
of  an  inch,  the  maximum  size  being  1 -3000th,  and  the  minimum 
1 -5000th  of  an  inch.  The  corpuscles  of  human  blood  are  larger  than 
those  of  domestic  animals.  The  subjoined  measurements,  in  fractions 
of  an  inch,  are  those  given  by  Mr.  Gulliver,  excepting  the  figures  in 
brackets,  which  are  from  my  own  micrometrical  observations.  The 
average  diameter  is,  in  the  dog,  1 -3540th  (max.  l-4000th  min. 
l-6000th)— in  the  hare,  l-3607th  (l-4000th;  max.  l-2000th,  min. 
l-8000th),  in  the  mouse,  l-3814th— in  the  ass,  l-4000ta— (rabbit, 
l-4000th)— in  the  pig,  l-4230th(l -4253th)— in  the  ox,  1 -4267th— (in 
the  cow,  l-4000th  to  1 -4200th)— in  the  cat,  l-4400th— in  the  horse, 
l-4600th(l-5000th),in  the  sheep,  1 -5300th  (l-5333d  to  l-6000th)— in 
the  goat,  l-6366th.  These  measurements  apply  to  recent  blood,  which 
has  not  been  allowed  to  become  dry  on  animal  and  vegetable  stuffs. 
In  this  case  a  distinction  might  be  made  between  the  blood  of  a 
human  being  and  a  sheep  or  goat.  With  respect  to  the  dog,  hare, 
and  rabbit  it  would  be,  even  under  these  favorable  circumstances,  a 
matter  of  some  difficulty.  "When  blood  is  dried  on  clothing,  and  it 
is  necessary  to  extract  the  corpuscles  by  means  of  a  liquid  of  a  dif- 
ferent nature  from  the  serum,  we  cannot  rely  on  slight  fractional 
differences,  since  we  cannot  be  sure  that  the  corpuscles,  after  having 
been  once  dried,  will  ever  reacquire  in  a  foreign  liquid,  the  exact 
size  which  they  had  in  serum.  Medical  evidence  must  therefore  be 
based,  in  such  cases,  on  mere  speculation.  (See  "  Guy's  Hospital 
Reports,"  vol.  7,  pt.  2,  1851.) 

In  reference  to  this  question,  therefore,  it  must  be  regarded  as  still 
unsolved.  There  are  no  certain  methods  of  distinguishing  micro- 
scopically or  chemically  the  blood  of  a  human  being  from  that  of  an 
animal,  when  it  has  been  once  dried  on  an  article  of  clothing.  The 
extent  to  which  a  medical  witness  is  justified  in  going  on  trials  for 
murder,  on  which  this  important  question  arises,  appears  to  me  to  be 
this :  the  size  and  shape  of  the  corpuscles  may  or  may  not  be  con- 
sistent with  their  being  the  corpuscles  of  human  blood,  but  it  is 
impossible,  in  the  present  state  of  science,  to  affirm  that  they  are  not 
those  of  some  domestic  animal,  belonging  to  the  class  mammalia. 
For  information  on  this  subject,  see  Bitter's  Prize  Essay,  "Ueber  die 
Ermittelung  der  Blutflecken  in  Kriminalfallen,"  Wurzberg,  1854, 
and  Friedberg's  "Histologie  des  Blutes,"  Berlin,  1852.  These 
authors  affirm,  from  their  observations,  that  it  is  not  possible  to  dis- 
tinguish by  the  microscope  human  from  animal  blood  in  criminal 
cases.  Evidence  based  upon  such  varying  averages  as  those  above 
given,  must  be  treated  as  speculative  and  unsafe.     [In  Commonwealth 


PRODUCTION"    OF    H^EMATIN    CRYSTALS.  249 

v.  Armstrong,  Philadelphia,  1860,  Dr.  Leidy  testified  from  a  micro- 
scopic examination  of  the  blood  alleged  by  the  accused  to  be  chicken 
blood,  that  the  assertion  was  false,  and  the  blood  was  that  of  a  human 
being. — P.] 

Blood-crystals.  Hvematin. — Another  process  for  the  microscopical 
detection  of  blood  has  been,  of  late  years,  suggested  by  some  German 
medical  jurists.  It  consists  in  procuring  crystals  from  the  red  color- 
ing matter  of  blood.  Lehmann  and  Kunze  ascertained  that  all  red 
blood  is  capable  of  crystallization,  from  whatever  animal  or  organ 
it  may  have  been  taken.  Lehmann  thus  describes  his  method  of 
procuring  these  hsematin  crystals.  A  drop  of  blood  which  has  been 
kept  a  day,  is  allowed  to  evaporate  on  a  glass  slide ;  a  drop  of  dis- 
tilled water  is  then  added,  and  the  whole  is  covered  with  a  slip  of 
thin  glass.  After  a  time,  when  the  water  has  to  some  extent  evapo- 
rated, regular  red-colored  crystals,  of  various  sizes  and  forms  become 
visible  under  the  microscope. 

The  following  plan  may  be  adopted  for  procuring  these  so-called 
Hasmatin  crystals :  Having  removed  a  portion  of  the  dried  coagulum 
of  blood,  it  should  be  powdered  and  boiled  with  glacial  acetic  acid 
in  a  small  porcelain  cup,  until  a  quantity  of  coloring  matter  has 
obviously  been  dissolved.  The  acetic  acid,  under  these  circum- 
stances, acquires  a  dark-reddish,  or  reddish-brown  color.  A  few 
drops  of  the  clear  liquid,  evaporated  on  a  slide,  will  leave  minute 
red-colored  crystalline-looking  masses.  They  are  plainly  distinguish- 
able from  the  cubic  crystals  of  common  salt,  naturally  contained  in 
the  blood,  as  well  as  from  the  phosphates.  They  vary  much  in  size 
and  shape,  but  generally  assume  the  form  of  slender  prisms  with 
irregular  rhombic  terminations.  Hasmatin  crystals,  as  they  were 
thus  procured  from  human  blood,  were  found  to  have  an  average 
length  of  l-2250th  of  an  inch,  and  a  width  of  l-9000th  of  an  inch. 
Those  obtained  from  sheep's  blood  were  smaller  than  those  obtained 
from  the  blood  of  man  and  of  the  bullock,  but  the  resemblance  is 
still  so  great,  that  it  would  be  obviously  impossible  to  base  any  dis- 
tinction between  human  and  animal  blood  upon  such  observations. 
The  results,  however,  show  that  the  coloring  matter  of  blood  thus 
treated,  may  be  converted  into  quasi-crystalline  forms,  still  preserv- 
ing its  red  color ;  and  that  microscopical  evidence  of  blood  may  be 
thus  obtained,  in  cases  in  which  the  blood-corpuscles  have  not  been 
successfully  extracted  by  liquids. 

Similar  experiments  performed  on  the  coloring  matters  of  cochi- 
neal, logwood,  and  kino,  gave  the  following  results:  Qn  treating  the 
first  with  acetic  acid,  a  pink-red  color,  differing  from  that  of  blood, 
was  produced,  while  the  extracts  of  logwood  and  kino  gave  a  yel- 
lowish-brown color  with  this  acid.  In  no  case,  on  evaporating  the 
acid  solutions,  were  any  crystals  resembling  those  of  hsematine  or 
chloride  of  sodium  obtained. 

Various  opinions  have  been  entertained  respecting  these  blood 
crystals  and  the  mode  of  producing  them.  Teichmann,  who  first 
announced  this  crystallizable  property,  added  chloride  of  sodium  to 
the  acetic  solution  of  the  coloring  matter.     He  thus  imparted  crys- 


250  SPECTRAL    ANALYSIS    OF    BLOOD. 

tallizable  matter  to  the  liquid  itself,  and  destroyed  the  collateral 
proof  sometimes  obtainable,  namely,  4he  detection  of  the  cubic  crys- 
tals of  chloride  of  sodium,  which  are  naturally  contained  in  the 
blood.  The  results  obtained  by  Teichmann's  process  are-  called  by 
some  hsemin  crystals,  the  term  hsematin  being  applied  to  certain 
spicular  crystals  obtained  by  agitating  blood  with  ether.  Hsematoidin 
crystals  are  of  a  rhomboidal  shape,  and  have  been  chiefly  found,  it 
is  said,  in  old  apoplectic  clots  of  blood.  ("Lancet,"  1864,  vol.  2, 
p.  465.) 

Spectral  analysis  has  been  applied  to  the  detection  of  blood  with 
and  without  the  use  of  the  microscope.  Dr.  Stokes  found  that  when 
a  diluted  solution  of  blood  was  viewed  through  a  prism  having  a 
narrow  slit  in  front  of  it,  it  presented  a  peculiar  spectrum  with  cer- 
tain dark  bands.  On  examining  other  red  liquids  the  results  were 
different.  The  dark  or  absorption  bands  were  considered  to  be 
characteristic  of  blood.  This  optical  examination,  however,  fails  to 
show  by  any  special  characters  whether  the  blood  is  fresh  or  of  old 
date,  and  whether  it  is  the  blood  of  an  animal  or  of  a  human  being. 
("Pro.  Eoyal  Society,"  vol.  13,  No.  Q6,  p.  360.)  When  a  sufficient 
quantity  of  coloring  matter  can  be  procured  for  an  experiment  of 
this  nature,  the  characters  of  blood  may  be  determined  with  equal  if 
not  greater  certainty  by  a  microscopical  and  chemical  analysis. 

A  great  step  has  been  recently  made  by  Mr.  Sorby  in  the  applica- 
tion of  the  spectroscope  to  the  microscope  for  the  examination  of 
suspected  blood-stains.  A  red,  or  reddish-colored  solution  in  water 
is  obtained  by  macerating  the  stained  linen  in  a  small  quantity  of 
distilled  water  in  a  watch-glass,  and  occasionally  squeezing  it.  This 
liquid  is  placed  in  a  glass-cell  and  is  then  examined  by  the  compound 
instrument  devised  by  Mr.  Sorby.  Blood  under  various  conditions, 
i.  e.,  whether  fresh  or  old,  and  whether  treated  with  acids,  alkalies, 
or  other  chemical  liquids,  such  as  a  solution  of  green  sulphate  of 
iron  (for  the  purpose  of  deoxidation),  presents  eight  different  spectra, 
well  characterized  by  absorption- bands  of  variable  intensity,  width, 
and  position.  One-half  of  the  spectrum  from  the  violet  end  is  en- 
tirely absorbed ;  but  dark  bands  appear  in  the  green  and  red  rays. 
Mr.  Sorby  found  that  a  perfectly  distinct  and  satisfactory  spectrum 
was  easily  obtained  from  l-100th  of  a  grain  of  liquid  blood,  making 
on  thin  linen  a  spot  of  about  l-10th  of  an  inch  in  diameter,  and  from 
his  experiments,  he  believes  that  the  l-1000th  of  a  grain  may  be 
recognized  with  confidence.  He  has  thus  been  able  to  detect  blood 
in  articles  of  clothing  which  had  been  washed,  provided  some  traces 
of  the  red  coloring  matter  still  remained  in  the  fibres  of  the  stuff. 
This  optical  method  of  examination  he  has  has  found  to  be  sucessful 
when  applied  to  blood  after  the  lapse  of  twenty  years. 

In  a  case  of  alleged  murder,  which  was  the  subject  of  investiga- 
tion in  January,  1866,  some  faint  reddish-colored  stains  on  gray 
Avoollen  cloth,  visible  only  in  a  strong  light,  were  suspected  to  have 
been  caused  by  blood.  Other  stains  on  an  overcoat  worn  by  the  ac- 
cused person  were  also  attributed  to  blood.  Mr.  Sorby  examined 
some  of  the  stains  by  his  optical  process,  and  he  obtained  a  distinct 


THE  CAUSE  OF  DEATH  FROM  WOUNDS.        251 

spectrum  characteristic  of  blood.  I  examined  microscopically  and 
chemically  other  stained  portions  of  the  gray  woollen  cloth,  and 
came  to  the  same  conclusion  as  Mr.  Sorby,  namely,  that  the  faint 
reddish-colored  stains  had  been  caused  by  blood.  Our  processes, 
although  widely  different,  agreed  in  the  results,  and  it  may  be  men- 
tioned that  from  the  fact  of  the  blood-stains  having  been  wetted  and 
sponged,  a  more  difficult  case  for  investigation  could  hardly  have 
presented  itself.  Our  methods  of  examination  also  agreed  in  the 
result  that  the  suspected  stains  or  marks  on  the  overcoat  were  not 
caused  by  blood.  The  date  of  a  blood-stain  cannot  however  be  de- 
termined with  any  certainty  by  this  process,  unless  the  conditions 
under  which  it  has  been  kept  are  known,  and  it  is  not  possible  to 
distinguish  by  it  animal  from  human  blood.  (The  reader  will  find 
a  full  description  of  this  ingenious  application  of  optics  to  legal  medi- 
cine by  Mr.  Sorby,  in  the  "Quarterly  Journal  of  Science,"  No.  6, 
April,  1865,  p.  205,  and  in  the  "Popular  Science  Eeview,"  Jan.  1866, 
p.  6Q.)  [See  further  on  the  subject  of  this  chapter,  an  excellent 
monograph  on  blood-stains  in  criminal  trials,  by  Dr.  A.  Flemming, 
of  Pittsburg,  Pa.,  "Am.  Journal  Med.  Science,"  April,  1860. — H.] 


CHAPTEE    XXVII. 

The  cause  of  death  from  wounds. — wounds  directly  or  indi- 
rectly FATAL. — DEATH  FROM  HEMORRHAGE. — INTERNAL  BLEED- 
ING.— DEATH  FROM  MECHANICAL  INJURY. — FROM  SHOCK. — DEATH 
FROM  NUMEROUS  PERSONAL  INJURIES  IRRESPECTIVE  OF  ANY  MOR- 
TAL WOUND. 

It  is  important  for  a  medical  witness  to  bear  in  mind  that  in  all 
cases  of  wounds  criminally  inflicted,  the  cause  of  death  must  be  cer- 
tain. No  man  is  ever  convicted  upon  mere  medical  probability. 
In  general,  there  is  only  one  real  cause  of  death,  although  other  cir- 
cumstances may  have  assisted  in  bringing  about  a  fatal  result.  Thus, 
a  person  cannot  die  of  disease  in  the  bowels  and  a  stab  in  the  chest 
at  the  same  time,  nor  of  apoplexy  from  disease  and  compression  of 
the  spinal  marrow  at  the  same  instant.  Hence  it  is  our  duty,  when 
several  apparent  causes  for  death  exist,  to  determine  which  was  the 
real  cause ;  and  in  stating  it  to  the  court,  to  be  prepared  to  offer  our 
reasons  for  this  opinion.  In  most  cases  of  local  injury,  when  a 
person  dies  speedily,  there  will  be  no  great  trouble  in  settling  whether 
disease  or  the  injury  was  the  cause.  A  difficulty  may,  however, 
exist  when  a  person  has  recovered  from  the  first  effects  of  a  wound, 
and  has  subsequently  died.  Besides,  there  may  be  cases  in  which 
the  cause  of  death,  in  spite  of  the  most  careful  deliberation,  will  be 
still  obscure ;  or  sometimes  it  may  happen  that  the  death  of  a  person 
appears  to  be  as  much  dependent  on  bodily  disease  as  on  an  injury 


252  DEATH    FROM    LOSS    OF    BLOOD. 

proved  to  have  been  received  at  the  time  he  was  laboring  under  dis- 
ease. How  is  an  opinion  to  be  expressed  in  such  a  case?  The 
course  which  I  apprehend  a  medical  witness  ought  to  pursue,  pro- 
vided he  has  duly  deliberated  on  the  circumstances  before  he  appears 
in  court,  and  his  mind  is  equally  balanced  between  the  two  causes, 
is  to  state  at  once  his  doubt  to  the  jury  without  circumlocution,  and 
not  allow  it  to  be  extracted  from  him  in  cross-examination.  It  is 
the  hesitating  to  assign  a  satisfactory  cause,  or  the  assigning  of  many 
causes  for  death,  that  gives  such  advantage  to  a  prisoner's  case,  even 
when  the  general  evidence  is  entirely  against  him.  Occasionally 
many  causes  of  death  are  assigned  by  a  medical  witness,  among 
which  some  have  a  tendency  to  exculpate,  and  others  to  inculpate 
an  accused  person  in  a  greater  or  less  degree,  and  it  is  left  to  the  jury 
to  select  from  the  number,  one  upon  which  to  found  a  verdict.  In 
a  case  of  this  kind  an  acquittal  is  commonly  obtained. 

Wounds  Directly  or  Indirectly  Fated. — A  wound  may  cause  death 
either  directly  or  indirectly.  A  wound  operates  as  a  direct  cause  of 
death  when  the  wounded  person  dies  either  immediately  or  very  soon 
after  its  infliction,  and  there  is  no  other  cause  internally  or  externally 
to  account  for  death.  In  wounds  which  cause  death  indirectly,  it  is 
assumed  that  the  person  survives  for  a  certain  period,  and  that  the 
wound  is  followed  by  inflammation,  suppuration,  pyaemia,  gangrene, 
tetanus,  erysipelas,  or  some  other  mortal  disease,  which  is  a  direct, 
and  not  an  unusual  consequence  of  the  injury.  Under  this  head  may 
be  also  arranged  all  those  cases  which  prove  fatal  by  reason  of  sur- 
gical operations  rendered  imperatively  necessary  for  the  treatment 
of  an  injury — presuming  that  these  operations  have  been  performed 
with  ordinary  skill  and  care.  We  shall  for  the  present  consider  only 
the  direct  causes  of  death  in  cases  of  wounds.  They  are  three  in 
number:  1.  Hemorrhage,  or  loss  of  blood.  2.  Great  mechanical 
injury  done  to  an  organ  important  to  life.  Shock,  or  concussion, 
affecting  the  brain  or  spinal  marrow,  whereby  the  functions  of  one 
or  more  vital  organs  are  arrested,  sometimes  with  but  slight  injury 
to  the  part  struck  or  wounded.  From  either  of  these  causes,  a 
wounded  person  may  die  immediately  or  within  a  few  minutes. 

1.  Death  from  Hemorrhage. — Loss  of  blood  operates  by  producing 
fatal  syncope  (p.  54).  A  quantity  of  blood  escaping  from  a  vessel, 
although  insufficient  to  cause  death  by  affecting  the  heart  and  circu- 
lation, may  readily  destroy  life  by  disturbing  the  functions  of  the 
organ  or  part  into  which  it  is  effused.  Thus,  a  small  quantity  effused 
in  or  upon  the  substance  of  the  brain,  or  at  its  base,  may  prove  fatal 
by  inducing  fatal  compression ;  and  again,  if,  in  a  case  of  wounded 
throat,  blood  should  flow  into  the  windpipe,  it  may  cause  death  by 
asphyxia — i.  e.,  by  stopping  the  respiratory  process  (p.  55).  In  these 
cases  it  is  obvious  that  the  blood  acts  mechanically ;  and  in  respect 
to  the  last  condition  a  medical  man,  unless  circumspection  is  used, 
may  involve  himself  in  a  charge  of  malapraxis.  If  he  allows  the 
wound  to  remain  open,  the  wounded  person  may  die  through  hemor- 
rhage— if  he  closes  it  too  soon,  he  may  die  through  suffocation;  and, 
in  either  case,  the  counsel  for  a  prisoner  will  not  fail  to  take  advan- 


DEATH    FROM    LOSS    OF    BLOOD.  253 

tage  of  a  plausible  objection  of  this  kind.  In  wounds  of  the  chest, 
involving  the  heart  and  lungs,  death  is  frequently  due  not  so  much 
to  the  actual  quantity  of  blood  effused,  as  to  the  pressure  which  it 
produces  upon  these  organs.  A  few  ounces  effused  in  the  cavity  of 
the  membrane  including  the  heart  (pericardium),  will  entirely  arrest 
the  action  of  this  organ. 

The  absolute  quantity  of  blood  required  to  be  lost  in  order  to  prove 
fatal,  will,  of  course,  vary  according  to  numerous  circumstances. 
The  young,  the  aged,  they  who  are  laboring  under  infirmity  or  dis- 
ease, will  perish  sooner  from  loss  of  blood  than  others  who  are 
healthy  and 'vigorous.  Women,  casteris  paribus,  are  more  speedily 
destroyed  by  bleeding  than  men.  Infants  are  liable  to  die  from  this 
cause,  as  a  result  of  slight  wounds.  An  infant  has  been  known  to 
bleed  to  death  from  the  bite  of  a  single  leech,  or  from  the  simple 
operation  of  lancing  the  gums.  Even  the  healthy  and  vigorous, 
when  their  vital  powers  have  been  depressed  by  mal-treatment  or  by- 
brutal  violence,  will  sink  under  the  loss  of  a  comparatively  small 
quantity  of  blood.  ("Watson  on  Homicide,"  p.  90.)  A  medical 
jurist  must  not  forget  that  some  persons  have  a  predisposition  to 
excessive  bleeding  from  slight  injuries;  and  this  condition  is  often 
hereditary.  The  slightest  wound  or  puncture — the  bite  of  a  leech 
or  the  extraction  of  a  tooth — will  be  attended  with  a  loss  of  blood 
which  cannot  be  arrested,  and  which  will  slowly  lead  to  death  by 
exhaustion.  Cases  have  been  frequently  recorded  in  our  medical 
journals  of  fatal  hemorrhage  following  the  extraction  of  teeth,  when 
there  had  been  previously  nothing  to  indicate  the  probable  occur- 
rence of  death  from  so  trivial  a  cause.  Such  cases  are  without  diffi- 
culty detected;  since  a  surgeon  may  always  infer,  from  the  part 
injured  and  the  extent  of  the  injury,  whether  the  bleeding  is  likely 
to  be  copious  or  not.  When  a  person  bleeds  to  death  from  what 
would,  under  common  circumstances,  be  a  simple  wound,  the  admis- 
sion of  this  fact  may  in  certain  cases  lessen  the  responsibility  of  an 
accused  party. 

A  sudden  loss  of  blood  has  a  much  more  serious  consequence  than 
the  same  quantity  lost  slowly.  A  person  may  fall  into  a  fatal  syn- 
cope from  a  quantity  of  blood  lost  in  a  few  seconds,  which  he  would 
have  been  able  to  bear  without  sinking  had  it  escaped  slowly.  This 
is  the  reason  why  the  wound  of  an  artery  proves  so  much  more 
rapidly  fatal  than  that  of  a  vein.  Death  speedily  follows  the  wound 
of  a  large  artery  like  the  carotid ;  but  it  takes  place  with  equal  cer- 
tainty, although  more  slowly,  from  wounds  of  smaller  arteries.  In 
a  case  in  which  one  of  the  intercostal  arteries  was  wounded  by  a 
small  shot,  hemorrhage  caused  death  in  thirty-eight  hours.  The 
loss  of  blood  which  follows  the  division  of  the  smaller  branches  of 
the  external  carotid  artery,  is  often  sufficient  to  destroy  life,  unless 
timely  assistance  be  rendered.  If  a  wound  is  in  a  vascular  part, 
although  no  vessel  of  any  importance  be  divided,  the  person  may 
die  from  bleeding.  It  is  difficult  to  say  what  quantity  of  blood  should 
be  lost,  in  order  that  a  wound  may  prove  fatal.  The  whole  quan- 
tity contained  in  the  body  of  an  adult  is  calculated  at  about  one-fifth 


254:  FATAL    INTERNAL    BLEEDING. 

of  its  weight — i.  e.,  about  thirty  pounds;  of  this,  one-fourth  is  con- 
sidered to  be  arterial,  and  the  remaining  three-fourths  are  venous 
blood.  Some  physiologists  have  estimated  the  proportion  as  one- 
eighth  of  the  weight  of  the  body.  ("Med.  Times  and  Gaz.,"  Aug. 
28,  1858,  p.  232.)  According  to  Mr.  Watson,  the  loss  of  from  five 
to  eight  pounds  is  sufficient  to  prove  fatal  to  adults.  But  while  this 
may  be  near  the  truth,  many  persons  will  die  from  a  much  smaller 
quantity;  the  rapidity  with  which  the  effusion  takes  place  having  a 
considerable  influence,  as  well  as  the  age,  sex,  and  bodily  condition 
of  the  wounded  person.  It  has  been  found,  by  experiment,  that  a 
dog  cannot  bear  the  loss  of  more  blood  than  is  equivalent  to  one- 
twelfth  part  of  the  weight  of  its  body. 

Internal  Hemorrhage. — Hemorrhage  may  prove  fatal,  although  the 
blood  does  not  visibly  escape  from  the  body.  In  incised  wounds, 
the  flow  externally  is  commonly  abundant ;  but  in  contused,  punc- 
tured, and  gunshot  wounds,  the  effusion  may  take  place  internally 
and  rapidly  cause  death.  In  severe  contusions,  or  contused  wounds, 
involving  highly  vascular  parts,  the  effusion  may  go  on  to  an  extent 
to  prove  fatal,  either  in  the  cavities  of  the  body  or  throughout  the 
cellular  membrane  and  parts  adjacent ;  many  pounds  of  blood  may 
thus  be  slowly  or  rapidly  effused.  The  most  fatal  internal  hemor- 
rhages are  those  which  follow  ruptures  of  the  organs  from  violence 
or  disease.  Kuptures  of  the  heart,  lungs,  liver,  and  kidneys,  have 
thus  caused  death.  In  November,  1864,  a  man  who  had  been  run 
over  was  brought  to  Guy's  Hospital.  He  complained  of  pain  in  the 
back,  but  there  were  no  symptoms  of  severe  injury,  and  no  marks  of 
violence  were  seen  on  the  skin  of  the  back.  He  left  the  hospital  and 
walked  with  some  assistance  to  his  home.  A  few  hours  afterwards 
he  was  found  dead  in  bed.  On  inspection  there  was  a  large  quantity 
of  blood  effused  in  the  abdomen.  This  had  proceeded  from  one  kid- 
ney, which  had  been  ruptured  transversely  through  its  whole  sub- 
stance. In  these  cases  the  bleeding  is  not  necessarily  immediate ; 
but  slight  muscular  exertion  may  increase  it  and  accelerate  death.  In 
death  from  severe  flagellation,  blood  may  be  effused  in  large  quantity 
beneath  the  skin  and  among  the  muscles ;  this  effusion  will  operate 
as  fatally  as  if  it  had  flowed  from  an  open  wound. 

The  means  of  ascertaining  whether  a  person  has  died  from  bleed- 
ing by  an  open  wound  are  these :  Unless  the  wound  is  situated  in  a 
vascular  part  we  shall  find  the  vessel  or  vessels  from  which  the  blood 
has  issued,  divided — the  neighboring  vessels  empty,  and  the  body 
more  or  less  palid  ;  although  this  last  condition  is  of  course  liable  to 
be  met  with  in  certain  cases  of  disease,  as  also  under  copious  vene- 
section— points  easily  determined  by  an  examination.  The  blood 
will  commonly  be  found  more  or  less  clotted  or  coagulated  on  those 
surfaces  on  which  it  has  fallen.  If,  with  these  signs,  there  is  an  ab- 
sence of  disease  likely  to  prove  rapidly  fatal,  and  no  other  probable 
cause  of  death  is  apparent,  it  may  be  fairly  referred  to  loss  of  blood. 
This  opinion  may,  however,  be  materially  modified  in  reference  to 
opeu  wounds,  by  the  fact  of  the  body  not  being  seen  on  the  spot 
where  the  injury  was  actually  inflicted — by  the  wound  having  been 


DEATH    FROM    SHOCK.  255 

sponged — the  blood  removed  by  washing,  and  all  traces  of  bleeding 
destroyed.  Under  these  circumstances,  the  case  must  in  a  great 
measure  be  made  out  by  presumptive  proof;  and  here  a  medical  wit- 
ness may  have  the  duty  thrown  upon  him  of  examining  articles  of 
dress,  furniture,  or  weapons,  for  marks  or  stains  of  blood.  It  must 
not  be  supposed  that  all  the  blood  met  with  round  a  wounded  dead 
body,  or  in  a  cavity  of  the  body,  was  actually  effused  during  life. 
As  soon  as  the  heart's  action  ceases,  the  arteries  pour  out  no  more ; 
but  the  blood,  so  long  as  it  remains  liquid,  i.  e.,  from  four  to  eight 
or  ten  hours,  and  the  warmth  of  the  body  is  retained,  continues  to 
drain  from  the  divided  veins  and  smaller  vessels.  The  quantity  thus 
lost,  however,  is  not  considerable,  unless  the  veins  implicated  are 
large,  or  the  part  is  highly  vascular,  i.  e.,  full  of  small  vessels. 

2.  Death  from  Great  Mechanical  Injury  done  to  a  Vital  Organ. — We 
have  instances  of  this  becoming  a  direct  cause  of  death  in  the  crush- 
ing of  the  heart,  lungs,  or  brain,  by  any  heavy  body  passing  over  or 
falling  on  the  cavities,  as  in  railway  accidents.  The  severe  mechan- 
ical injury  is  sometimes  accompanied  by  a  considerable  effusion  of 
blood,  so  that  the  person  really  dies  from  hemorrhage ;  but  in  other 
instances  the  quantity  of  blood  lost  is  inconsiderable,  and  the  fatal 
effects  may  be  referred  to  shock  to  the  nervous  system.  Sometimes  a 
slight  amount  of  violence  may  prove  suddenly  fatal.  These  are, 
however,  to  be  regarded  as  exceptional  instances. 

3.  Death  from  Shock. — This  is  sometimes  a  direct  cause  of  death 
under  the  infliction  of  external  violence ;  and  in  this  case  life  is 
destroyed  without  the  injury  being  to  all  appearance  sufficient  to 
account  for  so  speedily  fatal  a  result.  Mr.  Savory  has  suggested  that 
death  from  shock  is  nothing  more  than  death  from  temporary  exhaus- 
tion of  nerve-force,  the  result  of  a  violent,  sudden,  and  excessive 
expenditure  of  it.  ("Lectures  on  Life  and  Death,"  p.  171.)  What- 
ever theory  may  be  adopted  to  explain  it,  there  is  no  medical  doubt 
that  a  person  may  die  from  what  is  termed  shock,  without  any  marks 
of  severe  injury  being  discovered  on  his  body  after  death.  We  have 
examples  of  this  mode  of  death  in  accidents  from  lightning,  or  from 
severe  burns  or  scalds,  in  which  the  local  injury  is  often  far  from 
sufficient  to  explain  the  rapidly  fatal  consequences.  As  instances  of 
this  form  of  death  from  violence,  may  be  also  cited  those  cases  in 
which  a  person  has  been  suddenly  killed  by  a  blow  upon  the  upper 
part  of  the  abdomen  or  on  the  pit  of  the  stomach,  which  is  supposed 
to  operate  by  producing  a  fatal  impression  on  the  nerves  and  nerve- 
ganglia  of  the  cardiac  plexus.  Whether  this  be  or  be  not  the  true 
explanation,  it  is  admitted  by  experienced  surgeons,  that  a  person 
may  die  from  so  simple  a  cause  without  any  mark  of  a  bruise  ex- 
ternally, or  physical  injury  internally  to  account  for  death.  On  the 
skin  there  may  be  some  abrasion  or  slight  discoloration ;  but  as  it 
has  been  elsewhere  stated  these  are  neither  constant  nor  necessary 
accompaniments  of  a  blow.  Concussion  of  the  brain,  unattended  by 
visible  mechanical  injury,  furnishes  another  example  of  this  kind  of 
death.  A  man  receives  a  severe  blow  on  the  head ;  he  falls  dead 
on  the  spot,  or   becomes  senseless  and  dies  in  a  few  hours.     On 


256  MORTALITY    OF    WOUNDS. 

an  inspection,  there  may  be  merely  the  mark  of  a  bruise  on  the 
scalp ;  in  the  brain  there  may  be  no  rupture  of  vessels  or  laceration 
of  substance,  and  all  the  other  organs  of  the  body  may  be  found 
healthy.  In  certain  railway  accidents  persons  have  died  under  some- 
what similar  circumstances.  There  has  been  no  physical  indication 
of  a  mortal  injury,  and  no  cause  apparent  to  account  for  death.  This 
can  be  referred  only  to  the  shock  or  violent  impression  which  the 
nervous  system  has  sustained  from  the  blow  or  violence — an  im- 
pression which  the  vital  powers  were  wholly  unable  to  counteract  or 
resist.  A  medical  witness  must  give  his  evidence  with  caution  in 
such  cases ;  since  it  is  the  custom  to  rely  in  the  defence  upon  the 
absence  of  any  visible  mortal  wound  or  physical  injury  to  account 
for  death,  as  a  proof  that  no  injury  was  done — a  principle  which,  if 
once  unrestrictedly  admitted,  would  leave  a  larger  number  of  deaths, 
undoubtedly  occurring  from  violence,  wholly  unexplained. 

There  is  another  form  of  shock,  which  is  of  some  importance  in 
medical  jurisprudence.  A  person  may  have  received  many  injuries 
as  by  blows  or  stripes,  not  one  of  which,  taken  alone,  could,  in  me- 
dical language,  be  termed  mortal ;  and  yet  he  may  die  directly  from 
the  effects  of  the  violence,  either  on  the  spot,  or  very  soon  after- 
wards. In  the  absence  of  any  large  effusion  of  blood  beneath  the 
skin,  death  is  commonly  referred  to  exhaustion,  but  this  is  only 
another  mode  of  expression ;  the  exhaustion  is  itself  dependent  on 
a  fatal  influence  or  impression  produced  on  the  nervous  system.  A 
prizefighter  after  having,  during  many  rounds,  sustained  numerous 
blows  on  the  body,  may,  either  at  or  after  the  fight,  sink  and  die  ex- 
hausted. His  body  may  present  marks  of  bruises,  or  even  lacerated 
wounds,  but  there  may  be  no  internal  changes  to  account  for  death. 
In  common  language,  there  is  not  a  single  injury  which  can  be 
termed  mortal;  and  yet,  supposing  him  to  have  had  good  health  pre- 
viously to  the  fight,  and  all  marks  of  disease  indicative  of  sudden 
death  to  be  absent,  it  is  impossible  not  to  refer  his  death  to  the  direct 
effect  of  the  violence.  It  is  a  well-ascertained  medical  fact,  that  a 
number  of  injuries,  each  comparatively  slight,  are  as  capable  of  ope- 
rating fatally,  as  any  single  wound  whereby  some  bloodvessel  or 
organ  important  to  life  is  directly  affected.  Age,  sex,  constitution, 
and  a  previous  state  of  health  or  disease,  may  accelerate  or  retard 
the  fatal  consequences. 

From  these  considerations,  it  is  obviously  unreasonable  to  expect 
that  in  every  case  of  death  from  violence  or  maltreatment,  there 
must  be  some  specific  and  visible  mortal  injury  to  account  for  this 
•event.  When  the  circumstances  accompanying  death  are  unknown, 
a  medical  opinion  should  certainly  be  expressed  with  caution ;  but 
if  we  are  informed  that  the  deceased  was  in  ordinary  health  and  vigor 
previous  to  the  infliction  of  the  violence,  and  there  is  no  morbid 
•cause  to  account  for  his  sudden  illness  and  death,  there  is  no  reason 
^whj  we  should  hesitate  in  referring  death  to  the  effects  of  a  number 
•of  injuries.  Among  non-professional  persons  an  unfounded  preju- 
dice exists  that  no  persons  can  die  from  violence  unless  there  be  some 
•distinctly  mortal  wound  actually  inflicted  on  the  body.     By  this  we 


MORTALITY    OF    WOUNDS.  257 

are  to  understand  a  visible  mechanical  injury  to  some  organ  or  blood- 
vessel important  to  life ;  but  this  is  obviously  an  erroneous  notion, 
since  death  may  take  place  from  the  disturbance  of  the  functions  of 
an  organ  important  to  life,  without  this  being  necessarily  accompa- 
nied by  a  perceptible  alteration  of  structure.  The  prevalence  of 
this  popular  error  often  leads  to  a  severe  cross-examination  of  me- 
dical witnesses.  Among  the  questions  put,  we  sometimes  find  the 
following :  Would  you  have  said,  from  tlie  wounds  or  bruises  alone, 
that  they  were  likely  to  have  occasioned  death  ?  Now,  in  answer  to 
this,  it  may  be  observed,  that  we  cannot  always  judge  of  the  proba- 
bility of  death  ensuing  from  the  appearance  of  external  violence 
alone.  Because  the  appearances  were  slight,  it  would  be  wrong  to 
infer  that  they  were  not  sufficient  to  cause. death  by  shock.  Then  it 
may  be  inquired,  Were  the  wounds  or  bruises  mortal  ?  In  the  vulgar 
sense  of  the  word,  i.  e.,  by  producing  great  loss  of  blood,  or  a  de- 
struction of  parts,  they  might  not  be  so ;  but  in  a  medical  view,  they 
may  have  acted  mortally  by  producing  a  shock  to  the  nervous  sys- 
tem. Again  it  may  be  inquired,  AVhich  of  the  several  wounds  or 
bruises  found  on  the  body  of  the  deceased  was  mortal  ?  The  answer 
to  this  question  may  be — Not  one  individually,  but  all  contributed 
to  occasion  death  by  syncope  or  exhaustion.  It  must  be  remembered 
that  in  cases  in  which  a  person  has  sustained  a  number  of  injuries, 
the  loss  of  a  much  smaller  quantity  of  blood  than  in  other  instances 
will  suffice  to  destroy  life. 

When  there  are  several  wounds,  it  is  difficult  to  decide  on  their 
relative  degree  of  mortality,  and  on  the  share  which  each  may  have 
had  in  causing  death.  By  a  wound  being  of  itself  mortal,  we  are  to 
understand  that  it  is  capable  of  causing  death  directly  or  indirectly, 
in  spite  of  the  best  medical  assistance.  It  is  presumed  that  the  body 
is  healthy,  and  that  no  cause  has  intervened  to  bring  about  or  even 
accelerate  a  fatal  result.  The  circumstance  of  a  person  laboring  under 
disease  when  wounded  in  a  vital  part,  will  not,  of  course,  throw  any 
doubt  upon  the  fact  of  such  a  wound  being  necessarily  mortal,  and 
of  its  having  caused  death.  If  there  should  be  more  wounds  than 
one,  it  is  easy  to  say  from  the  nature  of  the  parts  involved,  which 
was  likely  to  have  led  to  a  fatal  result.  In  order  to  determine,  on 
medical  grounds,  whether  a  wound  was  or  was  not  mortal,  we  may 
propose  to  ourselves  this  question :  Would  the  deceased  have  been 
likely  to  die  at  the  same  time,  and  under  the  same  circumstances, 
had  he  not  received  the  wound  ?  There  can  obviously  be  no  gen- 
eral rule  for  determining  the  mortal  nature  of  wounds.  Each  case 
must  be  judged  by  the  circumstances  which  attend  it.  In  some  Con- 
tinental states,  the  law  requires  that  a  medical  witness  should  draw 
a  distinction  between  a  wound  which  is  absolutely  and  one  which  is 
conditionally  mortal.  An  absolutely  mortal  wound  is  defined  to  be 
that  in  which  the  best  medical  assistance  being  at  hand,  being  sent 
for,  or  actually  rendered,  the  fatal  event  could  not  be  averted. 
Wounds  of  the  heart,  aorta,  and  internal  carotid  arteries,  are  of  this 
nature.  A  conditionally  mortal  wound  is  one  in  which,  had  medical 
assistance  been  at  hand,  been  sent  for,  or  timelv  rendered,  the  patient 
17 


258  WOUNDS.      DEATH    FROM    NATURAL    CAUSES. 

would,  in  all  probability,  have  recovered.  Wounds  of  the  brachial, 
radial,  and  ulnar  arteries  may  be  taken  as  instances.  The  responsi- 
bility of  an  assailant  is  made  to  vary  according  to  the  class  of  inju- 
ries to  which  the  wound  may  be  referred  by  the  medical  witnesses ; 
and,  as  it  is  easy  to  suppose,  there  is  seldom  any  agreement  on  this 
subject.  Our  criminal  law  is  entirely  free  from  such  subtleties.  The 
effect  of  the  wound,  and  the  intent  with  which  it  was  inflicted,  are 
looked  to :  its  anatomical  relations,  which  must  depend  on  pure  acci- 
dent, are  never  interpreted  in  the  prisoner's  favor.  Some  extenua- 
tion may,  perhaps,  be  occasionally  admitted  when  a  wound  proves 
mortal  through  an  indirect  cause,  as  inflammation  or  fever,  and 
medical  advice  was  obtainable,  but  not  obtained  until  every  hope  of 
recovery  had  disappeared.  It  appears,  however,  from  the  case  of  the 
Queen  v.  Thomas  and  others  (Gloucester  Aut.  Ass.,  1841),  that  the 
mere  neglect  to  call  in  medical  assistance  is  not  allowed  in  law  to  be 
a  mitigatory  circumstance  in  the  event  of  death  ensuing.  The  de- 
ceased died  from  the  effects  of  a  severe  injury  to  the  head,  inflicted 
by  the  prisoners,  but  had  had  no  medical  assistance.  The  judge  said 
it  was  possible  that,  "if  he  had  had  medical  advice,  he  might  not 
have  died ;  but  whoever  did  a  wrongful  act  must  take  the  whole 
consequences  of  it.  It  never  could  make  any  difference  whether  the 
party  injured  had  or  had  not  the  means  or  the  mind  to  apply  for 
medical  advice."  The  prisoners  were  convicted.  According  to  Lord 
Hale,  if  a  man  be  wounded,  and  the  wound,  although  not  in  itself 
mortal,  turn  to  a  gangrene  or  fever  for  want  of  proper  applications, 
or  from  neglect,  and  the  man  die  of  gangrene  or  fever,  this  is  homi- 
cide in  the  aggressor ;  for  though  the  fever  or  gangrene  be  the  im- 
mediate cause  of  death,  yet  the  wound  being  the  cause  of  the  gangrene 
or  fever  is  held  the  cause  of  death,  causa  causati.  These  nice  ques- 
tions relative  to  the  shades  of  responsibility  for  personal  injuries, 
occasionally  arise  in  cases  in  which  persons  have  been  wounded  at 
sea  on  board  of  a  ship  in  which  there  was  no  surgeon. 


CHAPTER  XXVIII. 

Death  of  wounded  persons  from  natural  causes. — distinction 
between  real  and  apparent  cause. — death  from  wounds  or 
latent  disease. — accelerating  cause. — death  from  wounds 

after  long  periods. avoidable  causes  of  death. neglect. 

— imprudence. — unskilful  treatment. — unhealthy  state  of 

BODY. 

Death  of  Wounded  Persons  from  Natural  Causes. — It  is  by  no  means 
unusual  for  individuals  who  have  received  a  wound,  or  sustained 
some  personal  injury,  to  die  from  latent  natural  causes;  and  as.  in 
the  minds  of  non-professional  persons,  death  may  appear  to  be  a 


ACCELERATION    OF    DEATH.  259 

direct  result  of  the  injury,  the  case  can  only  be  cleared  up  by  the 
assistance  of  a  medical  practitioner.  Such  a  coincidence  has  been 
witnessed  in  many  instances  of  attempted  suicide.  A  man  has 
inflicted  a  severe  wound  on  himself  while  laboring  under  disease; 
or  some  morbid  change,  tending  to  destroy  life,  has  occurred  subse- 
quently to  the  infliction  of  a  wound,  and  death  has  followed.  AVith- 
out  a  careful  examination  of  the  body,  it  is  impossible  to  refer  death 
to  the  real  cause.  The  importance  of  an  accurate  discrimination  in 
a  case  in  which  wounds  or  personal  injuries  have  been  caused  by 
another,  must  be  obvious  on  the  least  reflection.  A  hasty  opinion 
may  involve  the  accused  in  a  charge  of  manslaughter ;  and  although 
a  barrister  might  be  able  to  show  on  the  trial  that  death  was  proba- 
bly attributable  not  to  the  wound,  but  to  coexisting  disease,  yet  it 
must  be  remembered,  that  the  evidence  of  a  surgeon  before  a  coroner 
or  magistrate,  in  remote  parts  of  this  country,  may  be  the  means  of 
causing  the  person  charged  to  be  imprisoned  for  some  months  pre- 
viously to  the  trial.  This  is  in  itself  a  punishment,  independently 
of  the  loss  of  character  to  which  he  must  be  in  the  meantime  ex- 
posed. 

Death  from  Wounds  or  Latent  Disease.  A  natural  cause  of  death 
may  be  lurking  within  the  body  at  the  time  that  a  wound  is  crimi- 
nally inflicted,  and  a  close  attention  to  the  symptoms  preceding,  and 
the  appearances  after  death,  can  alone  enable  a  surgeon  to  distinguish 
the  real  cause.  A  man  may  be  severely  wounded,  and  yet  death 
may  take  place  from  rupture  of  the  heart,  the  bursting  of  an  aneu 
rism,  from  apoplexy,  phthisis  or  other  morbid  causes  which  it  is 
here  unnecessary  to  specify.  ("  Cormack's  Ed.  Jour."  May,  1846,  p. 
843.)  If  death  can  be  clearly  traced  to  any  of  these  diseases  by  an 
experienced  surgeon,  the  prisoner  cannot  be  charged  with  man- 
slaughter ;  for  the  medical  witness  may  give  his  opinion  that  death 
would  have  taken  place  about  the  same  time  and  under  the  same 
circumstances  whether  the  wound  had  been  inflicted  or  not. 

On  these  occasions  one  of  the  following  questions  may  arise:  Was 
the  death  of  the  person  accelerated  by  the  wound,  or  was  the  disease 
under  which  he  was  laboring  so  aggravated  by  the  wound  as  to  pro- 
duce a  more  speedily  fatal  termination  ?  The  answer  to  either  of 
these  questions  must  depend  on  the  circumstances  of  each  case,  and 
the  witness's  ability  to  draw  a  proper  conclusion  from  these  circum- 
stances. The  maliciously  accelerating  of  the  death  of  another  already 
laboring  under  disease  is  criminal ;  for  in  a  legal  sense  that  which 
accelerates,  causes.  Lord  Hale,  in  remarking  upon  the  necessity  of 
proving  that  the  act  of  a  prisoner  caused  the  death  of  a  person,  says: 
"  It  is  necessary  that  the  death  should  have  been  occasioned  by  some 
corporeal  injury  done  to  the  party  by  force,  or  by  poison,  or  by  some 
mechanical  means  wliieh  occasion  death  ;  for  although  a  person  may, 
inforo  conscientise,  be  as  guilty  of  murder  by  working  on  the  passions 
or  fears  of  another,  and  as  certainly  occasion  death  by  such  means, 
as  if  he  had  used  a  sword  or  pistol  for  the  purpose,  he  is  not  the 
object  of  temporal  punishment."  (I.  247.)  Several  acquittals  have 
taken  place  of  late  years,  in  cases  in  which  the  deaths  of  persons 


260  WHICH    OF    TWO    WOUXDS    CAUSED    DEATH. 

have  been  occasioned  by  terror,  or  dread  of  impending  danger,  pro- 
duced by  acts  of  violence  on  the  part  of  the  prisoners ;  not,  however, 
giving  rise  to  bodily  injury  in  the  deceased.  Under  the  14  and  15 
Vict.,  c.  100,  the  necessity  for  tracing  death  to  some  corporeal  injury 
appears  to  be  practically  abolished.  According  to  the  fourth  sec- 
tion, in  any  further  indictment  for  murder  or  manslaughter  it  shall 
not  be  necessary  to  set  forth  the  manner  or  the  means  by  which  the 
death  of  the  deceased  was  caused. 

Which  of  two  Wounds  caused  Death. — It  is  possible  that  a  man 
may  receive  two  ivounds  on  provocation,  at  different  times,  and  from 
different  persons,  and  die  after  receiving  the  second :  in  such  a  case, 
the  course  of  justice  may  require  that  a  medical  witness  should  state 
which  wound  was  the  cause  of  death.  Let  us  take  the  following- 
illustration  :  A  man  receives  during  a  quarrel  a  gunshot  wound  in 
the  shoulder.  He  is  going  on  well,  with  a  prospect  of  recovery, 
when  in  another  quarrel  he  receives  a  severe  penetrating  wound  in 
the  chest  or  abdomen  from  another  person,  and  after  lingering  under 
the  effects  of  these  wounds  for  a  longer  or  shorter  period,  he  dies.  If 
the  gunshot  wound  was  clearly  shown  to  have  been  the  cause  of  death, 
the  second  prisoner  could  not  be  convicted  of  manslaughter ;  or  if 
the  stab  was  evidently  the  cause  of  death,  the  first  prisoner  would 
be  acquitted  on  a  similar  charge.  It  might  be  possible  for  a  surgeon 
to  decide  the  question  summarily,  when,  for  instance,  death  speedily 
followed  the  second  wound ;  and  on  inspection  of  the  body,  the 
heart  or  a  large  vessel  is  discovered  to  have  been  penetrated ;  or,  on 
the  other  hand,  extensive  sloughing  sufficient  to  account  for  death, 
might  take  place  from  the  gunshot  wound,  and  on  inspection,  the 
stab  might  be  found  to  be  of  a  slight  nature — not  involving  any  vital 
parts.  In  either  of  these  cases,  all  would  depend  upon  the  science, 
skill,  and  judgment  of  the  medical  practitioner — his  evidence  would 
be  so  important  that  no  correct  decision  could  be  arrived  at  without 
it ;  he  would  be,  in  fact,  called  upon  substantially  to  distinguish  the 
guilty  from  the  innocent.  On  some  occasions  death  may  appear  to 
be  equally  a  consequence  of  either  or  both  of  the  wounds ;  in  which 
case,  probably  both  parties  would  be  liable  to  a  charge  of  man- 
slaughter. (See  "Ann.  d'Hyg."  1835,  vol.  2,  p.  432.)  The  second 
wound,  which  is  here  supposed  to  have  been  the  act  of  another,  may 
be  inflicted  by  a  wounded  person  on  himself,  in  an  attempt  at  suicide, 
or  it  may  have  an  accidental  origin.  The  witness  would  then  have 
to  determine  whether  the  wounded  person  died  from  the  wound  in- 
flicted by  himself  or  from  that  which  he  had  previously  received. 

It  may  happen  that  the  wounded  person  has  taken  poison,  and  has 
actually  died  from  its  effects,  and  not  from  the  injuries  or  maltreat- 
ment. Again,  a  wounded  person  may  have  been  the  subject  of  sub- 
sequent ill-treatment,  and  the  question  will  arise — to  which  of  the 
two  causes  his  death  was  really  due.  It  is  to  be  observed  of  these 
cases,  that  the  supervening  disease,  the  poison,  or  the  subsequent  ill- 
treatment,  should  be  of  such  a  nature  as  to  account  for  sudden  or 
rapid  death;  since  it  would  be  no  answer  to  a  charge  of  death  from 
violence,  to  say  that  there  were  marks  of  chronic  disease  in  the 


WOUNDS.      DEATH    AFTER    A    LONG    PERIOD.  261 

body,  unless  it  was  of  such  a  nature  as  to  account  for  the  sudden 
destruction  of  life  under  the  symptoms  which  actually  preceded 
death.  In  the  medical  jurisprudence  of  wounds,  there  is  probably 
no  question  which  so  frequently  presents  itself  as  this :  it  is  admitted 
that  the  violence  was  inflicted,  but  it  is  asserted  that  death  was  due 
to  some  other  cause,  and  the  onus  of  proof  lies  on  the  medical  evi- 
denqe.  Among  numerous  cases  which  have  occurred  in  England 
during  the  last  twenty  years,  I  find  that  the  latent  causes  of  death 
in  wounded  persons  have  been  chiefly  inflammation  of  the  thoracic 
or  abdominal  viscera,  apoplexy,  diseases  of  the  heart  and  large  blood- 
vessels, phthisis,  ruptures  of  the  stomach  and  bowels  from  disease, 
internal  strangulation,  and  the  rupture  of  deep-seated  abscesses.  In 
some  of  these  cases  the  person  was  in  a  good  state  of  health  up  to  the 
time  of  the  violence,  and  in  others  there  was  a  slight  indisposition. 
The  history  is  nearly  the  same  in  all :  it  was  only  by  careful  con- 
duct on  the  part  of  the  medical  witnesses  that  the  true  cause  of  death 
was  ascertained.  It  is  obvious  that  questions  of  malapraxis  and  life- 
insurance,  giving  rise  to  civil  actions,  may  have  a  close  relation  to 
this  subject. 

Death  following  Slight  Personal  Injuries. — An  imputation  has  oc- 
casionally been  thrown  on  the  master  of  a  school,  when  a  boy  has 
died  soon  after  he  has  been  punished  in  an  ordinary  way,  and  when 
there  has  been  no  suggestion  that  an  undue  amount  of  violence  was 
used.  In  such  cases  there  has  been  commonly  some  unhealthy  state 
of  the  body  to  explain  the  fatal  result.  AVhen  the  disease  which 
gives  rise  to  doubt  is  seated  in  a  part  which  is  remote  from  that 
which  sustained  the  violence,  all  that  is  required  is,  that  the  exami- 
nation of  the  body  should  be  conducted  with  ordinary  care.  If  the 
disease  should  happen  to  be  in  the  part  injured  (the  head  or  chest), 
the  case  is  more  perplexing.  The  difficulty  can  then  be  removed 
only  by  attentively  considering  the  usual  consequences  of  such  inju- 
ries. The  violence  may  have  been  too  slight  to  account  for  the  dis- 
eased appearance ;  and  the  disease  itself,  although  situated  in  the  part 
injured,  may  be  regarded  as  an  unusual  consequence  of  such  an 
injury.  On  the  other  hand,  the  presence  of  chronic  disease  will  form 
no  exculpation  of  acts  of  violence  of  this  nature. 

Death  from  Wounds  after  Long  Periods. — Certain  kinds  of  injuries 
are  not  immediately  followed  by  serious  consequences,  but  a  wounded 
person  may  die  after  a  longer  or  shorter  period  of  time,  and  his  death 
may  be  as  much  a  consequence  of  the  injury  as  if  it  had  taken  place 
on  the  spot.  The  aggressor,  however,  is  just  as  responsible  as  if  the 
deceased  had  been  directly  killed  by  his  violence,  provided  the  fatal 
result  can  be  traced  to  the  usual  and  probable  consequences  of  the 
injury.  Wounds  of  the  head  are  especially  liable  to  cause  death 
insidiously — the  wounded  person  may  in  the  first  instance  recover — 
he  may  appear  to  be  going  on  well,  when,  without  any  obvious 
cause,  he  will  suddenly  expire.  It  is  scarcely  necessary  to  observe, 
that  in  general  an  examination  of  the  body  will  suffice  to  determine 
whether  death  is  to  be  ascribed  to  the  wound  or  not.  In  severe  inju- 
ries affecting  the  spinal  marrow,  death  is  not  an  immediate  conse- 


262  SECONDARY    CAUSES    OF    DEATH. 

quence,  unless  that  part  of  the  organ  which  is  above  the  origin  of 
the  phrenic  nerves  (supplying  the  diaphragm)  is  wounded.  Injuries 
affecting  the  lower  portion  of  the  spinal  column  do  not  commonly 
prove  fatal  until  after  some  days  or  weeks  ;  but  the  symptoms  mani- 
fested by  the  patient  during  life,  as  well  as  the  appearances  observed 
in  the  body  after  death,  will  sufficiently  connect  the  injury  with  that 
event.  Death  may  follow  a  wound,  and  be  a  consequence  of  that 
wound,  at  almost  any  period  after  its  infliction.  It  is  necessary, 
however,  in  order  to  maintain  a  charge  of  homicide,  that  death  should 
be  strictly  and  clearly  traceable  to  the  injury,  and  not  be  dependent 
on  any  other  cause.  A  doubt  on  this  point  must,  of  course,  lead  to 
an  acquittal  of  the  accused. 

Many  cases  might  be  quoted  in  illustration  of  the  length  of  time 
which  may  elapse  before  death  takes  place  from  certain  kinds  of 
injuries— the  injured  person  having  ultimately  fallen  a  victim  to 
their  indirect  consequences.  A  case  is  related  by  Sir  A.  Cooper,  of 
a  gentleman  who  died  from  the  effects  of  an  injury  to  the  head  re- 
ceived about  two  years  previously.  The  connection  of  death  with 
the  wound  was  clearly  made  out  by  the  continuance  of  the  symptoms 
of  cerebral  disturbance  during  the  long  period  which  he  survived. 
Another  case  is  mentioned  by  Hoffbauer,  in  which  a  person  died 
from  the  effects  of  concussion  of  the  brain  as  the  result  of  an  injury 
received  eleven  years  before.     ("  Ueber  die  Kopfverletzungen,"  1842, 

There  is  a  singular  rule  in  our  law  relative  to  the  period  at  which 
a  person  dies  from  the  wound— namely,  that  the  assailant  shall  not 
be  adjudged  guilty  of  homicide,  unless  death  takes  place  within  a 
year  and  a  day  after  the  infliction  of  the  wound.  (Archbold,  p. 
3-A5.)  In  practice,  the  existence  of  this  rule  is  of  little  importance, 
but  in  principle  it  is  erroneous.  Most  wounds  leading  to  death  gene- 
rally destroy  life  within  two  or  three  months  after  their  infliction : 
sometimes  the  person  does  not  die  for  five  or  six  months,  and,  in 
more  rare  instances,  death  does  not  ensue  until  after  the  lapse  of 
twelve  months,  or  even  several  years.  These  protracted  cases  occur 
especially  in  respect  to  injuries  of  the  head  and  chest. 

Secondary  Causes  of  Death. — A  person  who  recovers  from  the 
immediate  effects  of  a  wound  may  die  from  fever,  inflammation  or  its 
consequences,  pyemia,  erysipelas,  delirium  tremens,  tetanus,  or 
gangrene;  or  an  operation  required  during  the  treatment  of  a  wound 
may  prove  fatal.  These  are  what  may  be  called  secondary  causes  of 
death,  or  secondary  consequences  of  a  wound.  The  power  of  de- 
ciding on  the  responsibility  of  an  accused  person  for  an  event  which 
depends  only  in  an  indirect  manner  on  an  injury  originally  inflicted 
b}'  him,  rests  of  course  with  the  authorities  of  the  law.  But  it  is 
impossible  that  they  can  decide  so  difficult  and  nice  a  question  in 
the  absence  of  satisfactory  medical  evidence ;  and  on  the  other  hand,  it 
is  right  that  a  medical  witness  should  understand  the  importance  of 
the  duty  here  required  of  him.  Fever  or  erysipelas  may  follow  many 
kinds  of  serious  wounds,  and  in  some  few  instances  be  distinctly 
traceable  to  them ;  but  in  others,  the  constitution  of  a  person  may 


AVOIDABLE    AND    UNAVOIDABLE    CAUSES.  203 

be  so  broken  up  by  dissipated  habits  as  to  render  a  wound  fatal 
which,  in  a  healthy  subject  might  have  run  through  its  course  mildly, 
and  have  healed.  When  the  fever  or  erysipelas  can  be  traced  to  a 
wound,  or  there  is  no  other  apparent  cause  of  aggravation  to  which 
either  of  these  disordered  states  of  the  body  can  be  attributed,  they 
can  scarcely  be  regarded  by  a  medical  practitioner  as  unexpected 
and  unusual  consequences,  especially  when  the  injury  is  extensive, 
and  seated  in  certain  parts  of  the  body,  as  in  the  scalp.  If  death 
take  place  under  these  circumstances,  the  prisoner  will  be  held  as 
much  responsible  for  the  result  as  if  the  wound  had  proved  directly 
mortal.  This  principle  has  been  frequently  admitted  by  our  law, 
and,  indeed,  were  it  otherwise,  many  reckless  offenders  would  escape, 
and  many  lives  would  be  sacrificed  with  impunity.  It  is,  however, 
difficult  to  lay  down  general  rules  upon  a  subject  which  is  liable  to 
vary  in  its  relations  in  every  case;  but  when  a  wound  is  not  serious, 
and  the  secondary  cause  of  death  is  evidently  due  to  constitutional 
peculiarities  from  acquired  habits  of  dissipation,  the  ends  of  justice 
are  probably  fully  answered  by  an  acquittal ;  in  fact,  such  cases  do 
not  often  pass  beyond  a  coroner's  inquest. 

The  secondary  causes  of  death  may  be  arranged  under  the  follow- 
ing heads : — 

1.  The  Cause  is  Unavoidable. — Of  this  kind  are  tetanus,  following 
laceration  of  tendinous  and  nervous  structures — erysipelas  following 
lacerated  wounds  of  the  scalp — peritoneal  inflammation  following 
blows  on  the  abdomen  with  or  without  rupture  of  the  bladder  or 
intestines,  and  effusion  of  their  contents — strangulation  of  the  intes- 
tines (phrenic  hernia),  following  rupture  of  the  diaphragm,  and  others 
of  a  like  nature.  Here,  supposing  proper  medical  treatment  and 
regimen  to  have  been  pursued,  the  secondary  cause  of  death  was 
unavoidable,  and  the  fatal  result  certain. 

2.  The  Cause  Avoidable  by  Good  Medical  Treatment. — There  are,  it 
is  obvious,  many  kinds  of  wounds  which,  if  properly  treated  in  the 
first  instance  may  be  healed  and  the  patient  recover,  but  when  im- 
properly treated  they  prove  fatal.  In  the  latter  case  it  will  be  a 
question  for  a  witness  to  determine  how  far  the  treatment  aggravated 
the  effects  of  the  violence,  and  from  his  answer  to  this  the  jury  may 
have  to  decide  on  the  degree  of  criminality  which  attaches  to  the 
accused.  Let  us  suppose,  for  instance,  that  an  ignorant  person  has 
removed  a  clot  of  blood,  which  sealed  up  the  extremity  of  a  blood- 
vessel, in  consequence  of  which  fatal  bleeding  has  ensued ;  or  that 
he  has  caused  death  by  unnecessarily  interfering  with  a  penetrating 
wound  of  the  chest  or  abdomen ;  it  would  scarcely  be  just  to  hold 
the  aggressor  responsible,  since,  but  for  the  gross  ignorance  and  un- 
skilfulness  of  his  attendant,  the  wounded  person  might  have  reco- 
vered from  the  effects  of  the  wound.  When  death  is  really  traceable 
to  the  negligence  or  unskilfulness  of  a  surgeon  who  is  called  to  at- 
tend on  a  wounded  person,  this  circumstance  ought  to  be,  and  com- 
monly is,  admitted  in  mitigation,  supposing  that  the  wound  was  not 
originally  of  a  mortal  nature.  Lord  Hale  observes :  "  It  is  suffi- 
cient to  constitute  murder,  that  the  party  dies  of  the  wound  given 


264:       WOUNDS.      COMPARATIVE    SKILL    IK    TREATMENT. 

by  the  prisoner,  although  the  wound  was  not  originally  mortal,  but 
became  so  in  consequence  of  negligence  or  unskilful  treatment;  but 
it  is  otherwise  where  death  arises,  not  from  the  wound,  but  from  un- 
skilful applications  or  operations  used  for  the  purpose  of  curing  it." 
( 1,  428.)  The  medical  jurist  will  perceive  that  a  very  nice  distinction 
is  here  drawn  by  this  great  judge,  between  death  as  it  results  from 
a  wound  rendered  mortal  by  improper  treatment,  and  death  as  it 
results  from  improper  treatment,  irrespective  of  the  wound.  In  the 
majority  of  cases  such  a  distinction  could  scarcely  be  established, 
except  upon  speculative  grounds,  and  in  no  case,  probably,  would 
there  be  any  accordance  in  the  opinions  of  medical  witnesses.  In 
slight  and  unimportant  wounds,  it  might  not  be  difficult  to  distinguish 
the  effects  resulting  from  bad  treatment  from  those  connected  with 
the  wound,  but  there  can  be  few  cases  of  severe  injury  to  the  person, 
wherein  a  distinction  of  this  nature  could  be  safely  made ;  and  the 
probability  is,  that  no  conviction  of  murder  would  now  take  place, 
if  the  medical  evidence  showed  that  the  injury  was  not  originallv 
mortal,  but  only  became  so  by  unskilful  or  improper  treatment.  In 
such  a  case,  it  would  be  impossible  to  ascribe  death  to  the  wound, 
or  to  its  usual  or  probable  consequences ;  and  without  this  it  is  not 
easy  to  perceive  on  what  principle  an  aggressor  could  be  made  re- 
sponsible for  the  result.  [In  Commonwealth  v.  Hackett,  2  Allen  i  Mas- 
sachusetts) 186,  it  was  held  that  one  who  has  wilfully  inflicted  upon 
another  a  dangerous  wound,  with  a  deadly  weapon,  from  which 
death  ensues,  is  guilty  of  murder  or  manslaughter,  as  the  evidence 
may  prove,  although  through  want  of  care  or  skill,  the  improper 
treatment  of  the  wound  by  surgeons  may  have  contributed  to  the 
death.     See  also  Commonwealth  v.  Green,  1  Ash.  289. — P.] 

3.  Comparative  Skill  in,  Treatment. — If  death  has  been  caused  by  a 
wound,  the  responsibility  of  a  person  is  not  altered  by  the  allegation 
that  under  more  favorable  circumstances  and  with  more  skilful 
ment,  a  fatal  result  might  have  been  averted.  At  the  same  time  it  is 
obvious  that  a  serious  responsibility  is  thrown  on  practitioners  who 
undertake  the  management  of  cases  of  criminal  wounding.  Any 
deviation  from  ordinary  practice  should  therefore  be  made  with  the 
greatest  caution,  since  novelties  in  practice  will,  in  the  event  of  a 
fatal  result,  form  one  of  the  best  grounds  of  defence  in  the  hands  of 
a  prisoner's  counsel.  On  these  occasions  every  point  connected  with 
the  surgical  treatment  will  be  the  subject  of  rigorous  inquiry  and 
adverse  professional  criticism.  In  the  case  of  a  severe  lacerated 
wound  in  the  hand  or  foot  followed  by  fatal  tetanus,  it  may  be  said 
that  the  wounded  person  would  not  have  died  had  amputation  been 
at  once  performed.  In  this  instance,  however,  a  practitioner  may 
justify  himself  by  showing  either  that  the  injury  was  too  slight  to 
require  amputation,  or  that  the  health  or  other  circumstances  con- 
nected with  the  deceased  would  not  allow  of  its  being  performed  with 
any  reasonable  hope  of  success.  On  the  other  hand,  if  the  practi- 
tioner performed  amputation,  and  the  patient  died,  then  it  would  be 
urged  that  the  operation  was  premature,  or  wholly  unjustifiable,  and 
that  it  had  caused  death.     Here  the  surgeon  is  bound  to  show  that 


DEATH  FROM  IMPRUDENCE  OR  NEGLECT.       265 

the  operation  was  necessary  according  to  the  ordinary  rules  of  prac- 
tice. The  treatment  of  severe  incised  wounds  of  the  throat,  when 
the  windpipe  is  involved,  sometimes  places  a  practitioner  in  an  em- 
barrassing position.  If  the  wound  is  left  open,  death  may  take  place 
from  bleeding;  if  it  be  prematurely  closed,  blood  may  be  infused 
into  the  windpipe  and  cause  death  by  suffocation. 

•i.  The  Cause  Avoidable  but  for  Imprudence  or  Neglect  on  the  Part  of 
a  Wounded  Person. — A  man  who  has  been  severely  wounded  in  a 
quarrel,  may  obstinately  refuse  medical  assistance,  or  he  may  insist 
upon  taking  exercise,  or  using  an  improper  diet,  contrary  to  the 
advice  of  his  medical  attendant ;  or  by  other  imprudent  practices, 
he  may  thwart  the  best  conceived  plans  for  his  recovery.  Let  us 
take  a  common  case  as  an  illustration.  A  man  receives  a  blow  on 
the  head  in  a  pugilistic  combat,  from  the  first  effects  of  which  he 
recovers,  but  after  having  received  surgical  assistance,  he  indulges 
in  excessive  drinking,  and  dies.  The  aggressor  is  tried  on  a  charge 
of  manslaughter,  and  found  guilty.  Death  under  these  circumstances 
is  commonly  attributed  by  the  medical  witness  to  effusion  of  blood 
on  the  brain ;  but  it  cannot  be  denied  that  the  excitement  produced 
by  intoxicating  liquors,  will  sometimes  satisfactorily  account  for  the 
fatal  symptoms.  In  the  case  which  we  are  here  supposing,  such  an 
admission  might  be  made,  and  the  prisoner  receive  the  benefit  of  it; 
for  the  imprudence  or  negligence  of  a  wounded  person  ought  not, 
morally  speaking,  to  be  considered  as  adding  weight  to  the  offence 
of  the  aggressor.  If  the  symptoms  were  from  the  first  unfavorable, 
or  the  wound  likely  to  prove  mortal,  circumstances  of  this  kind 
could  not  be  received  in  mitigation.  Our  judges  have  shown  them- 
selves at  all  times  unwilling  to  admit  them.  The  legal  responsi- 
bility of  the  assailant  is  the  same,  whether  the  deceased  die  on  the 
spot,  or  some  days,  weeks,  or  months  afterwards,  unless  it  can  be 
distinctly  proved  that  his  death  was  immediately  connected  with  the 
imprudence  or  excess  of  which  he  was  guilty,  and  wholly  indepen- 
dent of  the  wound.  But,  although  a  prisoner  should  be  found  guilty 
of  manslaughter  under  these  circumstances,  the  punishment  is  so 
adjusted  by  our  law  as  to  leave  a  considerable  discretionary  power 
in  the  hands  of  a  judge.  This  is,  indeed,  tantamount  to  a  direct 
legal  provision,  comprehending  each  different  shade  of  guilt;  a  man 
is  held  responsible  for  a  wound  rendered  accidentally  mortal  by 
events  over  which  he  could  have  no  control,  but  which  in  them- 
selves ought  to  be  regarded  as  in  some  degree  exculpatory.  The 
punishment  attached  to  his  offence  may  be  severe  or  slight,  accord- 
ing to  the  representation  made  by  a  medical  witness  of  the  circum- 
stances wdiich  rendered  the  wound  mortal;  if  he  neglect  to  state  the 
full  influence  of  imprudence  or  excess  on  the  part  of  the  wounded 
person,  where  either  has  existed,  over  the  progress  of  the  wound, 
lie  may  cause  the  prisoner  to  be  punished  with  undue  severity.  The 
humanity  of  our  judges  is  such,  that  when  medical  evidence  is  clear 
and  consistent  on  a  point  of  this  nature,  and  there  are  no  circum- 
stances in  aggravation,  they  commonly  pass  a  mild  sentence.  (See 
case  by  M.  Olliyier,  "Ann'.  dTIyg."     1842,  p.  128.)     The  neglect  to 


266  WOUNDS.      UNHEALTHY    STATE    OF    BODY. 

call  in  a  medical  practitioner,  or  the  refusal  to  receive  medical  ad- 
vice, will  not,  however,  according  to  the  decision  in  Reg.  v.  Thomas 
(Gloucester  Aut.  Ass.  1841),  be  considered  a  mitigatory  circumstance 
in  favor  of  the  prisoner,  even  although  the  wound  was  susceptible 
of  being  cured.  A  man  may  receive  a  lacerated  wound  of  a  limb, 
which  is  followed  by  tetanus  or  gangrene,  and  thus  proves  fatal ;  he 
may  have  declined  receiving  medical  advice,  or  have  obstinately 
refused  amputation,  although  proposed  by  his  medical  attendant. 
This  would  not  operate  as  a  mitigatory  circumstance  on  the  part  of 
an  assailant,  because  a  wounded  person  is  not  compelled  to  call  for 
medical  assistance,  or  to  submit  to  an  operation,  and  a  medical  wit- 
ness could  not  always  be  in  a  condition  to  swear  that  the  operation 
would  have  positively  saved  his  life ;  he  can  merely  affirm  that  it 
might  have  afforded  him  a  better  chance  of  recovery.  Again,  a 
person  may  receive  a  blow  on  the  head,  producing  fracture,  with 
great  depression  of  bone,  and  symptoms  of  compression  of  the  brain : 
a  surgeon  may  propose  the  operation  of  trephining  to  elevate  the 
depressed  bone,  but  the  friends  of  the  wounded  man  may  not  per- 
mit the  operation  to  be  performed.  In  such  a  case,  his  line  of  duty 
will  be  to  state  the  facts  to  the  court,  and  it  is  probable  that  in  the 
event  of  conviction  there  would  be  some  mitigation  of  punishment; 
because  such  an  injury,  if  left  to  itself,  must  in  general  prove  mor- 
tal, and  no  doubt  could  exist  in  the  mind  of  any  surgeon,  as  to  the 
absolute  necessity  for  the  operation.  But  the  neglect  or  improper 
conduct  of  a  person  who  receives  a  wound  thus  rendered  fatal,  does 
not  exculpate  the  aggressor.  The  crime  is  either  murder  or  man- 
slaughter. 

5.  The  Cause  Avoidable  but  for  an  Abnormal  or  Unhealthy  State  of 
the  Body  of  the  Wounded  Person. — Wounds  which  are  comparatively 
slight  sometimes  prove  indirectly  fatal,  owing  to  the  person  being 
in  an  unhealthy  condition  at  the  time  of  their  infliction.  In  bad 
constitutions,  compound  fractures  or  slight  wounds,  which  in  a  healthy 
person  would  have  a  favorable  termination,  are  folloAved  by  gan- 
grene, fever,  or  erysipelas,  proving  fatal.  Here  the  responsibility 
of  an  assailant  for  the  death  may  become  reduced,  so  that,  although 
found  guilty  of  manslaughter,  a  mild  punishment  might  be  inflicted. 
The  consequence  may  be,  medically  speaking,  unusual  or  unex- 
pected, and,  but  for  circumstances  wholly  independent  of  the  act  of 
the  accused,  would  not  have  been  likely  to  destroy  life.  In  general, 
in  the  absence  of  malice,  this  appears  to  be  the  point  to  which  the 
law  closely  looks,  in  order  to  make  out  the  responsibility  of  the 
accused — namely,  that  the  fatal  secondary  cause  must  be  something 
not  unusual  or  unexpected  as  a  consequence  of  this  particular  injury. 
The  medico-legal  question  presents  itself  under  this  form  :  Would 
the  same  amount  of  injury  have  been  likely  to  cause  death  in  a  per- 
son of  ordinary  health  and  vigor?  Men  who  have  suddenly  changed 
their  habits  of  living,  and  have  passed  from  a  full  diet  to  abstemi- 
ousness, are  sometimes  unable  to  bear  up  against  comparatively 
slight  injuries,  and  often  sink  from  the  secondary  consequences.  So 
a  man  othenvisc  healthy  laboring  under  rupture,  may  receive  a  blow 


DEATH    FROM    SLIGHT    INJURIES.  267 

on  the  groin,  attended  with  laceration  of  the  intestine,  gangrene,  and 
death;  another  with  a  calculus  in  the  kidney  may  be  struck  in  the 
loins  and  die,  in  consequence  of  the  calculus  perforating  the  blood- 
vessels and  causing  fatal  bleeding  or  subsequent  inflammation. 

It  must  be  evident  that  there  exist  numerous  internal  diseases, 
such  as  aneurism,  and  various  morbid  affections  of  the  heart  and 
brain,  which  are  liable  to  be  rendered  fatal  by  slight  external  vio- 
lence. The  law,  as  applied  to  these  cases,  is  thus  stated  by  Lord 
Hale:  "It  is  sufficient  to  prove  that  the  death  of  a  person  was  ac- 
celerated by  the  malicious  act  of  the  prisoner,  although  the  former 
labored  under  a  mortal  disease  at  the  time  of  the  act."  (1,  428.)  In 
those  cases  in  which  a  slight  degree  of  violence  has  been  followed 
by  fatal  consequences,  it  is  for  a  jury  to  decide,  under  all  the  cir- 
cumstances, upon  the  actual  and  specific  intention  of  the  prisoner  at 
the  time  of  the  act  which  occasioned  death.  According  to  Starkie, 
"it  seems  that  in  general,  notwithstanding  any  facts  which  tend  to 
excuse  or  alleviate  the  act  of  the  prisoner,  if  it  be  proved  that  he 
was  actuated  by  prepense  and  deliberate  malice,  and  that  the  par- 
ticular occasion  and  circumstances  upon  which  he  relies  were  sought 
for  and  taken  advantage  of  merely  with  a  view  to  qualify  actual 
malice,  in  pursuance  of  a  preconceived  scheme  of  destruction,  the 
offence  will  amount  to  murder."  In  most  of  these  cases  there  is  an 
absence  of  intention  to  destroy  life,  but  the  nature  of  the  wound,  as 
well  as  the  means  by  which  it  was  inflicted,  will  often  suffice  to  de- 
velop the  intention  of  the  prisoner.  An  accurate  description  of  the 
injury,  if  slight,  may  afford  strong  evidence  in  favor  of  the  accused, 
since  the  law  does  not  so  much  regard  the  means  used  by  him  to 
perpetrate  the  violence,  as  the  actual  intention  to  kill,  or  to  do  great 
bodily  harm.  Serious  injury,  causing  death  by  secondary  conse- 
quences, will  admit  of  no  exculpation  when  an  assailant  was  aware, 
or  ought  to  have  been  aware,  of  the  condition  of  the  person  whom 
he  struck.  Thus,  if  a  person  notoriously  ill,  or  a  woman  while 
pregnant,  be  maltreated,  and  death  ensue  from  a  secondary  cause, 
the  assailant  will  be  held  responsible ;  because  he  ought  to  have 
known  that  violence  of  any  kind  to  persons  so  situated,  must  be  at- 
tended with  dangerous  consequences.  So,  if  the  person  maltreated 
be  an  infant  or  a  decrepit  old  man,  or  one  laboring  under  a  mortal 
disease,  it  is  notorious  that  a  comparatively  slight  degree  of  violence 
will  destroy  life  in  these  cases,  and  the  prisoner  would  properly  be 
held  responsible.  A  wound  which  accelerates  death  causes  death,  and 
may  therefore  render  the  aggressor  responsible  for  murder  or  man- 
slaughter, according  to  the  circumstances.  The  Commissioners  ap- 
pointed to  define  the  criminal  law  on  the  subject  of  homicide  thus 
express  themselves :  "  Art.  8.  It  is  homicide,  although  the  effect  of 
the  injury  be  merely  to  accelerate  the  death  of  one  laboring  under  some 
previous  injury  or  infirmity,  or  although,  if  timely  remedies  or 
skilful  treatment  had  been  applied,  death  might  have  been  pre- 
vented." This  is  conformable  to  the  decisions  of  our  judges.  Ac- 
cording to  Lord  Hale,  if  a  man  has  a  disease  which  in  all  likelihood 
would  terminate  his  life  in  a  short  time,  and  another  give  him  a 


268  DEATH    UNDER    ABNORMAL    CONDITIONS. 

wound  or  hurt  which  hastens  his  death,  this  is  such  a  killing  as  con- 
stitutes murder.     (Archbold,  p.  345.) 

6.  Abnormal  Conditions. — -When  an  assailant  could  not  have  been 
aware  of  the  existence  of  a  diseased  or  an  abnormal  condition  of 
parts  in  the  wounded  person,  the  question  is  somewhat  different. 
In  many  persons  the  skull  is  preternaturally  thin,  and  in  most  per- 
sons it  is  so  in  those  places  corresponding  to  the  gland ulse  Pacchioni. 
In  a  case  of  this  kind  a  moderate  blow  on  the  head  might  cause  frac- 
ture, accompanied  by  effusion  of  blood,  depression  of  bone,  or  sub- 
sequent inflammation  of  the  brain  and  its  membranes,  any  of  which 
causes  might  prove  fatal.  In  some  persons,  all  the  bones  of  the 
body  are  unusually  brittle,  so  that  they  are  fractured  by  the  slightest 
force.  Inflammation,  gangrene,  and  death  may  follow,  when  no  con- 
siderable violence  has  been  used ;  but  these  being  unexpected  conse- 
quences, and  depending  on  an  abnormal  condition  of  parts  unknown 
to  the  prisoner,  his  responsibility  may  not,  coeteris  paribus,  be  so  great 
as  under  other  circumstances.  This  condition  of  the  bones  can  be 
determined  only  by  a  medical  practitioner.  Facts  of  this  kind  show 
that  the  degree  of  violence  used  in  an  assault  cannot  always  be 
measured  by  the  effects,  unless  a  careful  examination  of  the  injured 
part  is  previously  made. 

7.  Difficulty  of  Proof  in  Death  from  Secondary  Causes. — When  a 
person  is  charged  with  having  caused  the  death  of  another  through 
violence  terminating  in  some  fatal  disease,  the  case  often  admits  of  a 
skilful  defence,  and  this  in  proportion  to  the  length  of  time  after  the 
violence,  at  which  the  deceased  dies.  The  disease,  it  may  be  urged, 
is  liable  to  appear  in  all  persons,  even  the  most  healthy ;  or  it  may 
arise  from  causes  unconnected  with  the  violence.  In  admitting  these 
points,  it  must  be  remembered  that  death  may  be  proved  to  have 
been  indirectly  a  consequence  of  the  wound  by  the  facts:  1,  that  the 
supervention  of  the  secondary  cause,  although  not  a  common  event, 
lay  in  the  natural  course  of  things ;  2,  that  there  did  not  exist  any 
accidental  circumstances  which  were  likely  to  have  given  rise  to  this 
secondary  cause  independently  of  the  wound.  The  proof  of  the 
first  point  amounts  to  nothing,  unless  the  evidence  on  the  second 
point  is  conclusive. 


CHAPTER   XXIX. 

Wounds  indirectly  fatal. — tetanus  following  wounds. — ery- 
sipelas.— DELIRIUM  TREMENS. — GANGRENE. — DEATH  FROM  SURGI- 
CAL OPERATIONS. — PRIMARY  AND  SECONDARY  CAUSES  OF  DEATH. 

UNSKILFULNESS    IN    OPERATIONS. — PYJBMIA. — MEDICAL    RESPONSI- 
BILITY IN  REFERENCE  TO  OPERATIONS. — ACTIONS  FOR  MALAPRAX1S. 

Tetanus  following  Wounds. — Tetanus  frequently  presents  itself  as  a 
secondary  fatal  consequence  of  wounds,  especially  of  those  which  are 


WOUNDS.      DEATH    FROM    TETANUS.  209 

lacerated  or  contused,  and  affect  nervous  or  tendinous  structures.  It 
lias  often  occurred  as  a  result  of  slight  braises  or  lacerations,  when 
the  injury  was  so  superficial  as  to  excite  no  alarm  ;  and  it  is  a  disease 
which  gives  no  warning  of  its  appearance.  Tetanus  may  come  on 
spontaneously,  i.  e.,  independently  of  the  existence  of  any  wound 
on  the  body.  Cases  have  been  brought  into  the  London  hospitals, 
in  which  the  only  cause  of  this  disease  appeared  to  be  exposure  to 
cold  or  wet,  or,  in  some  instances,  exposure  to  a  current  of  air. 
("  Lancet,"  Dec.  14,  1844,  351.)  It  is  scarcely  possible  to  distinguish, 
by  the  symptoms,  tetanus  from  wounds  (traumatic)  from  that  which 
occurs  spontaneously  as  a  result  of  natural  causes  (idiopathic).  In 
endeavoring  to  connect  its  appearance  with  a  particular  wound  or 
personal  injury,  it  will  be  proper  to  observe — 1,  whether  there  were 
any  symptoms  indicative  of  it  before  the  maltreatment;  2,  whether 
any  probable  cause  could  have  intervened  to  produce  it,  between  the 
time  of  its  appearance  and  the  time  at  which  the  violence  was  in- 
flicted ;  3,  whether  the  deceased  ever  rallied  from  the  effects  of  the 
violence.  The  time  at  which  tetanus  usually  makes  its  appearance, 
when  it  is  the  result  of  a  wound,  is  from  the  third  to  the  sixth  day ; 
but  it  may  not  appear  until  three  or  four  weeks  after  the  injury,  and 
the  exciting  cause  may  still  be  traced  to  the  wound  which  may  have 
healed.     When  resulting  from  a  wound  it  is  generally  fatal. 

A  medical  practitioner  is  bound  to  exercise  great  caution  before 
he  pronounces  an  opinion  that  a  fatal  attack  of  tetanus  has  arisen 
either  from  spontaneous  causes,  or  from  slight  blows  or  personal  in- 
juries. A  rigorous  inquiry  should  be  made  into  all  the  attendant 
circumstances.  Slight  punctured  wounds,  operating  as  a  cause  of 
tetanus,  have  been  overlooked  or  only  discovered  by  accident  after 
death,  and  it  is  highly  probable  that  many  cases  have  been  set  down 
as  idiopathic  tetanus  in  which,  by  proper  inquiry,  the  disease  might 
have  been  traced  to  a  wound  or  some  personal  injury.  In  one  in- 
stance the  tetanus  was  at  first  considered  to  be  idiopathic ;  but 
shortly  before  death  a  small  black  mark  was  observed  on  the  thumb 
nail.  On  making  inquiry,  it  was  found  that  a  few  days  previously 
to  the  attack  a  splinter  of  wood  had  accidentally  penetrated  the 
thumb.  The  patient  attached  so  little  imprtance  to  the  accident  that 
he  did  not  mention  the  circumstance  to  his  medical  attendant.  This 
was  no  doubt  the  sole  cause  of  the  disease.  Many  trials  for  murder 
have  occurred  in  this  country  in  which  tetanus  was  the  immediate 
cause  of  death ;  and  the  defence  has  generally  rested  upon  the  pro- 
bable origin  of  the  disease  from  accidental  causes. 

Erysipelas,  like  tetanus,  may  be  a  fatal  result  of  slight  injuries. 
Wounds  affecting  the  scalp  are  liable  to  be  followed  by  this  disease. 
Burns  and  scalds  sometimes  prove  fatal  through  this  secondary 
cause.  Some  constitutions  are  particularly  prone  to  erysipelatous 
inflammation,  and  thus,  wounds  comparatively  slight,  may  have  a 
fatal  termination.  When  a  wounded  person  has  died  from  this  dis- 
ease, an  assailant  cannot  be  made  responsible  for  the  fatal  result, 
unless  the  erysipelas  is  clearly  traced  to  the  injury.  The  medical 
facts  that  the  person  assaulted  has  never  recovered  from  the  effects 


270      WOUNDS.      DEATH    FROM    SURGICAL    OPERATIONS. 

of  the  violence,  and  that  the  inflammation  set  up  has  suddenly  as- 
sumed as  erysipelatous  character,  are  sufficient  to  establish  this  con- 
nection. If  there  has  been  recovery,  and  an  interval  of  some  days 
has  elapsed,  a  doubt  may  arise  respecting  the  connection  of  the  ery- 
sipelas with  the  violence  inflicted.  This  disease  is  occasionally  idio- 
pathic, i.  e.,  it  appears  like  tetanus  without  any  assignable  cause. 

It  is  sometimes  difficult  to  establish  the  connection  of  erysipelas 
with  a  wound,  especially  when  the  disease  occurs  after  some  time 
and  in  a  remote  part  of  the  body,  not  implicated  in  the  wound. 
"When  this  connection  cannot  be  distinctly  made  out,  there  will  be 
an  acquittal. 

Delirium  tremens  is  a  disease  which  frequently  presents  itself  as  a 
secondary  consequence  of  injuries  to  persons  of  intemperate  habits. 
Whether  the  injury  be  slight  or  severe,  this  disease  may  equally 
supervene  and  prove  fatal.  It  is  observed  occasionally  as  a  conse- 
quence of  operations  required  for  the  treatment  of  wounded  persons. 
The  remarks  made  at  p.  266  upon  the  influence  of  unhealthy  consti- 
tutions on  wounds,  apply  with  especial  force  to  cases  of  this  descrip- 
tion. 

Death  from  Surgical  Operations. — In  the  treatment  of  wounds,  sur- 
gical operations  are  frequently  resorted  to,  and  a  wounded  person 
may  die  either  during  the  performance  of  an  operation,  or  from  its 
consequences.  A  question  will  thence  arise,  whether  the  person 
who  inflicted  the  wound  should  be  held  responsible  for  the  fatal  re- 
sult. The  law  regards  a  surgical  operation  as  part  of  the  treatment, 
and  if  undertaken  bona  fide,  and  performed  with  reasonable  care 
and  skill,  the  aggressor  will  be  held  responsible,  whatever  may  be 
the  result.  The  necessity  for  the  operation,  and  the  mode  of  per- 
forming it,  will  be  left  to  the  operator's  judgment.  As  the  defence 
may  turn  upon  the  operation  having  been  performed  unnecessarily, 
and  in  a  bungling  and  unskilful  manner,  it  will  be  right  for  a  prac- 
titioner, if  possible,  to  defer  it  until  he  has  had  the  advice  and  assist- 
ance of  other  practitioners.  According  to  Lord  Hale,  if  death  takes 
place  from  an  unskilful  operation,  performed  for  the  cure  of  a  wound, 
andnot  from  the  wound,  the  responsibility  of  the  prisoner  ceases; 
but  this  eminent  lawyer  does  not  appear  to  have  considered  that 
death  may  take  place  as  a  consequence  of  the  most  skilful  operation 
required  lor  the  treatment  of  a  wound,  and  yet  be  wholly  indepen- 
dent of  the  wound  itself. 

If  the  operation  has  been  performed  by  the  medical  witness  him- 
self, and  the  necessity  for  its  performance  is  questioned  by  counsel 
for  the  prisoner,  it  is  open  to  the  witness  to  give  the  requisite  ex- 
planation in  his  evidence.  It  would  appear  from  a  recent  case,  tried 
before  Shee  J.,  that  the  necessity  for  an  operation  will  not  be  assumed ; 
but  if  called  in  question,  it  must  be  proved  by  witnesses  for  the 
prosecution.  In  Beg.  v.  Moreland  (C.  C.  C,  Sept.  20,  1865),  the  pri- 
soner threw  deceased  on  the  ground  and  fractured  his  leg.  The 
limb  was  amputated  at  the  London  Hospital,  and  the  man  subse- 
quently died.  Counsel  for  the  prisoner  asked  the  surgeon  from  the 
hospital  who  spoke  to  the  death  of  the  deceased  whether  an  opera- 


DEATH  FROM  SURGICAL  OPERATIONS.        271 

tion  was  necessary.  The  witness  said  he  could  not  tell,  as  he  had 
not  charge  of  the  case  previous  to  the  operation.  Counsel  then 
raised  the  question  whether  prisoner  or  the  doctors  had  caused  the 
man's  death.  The  counsel  for  the  prosecution  suggested  that  the 
court  might  accept  as  a  fact  that  amputation  would  not  have  been 
performed  had  it  not  been  necessary  :  but  the  learned  judge  said  that 
would  not  do.  They  must  deal  with  the  case  on  the  evidence  before 
them.  He  then  observed  to  the  jury  that  although  undoubtedly 
amputation  would  not  be  adopted  at  such  a  place  as  the  London 
Hospital  without  the  necessity  for  it,  yet  evidence  to  that  effect  must 
be  before  them  on  oath.  They  could  not  act  on  what  they  had  every 
reason  to  believe;  therefore  they  must  acquit  the  prisoner.  The 
failure  of  justice  in  this  case  rested  with  those  who  were  concerned 
for  the  prosecution.  The  operator,  who  could  probably  have  satis- 
fied the  court  that  he  had  not  cut  off  the  wrong  leg,  and  that  there 
were  good  reasons  for  performing  the  operation,  was  not  called  as  a 
witness :  but  in  his  place  a  gentleman  was  summoned  who  could  not 
answer  these  necessary  questions. 

Death  is  by  no  means  an  unusual  result  of  severe  operations,  the 
secondary  consequences  under  which  the  patient  may  die  being  very 
numerous  even  when  the  case  is  most  skilfully  managed.  Sometimes 
the  patient  will  die  on  the  table,  although  but  little  blood  may  have 
been  lost.  Fear,  pain,  and  sudden  shock  to  the  nervous  system,  have 
caused  death  under  these  circumstances.  The  most  common  indirect 
causes  of  death  after  severe  operations,  are  secondary  hemorrhage, 
erysipelas,  tetanus,  delirium  tremens,  pyemia,  and  hectic  fever  with 
gangrene  of  the  stump.  Mr.  Travers  observes,  that,  "  a  pre-existing 
disease  of  the  liver,  kidney,  or  testicles,  though  chronic,  and  in  itself 
not  alarming  to  the  constitution,  becomes  a  drag  upon  its  elasticity, 
and  stands  in  the  way  of  recovery.  Inspection  of  the  body  after 
death  frequently  explains  the  unfavorable  result  of  operations  that 
promise  well,  by  discovering  one  or  more  organs  in  a  state  of  chronic 
disease,  which  had  not  previously  deranged  the  health  in  a  degree 
sufficient  to  give  notice  of  its  existence ;  and  which  might,  therefore, 
have  remained  quiet  for  years  to  come,  had  no  extraordinary  call 
been  made  upon  the  powers  of  the  system."  ("  On  Constitutional 
Irritation,"  p.  4q,  121,  et  seq.) 

Should  an  operation  be  unnecessarily  or  unskilfully  performed, 
the  responsibility  of  an  aggressor  would,  it  is  presumed,  cease,  if 
the  death  of  a  wounded  party  should  be  clearly  traced  to  it.  Thus, 
if  in  carelessly  bleeding  a  wounded  person,  the  brachial  artery  should 
be  laid  open  ("  Aan.  d'Hyg.,"  1881,  t.  2,  p.  115),  or  if,  in  performing 
amputation,  a  large  artery  be  improperly  secured,  so  that  the  patient 
in  either  case  dies  from  loss  of  blood,  the  prisoner  could  not  be 
equitably  held  responsible ;  because  it  would  be  punishing  him  for 
an  event  depending  on  the  unskill'ulness  of  a  medical  practitioner. 
According  to  Piatt  B.  a  prisoner  will  be  held  responsible,  if  the 
original  wound  were  likely  to  produce  death,  although  unskilfully 
treated.  Supposing  the  bleeding  or  amputation  to  be  performed 
with  ordinary  care  and  skill — and  yet,  in  the  one  case,  inflammation 


272      WOUNDS.      DEATH    PROM    SURGICAL    OPERATIONS. 

of  the  veins,  and  in  the  other  erysipelas,  tetanus,  gangrene,  or  fever 
should  destroy  life,  the  prisoner  will  be  liable  for  the  consequences. 
The  practice  of  the  law  is  strictly  consistent  with  justice.  Should 
the  operation  be  considered  to  be  absolutely  required  for  the  treat- 
ment of  a  wound,  which,  according  to  all  probability,  would  prove 
mortal  without  it — should  it  be  performed  with  ordinary  skill,  and 
still  death  ensue  as  a  direct  or  indirect  consequence,  it  is  only  just 
that  the  person  who  inflicted  the  injury  should  be  held  responsible 
for  the  result.  It  is  presumed  in  these  cases,  that  were  the  patient 
left  to  himself,  he  would,  in  all  probability,  die  from  the  effects  of 
the  wound.  If,  therefore,  a  surgeon,  knowing  that  an  operation 
would  give  a  chance  of  saving  life  on  such  an  occasion,  did  not  per- 
form it,  it  might  be  contended  in  the  defence,  that  the  deceased  had 
died,  not  from  the  wound,  but  from  the  incompetency  and  neglect  of 
his  medical  attendant.  Hence  it  follows  that  if,  during  this  necessary 
treatment,  unforeseen  though  not  unusual  causes  cut  short  life,  no 
exculpation  should  be  admitted,  if  it  went  to  attack  the  best-directed 
efforts  made  for  the  preservation  of  life.  (See  "  Ann.  d'Hyg."  1835, 
t.  1,  p.  231.)  If  an  operation  is  rendered  necessary  by  reason  of  the 
improper  treatment  of  the  wound,  the  responsibility  of  an  assailant 
for  a  fatal  result  ceases. 

In  a  large  number  of  operations  it  is  now  the  general  practice 
among  surgeons  to  administer  chloroform  vapor,  not  only  to  allay  pain 
but  to  prevent  that  exhaustion  to  the  patient  which  is  likely  to  arise 
from  protracted  surgical  proceedings.  In  spite  of  care  on  the  part 
of  the  operator,  this  vapor  is  liable  to  destroy  life  in  an  unexpected 
manner,  and  the  patient  may  die  either  before  the  operation  is  com- 
menced or  during  its  performance.  The  facts  may  leave  no  doubt 
that  the  wounded  person  died  from  chloroform,  and  not  from  the 
wound  or  the  operation.  On  inspection  of  the  body,  the  heart  may 
be  found  in  an  unhealthy  state,  a  fact  which  is  usually  considered 
sufficient  to  account  for  the  fatal  effects  of  chloroform  vapor.  In  a 
case  of  this  kind — What  becomes  of  the  responsibility  of  the  per- 
son who  inflicted  the  original  wound  ?  No  decision,  so  far  as  I  know, 
has  ever  been  given  on  this  point.  Was  the  use  of  chloroform  vapor 
in  a  professional  view  a  necessary  part  of  the  treatment  ?  Was  it 
skilfully  and  properly  administered?  Could  the  diseased  condition 
of  the  heart  which  rendered  the  effects  of  the  vapor  more  fatal  than 
usual  have  been  detected  by  the  operator,  so  as  to  show  the  impro- 
prietv  of  administering  it  in  this  case?  These  questions  should 
receive  satisfactory  answers  before  the  aggressor  is  rendered  respon- 
sible for  death  under  such. peculiar  circumstances.* 

By  an  operation  being  absolutely  reqtiired,  are  we  to  understand 
that  it  is  necessary  to  preserve  life,  i.  e.,  that  the  wound  will  proba- 
bly prove  fatal  without  it  ?  Bleeding  and  cupping  may  be  necessary 
as  part  of  the  treatment  of  a  wounded  person;  but  unless  it  could 
be  sworn  that  this  treatment  was  required,  in  the  judgment  of  the 
surgeon,  for  the  preservation  of  life  from  the  injury  inflicted,  it  is 
doubtful  whether,  in  the  event  of  death  occurring  from  these  simple 
operations,  the  assailant  would  be  held  responsible  for  the  fatal  re- 


OPERATIONS    UNDER    A    MISTAKEN"    OPINION.  273 

suit.  From  cases  hitherto  decided,  it  would  appear  that  the  law- 
regards  three  circumstances  in  death  following  surgical  operations : 
1st,  the  necessity  of  the  operation  itself;  2d,  the  competency  of  the 
operator ;  and  3d,  the  fact  that  the  wound  would  be  likely  to  prove 
mortal  without  it. 

Operations  Under  a  Mistaken  Opinion. — It  may  happen  that  the 
wound  is  not  of  a  mortal  nature,  and  that,  although  an  operation 
was  skilfully  performed,  it  was  not  necessary  to  save  life ;  in  other 
words,  the  wounded  person  may  die  from  the  immediate  results  of  a 
serious  operation,  performed  under  a  mistaken  view  of  the  case.  It 
is  well  known  to  surgeons  that  a  cancerous  tumor  has  been  occa- 
sionally mistaken  for  aneurism,  an  artery  has  been  secured,  and  death 
has  followed. 

Let  us  assume  that  a  man  laboring  under  a  slight  aneurismal  dila- 
tation of  a  large  artery  receives  a  blow  on  the  part ;  the  tumor  gradu- 
ally increases,  and  is  mistaken  for  an  abscess  by  three  or  four  sur- 
geons, whose  professional  standing  would  permit  their  general 
competency  from  being  questioned.  Under  a  wrong  diagnosis,  it  is 
opened,  and  the  patient  dies  on  the  spot ;  in  such  a  case  it  would  be 
unjust  to  make  the  aggressor  liable ;  for,  even  admitting  that  the 
aneurism  resulted  from  the  blow,  and  that  a  competent  surgeon  acted 
with  bona  fides,  the  treatment  would  be  unskilful,  and  the  case  would 
fall  under  the  rule  laid  down  by  Lord  Hale  (ante,  p.  270).  The  real 
facts,  however,  may  not  transpire  until  after  the  death  of  the  wounded 
person ;  and  it  may  then  be  alleged  by  a  prisoner's  counsel  that  the 
operation  was  not  necessary  to  save  life,  and  that  the  wounded  man 
might  have  recovered  without  it.  From  the  ruling  of  our  judges  on 
various  occasions  in  which  this  question  has  arisen,  it  would  appear 
that  the  relative  degree  of  skill  possessed  by  medical  men  is  not  a 
question  for  a  jury  in  a  criminal  case ;  although  in  a  civil  case,  as  in 
an  action  for  malapraxis,  the  whole  of  the  medical  facts  are  invariably 
submitted  to  their  judgment.  This  difference  can  only  be  justified 
b}r  the  assumption,  that  a  man  who  inflicts  a  wound  must  take  all 
the  consequences,  good  or  bad.  No  operation  would  have  been  re- 
quired, but  for  the  injury,  and  the  prisoner  ought  not  to  escape  on 
account  of  want  of  skill  in  a  surgeon,  or  of  a  mistake  made  by  a 
skilful  operator.  It  was  decided  in  the  cases  of  Rex  v.  Quain  and 
Reg.  v.  Pym,  that  although  the  indictment  alleged  that  the  deceased 
died  of  the  wound,  while  in  fact  he  died  from  the  results  of  an  opera- 
tion, yet  it  was  good  in  point  of  law. 

When  a  wounded  person  is  taken  to  an  hospital  in  which  gangrene 
or  erysipelas  is  diffusing  itself  by  infectious  propagation,  and  he  is 
attacked  by  one  of  these  diseases  before  or  after  the  performance  of 
an  operation,  and  dies,  a  prisoner  may  be  held  responsible  for  the 
fatal  result.  It  might  be  contended  that  the  transportation  of  the 
wounded  man  to  such  a  locality  was  not  absolutely  necessary  for  his 
treatment  or  for  the  preservation  of  his  life,  and  that  he  would  not 
have  died,  but  for  the  accidental  presence  of  an  infectious  disease. 
Cases  of  this  kind  cannot  be  easily  determined  by  any  general  rules. 

Pyuemia. — In  addition  to  erysipelas  and  tetanus,  there  is  another 
18 


274:  OPERATIONS.      MEDICAL    RESPONSIBILITY. 

cause  of  death  which  is  liable  to  follow  personal  injuries  and  opera- 
tions, namely,  pyeem.ia,  or  the  introduction  of  pus  into  the  blood  by 
absorption  or  by  the  mouths  of  divided  bloodvessels.  The  purulent 
matter  appears  to  act  as  a  poison,  and  one  of  its  marked  effects  is  to 
coagulate  the  blood  either  in  the  large  vessels  or  in  the  capillaries. 
According  to  Dr.  Wilks's  observations,  pyaemia  is  seldom  observed 
after  superficial  injuries  during  the  process  of  healing,  or  after 
wounds  resulting  from  simple  operations,  but  it  occurs  frequently 
when  a  bone  is  involved  either  in  the  injury  or  as  the  result  of  an 
operation.  Inflammation  of  the  cellular  membrane  surrounding 
bone  is  a  condition  highly  favorable  to  its  occurrence.  It  has  been 
stated  that  the  cause  of  death  in  one -half  of  the  cases  of  amputation 
is  pyaemia.  (See  a  paper  on  this  subject  by  Dr.  Wilks,  "  Guy's  Hos- 
pital Eeports,"  1861,  p.  119.)  The  medical  witness  must  remember 
that  pyaemia,  like  tetanus  and  erysipelas,  may  arise  from  causes 
totally  irrespective  of  wounds  or  personal  injuries.  (Cases  D3"  Dr. 
Habershon,  "  Guy's  Hospital  Eeports,"  1859,  p.  179.) 

Questions  relative  to  responsibility  in  death  following  operations 
would  come  more  frequently  before  courts  of  law,  were  it  not  that 
the  cases  are  stopped  in  the  Coroners'  courts  by  verdicts  of  acciden- 
tal death.  (See  "Med.  Gaz.,"  vol.  19,  p.  157.)  It  unfortunately 
happens  that  on  these  occasions  there  is  great  difference  of  opinion 
among  medical  witnesses  respecting  the  connection  of  the  disease 
with  the  death,  and,  indeed,  the  necessity  for  the  operation  itself. 
The  evidence  of  opinion  in  favor  of  the  prosecution  is  sometimes 
exactly  balanced  by  that  urged  in  the  defence,  and  under  these  cir- 
cumstances, the  only  course  open  to  the  court  is  to  direct  an  acquit- 
tal. Differences  of  opinion  upon  these  subjects  among  members  of 
the  profession  tend  to  convey  to  the  public,  the  impression  that  there 
are  no  fixed  principles  upon  which  medical  opinions  are  based,  and, 
consequently,  that  it  would  be  dangerous  to  act  upon  them.  Thus 
it  is  that  we  are  accustomed  to  hear  of  a  medical  prosecution  and  a 
medical  defence,  as  if  the  whole  duty  of  a  medical  jurist  consisted 
in  his  making  the  best  of  a  case,  on  the  side  for  which  he  happens 
to  be  engaged — adopting  the  legal  rule  for  suppressing  those  points 
which  are  against  him,  and  giving  an  undue  prominence  to  others 
which  may  be  in  his  favor.  This  is  an  unfortunate  condition  of 
things,  for  which  at  present  there  appears  to  be  no  other  remedy 
than  that  of  appointing  a  Medical  Board  of  competent  persons  to 
act  as  assessors  to  the  learned  judge,  to  whom  such  questions  should 
be  referred,  in  the  same  manner  as  questions  relative  to  navigation 
are  referred  by  the  Admiralty  Court  to  a  Board  formed  of  members 
of  the  Trinity  House — professionally  acquainted  with  the  matters  in 
dispute. 

Medical  Responsibility  in  Operations.  Malapraxis. — This  is  a  very 
wide  subject,  but  it  can  here  be  only  glanced  at  in  a  few  of  its  lead- 
ing features.  It  was  held  bv  Lord  Ellenborough,  that  if  a  person 
acting  in  a  medical  capacity  be  guilty  of  misconduct  arising  either 
from  gross  ignorance  or  criminal  inattention,  by  which  a  patient 
dies,  he  is  guilty  of  manslaughter.     Faults,  such  as  omissions,  or 


MEDICAL    RESPONSIBILITY.  275 

errors  in  judgment,  to  which  all  are  liable,  are  not  visited  with  this 
amount  of  criminality.  The  same  rule  applies  to  the  licensed  as  to 
the  unlicensed  practitioner;  but  it  would  appear,  from  the  charge  of 
Williams  J.  (Winchester  Spring  Ass.  1847),  that  a  degree  of  unskil- 
fulness  which  might  lead  to  the  conviction  of  a  licensed,  would  jus- 
tify the  acquittal  of  an  unlicensed  person.  This  was  in  the  case  of 
a  midwife,  aged  72,  alleged  to  have  caused  the  death  of  a  woman  on 
whom  she  had  been  called  to  attend.  "The  charge,"  said  the  learned 
judge,  "appeared  to  be  that  by  want  of  skill  or  attention  to  her 
duties,  she  had  caused  the  death  of  the  woman  upon  whom  she  was 
attending.  In  order  to  constitute  this  offence,  it  must  be  shown  that 
the  party  was  guilty  of  criminal  misconduct,  either  arising  from 
gross  ignorance,  or  want  of  skill,  or  gross  inattention.  With  respect 
to  the  degree  of  want  of  skill,  he  must  say,  that  it  was  not  to  be  ex- 
pected that  a  midwife,  who  was  called  in  to  attend  a  person  in  the 
humble  class  of  the  deceased,  a  soldier's  wife,  should  exhibit  what 
a  regular  medical  practitioner  would  call  competent  skill.  It  was 
enough  if  she  applied  that  humble  skill  which,  in  ordinary  cases, 
would  lead  to  a  safe  delivery.  She  was  not  bound  to  have  skill 
sufficient  to  meet  peculiar  and  extraordinary  exigencies,  although  in 
the  case  of  a  regular  medical  man,  such  skill  might  be  required. 
The  class  of  this  humble  practitioner  was  absolutely  necessary  for 
the  poorer  classes,  and,  although  on  the  one  hand  it  was  fit  the  law 
should  protect  a  patient,  by  punishment  for  gross  want  of  skill,  yet 
he  thought  there  would  be  much  to  be  lamented  if  it  was  applied 
with  such  severity  as  to  render  a  party  not  possessing  skill  of  this 
kind  liable  to  punishment  for  manslaughter  I" 

Charges  of  manslaughter  have  frequently  been  brought  against 
medical  practitioners  in  cases  of  midwifery.  In  some  instances  gross 
mismanagement  has  been  proved ;  the  uterus,  and  even  parts  of  the 
viscera,  have  been  torn  away,  and  in  such  cases  convictions  have 
very  properly  followed.  It  is  well  known,  however,  that  much  dif- 
ference of  opinion  exists  among  the  most  eminent  practitioners  of 
midwifery  respecting  the  treatment  to  be  pursued  in  certain  cases  of 
difficulty,  as  where  the  after-birth  presents  (placenta  praevia).  There 
are  eminent  accoucheurs  who  advise  in  this  case  entirely  opposite 
modes  of  practice,  and  who  look  upon  that  pursued  by  the  other  as 
of  the  most  dangerous  kind. 

When  death  is  not  a  result  of  medical  treatment,  an  action  for 
damages  may  be  brought  against  the  practitioner  for  malapraxis. 
From  the  evidence  given  on  some  of  these  occasions,  it  appears  that 
an  action  of  this  kind  is  occasionally  resorted  to  as  a  very  conve- 
nient way  of  settling  a  long  account. 

It  has  been  a  question  whether  slight  deviations  from  the  ordinary 
mode  of  performing  operations  should  involve  a  practitioner  in  a 
charge  of  malapraxis.  I  am  not  aware  that  this  question  has  been 
raised  in  England;  but  a  remarkable  instance  occurred  in  the  United 
States  a  few  years  since,  in  which  an  action  was  brought  and  dam- 
ages were  recovered  against  a  medical  man  for  alleged  negligence  in 
vaccinating  a  young  woman  (case  of  H.  L.  Landon).     Some  inflam- 


276  WOUNDS    OF    THE    HEAD. 

mation  of  the  skin  followed  the  operation,  which,  it  was  alleged, 
was  performed  nearer  to  the  elbow-joint  than  was  usual.  The  plain- 
tiff soon  recovered  from  the  effects.  The  most  singular  feature  of 
this  case  was  the  ruling  of  the  judge :  he  said — "  In  performing  the 
operation  of  vaccination  or  inoculation,  the  physician  is  liable  for 
all  consequences  if  he  neglects  the  usual  precautions,  or  fails  to  in- 
sert the  virus  in  that  part  of  the  arm  usually  selected  for  the  purpose ; 
notwithstanding  many  other  parts  of  the  body  might  be  proved  to 
be  equally  proper  and  even  more  suitable  locations !"  If  this  be 
law,  it  is  a  very  singular  specimen  of  transatlantic  jurisprudence.  It 
might  as  well  be  ruled  that  legs  should  always  be  amputated  at  the 
same  spot ;  and  in  case  of  neglect  of  this  rule,  that  the  operator 
should  be  made  responsible  for  the  result ! 

When  on  these  occasions  there  is  a  division  of  opinion  among 
men  of  equal  experience  respecting  the  necessity  for  an  operation 
or  the  proper  performance  of  it,  a  practitioner  who  is  made  defend- 
ant has  a  right  to  expect  that  a  verdict  will  be  returned  in  his 
favor;  since  it  is  not  to  be  supposed  that  in  order  to  recover  pay- 
ment for  a  bill,  or  to  answer  a  charge  of  unskilfulness,  a  man's  prac- 
tice should  receive  the  unanimous  approval  of  the  whole  of  his 
professional  brethren,  especially  in  cases  in  which  there  is  an 
acknowledged  difference  of  opinion  respecting  the  treatment.  On 
this  showing,  a  man  would  never  be  able  to  recover  his  charges  for 
the  treatment  of  a  case  of  severe  burn  or  scald ;  since  some  practi- 
tioners consider  it  malapraxis  to  adopt  the  stimulating,  while  others 
equally  regard  it  as  malapraxis  to  adopt  the  cooling  plan  of  treat- 
ment !  All  that  appears  to  be  expected  is  a  reasonable  accordance 
in  treatment  with  received  professional  doctrines. 


CHAPTER    XXX. 

Wounds  of  the  head. — concussion. — how  distinguished  from 
intoxication. — effusion  of  blood  as  a  result  of  violence, 
disease,  or  mental  excitement. — wounds  of  the  face. — ■ 
deformity  as  a  consequence  of  wounds  of  the  face. — inju- 
ries to  the  spine  and  spinal  marrow. — fractures  of  the 
vertebrae. 

The  danger  of  wounds,  and  their  influence  in  causing  death,  are 
the  two  principal  points  to  which  the  attention  of  a  medical  jurist 
must  be  directed. 

Wounds  of  the  Head. 

Incised  wounds,  affecting  the  scalp,  unless  of  great  extent,  rarely 
produce  any  serious  effects.  When  the  wound  is  contused  or  accom- 
panied by  much  laceration  of  the  skin,  it  is  highly  dangerous   in 


CONCUSSION    OF    THE    BRAIN.  277 

consequence  of  the  tendency  which  the  inflammatory  process  has 
to  assume  an  erysipelatous  character.  The  results  of  these  wounds 
are,  however,  such  as  to  set  all  general  rules  of  prognosis  at  defiance. 
Slight  punctured  wounds  will  sometimes  terminate  fatally  in  conse- 
quence of  inflammation,  followed  by  extensive  suppuration ;  while, 
on  the  other  hand,  a  man  may  recover  from  a  lacerated  wound  by 
which  the  greater  part  of  the  skin  may  have  been  stripped  from  the 
bone.  There  are  two  sources  of  danger  in  wounds  of  the  scalp:  1. 
The  access  of  erysipelatous  inflammation.  2.  Inflammation  of  the 
tendinous  structures,  followed  or  not  by  a  process  of  suppuration. 
Either  of  these  secondary  effects  may  be  a  consequence  of  slight  or 
severe  wounds  and  prove  fatal.  Neither  can  be  regarded  as  an  unu- 
sual result  of  a  severe  wound  of  the  scalp,  but  when  one  or  the 
other  follows  a  slight  injury,  there  is  reason  to  suspect  that  the 
patient  may  have  been  constitutionally  predisposed  to  the  attack. 
Bad  treatment  may  likewise  lead  to  a  fatal  result  from  a  wound  not 
serious  in  the  first  instance,  but  the  question — how  far  the  responsi- 
bility of  an  aggressor  would  be  affected  by  a  circumstance  of  this 
nature  has  been  considered  in  another  place  (ante,  p.  264).  Wounds 
of  the  head  are  dangerous  in  proportion  as  they  affect  the  brain ;  and 
it  is  rare  that  a  severe  contused  wound  is  unaccompanied  by  some 
injury  to  this  organ.  There  is,  however,  a  difficulty  which  a  practi- 
tioner has  here  to  contend  with — namely,  that  it  is  scarcely  possible 
to  predict  from  external  appearances,  the  degree  of  mischief  which 
has  been  produced  within.  These  injuries,  as  it  is  well  known,  are 
capricious  in  their  after-effects — the  slightest  contusions  may  be 
attended  with  fatal  consequences,  while  fractures,  accompanied  by 
great  depression  of  bone,  and  an  absolute  loss  of  substance  of  the 
brain,  are  sometimes  followed  by  perfect  recovery.  Another  diffi- 
culty in  the  way  of  forming  a  correct  opinion  consists  in  the  fact, 
that  a  person  may  recover  from  the  first  effects  of  an  injury,  but 
after  some  days  or  weeks  he  will  suddenly  die ;  and  on  examination 
of  the  body,  the  greater  part  of  the  brain  will  be  found  destroyed 
by  suppuration,  although  no  symptoms  of  mischief  may  have  mani- 
fested themselves  until  within  a  few  hours  of  death. 

Concussion. — The  common  effect  of  a  violent  blow  on  the  head 
is  to  produce  concussion  or  effusion  of  blood,  or  both.  Concussion 
is  usually  indicated  by  fainting,  insensibility,  or  sudden  death  occur- 
ring immediately  after  the  application  of  external  violence.  In 
concussion  the  symptoms  come  on  at  once,  and  the  patient  sometimes 
dies  without  any  tendency  to  reaction  manifesting  itself.  In  the 
most  severe  form,  the  person  drops  at  the  very  moment  when  struck 
and  dies  on  the  spot.  (Chelius's  "  Surgery,"  vol.  1,  p.  408.)  In 
other  cases,  he  may  linger  in  a  state  of  insensibility  for  several  days 
or  weeks  and  then  die.  In  concussion  there  is  generally  more  or 
less  vomiting.  It  is  important  to  remember  that  neither  compression 
nor  physical  injury  to  the  brain  is  necessary  to  render  concussion 
fatal.  This  ma}'-  be  entirely  dependent  on  shock  to  the  nervous  sys- 
tem. After  death,  no  particular  morbid  change  may  be  discovered 
in  the  body,  or  there  may  be  merely  the  mark  of  a  slight  bruise  on 


278      CONCUSSION    DISTINGUISHED    FROM    INTOXICATION. 

the  head.  The  state  of  insensibility  observed  in  concussion  may  be 
only  apparent :  some  consciousness  may  be  retained. 

Inflammation  may  follow  the  primary  shock  from  concussion — 
suppuration  may  take  place,  and  the  patient  die  after  the  lapse  of 
several  weeks,  or  even  months.  It  is  necessary  in  a  medico-legal 
point  of  view  to  notice  that  a  person  may  move  about  and  occupy 
himself,  while  apparently  convalescent,  for  a  week  or  ten  days  after 
recovery  from  the  first  shock,  and  then  suddenly  be  seized  with  fatal 
symptoms,  and  die.  This  apparent  recovery  leads  to  the  common 
supposition,  that  death  must  have  been  produced  by  some  interven- 
ing cause,  and  not  by  the  original  violence  to  the  head,  a  point  gen- 
erally urged  in  the  defence  of  such  cases.  When  the  inflammation 
that  follows  concussion  is  of  a  chronic  character,  the  person  may 
suffer  from  pain  in  the  head  and  vomiting,  and  die  after  the  lapse  of 
weeks,  months,  or  even  years.  Concussion  may  sometimes  take 
place  as  a  consequence  of  a  violent  fall  on  the  feet,  in  which  case 
the  head  receives  a  shock  through  the  medium  of  the  spinal  column. 
The  skull  may  be  thereby  extensively  fractured  at  the  base,  and  the 
brain  may  be  even  shattered  by  such  a  fall.  This  was  the  cause  of 
death  in  the  case  of  the  Duke  of  Orleans.  ("Med.  Gaz.,"  vol.  36,  p. 
368.) 

Concussion  Distinguished  from  Intoxication. — The  symptoms  under 
which  a  wounded  person  is  laboring  may  be  sometimes  attributed  to 
intoxication,  and  a  medical  witness  may  be  asked  what  difference  ex- 
ists between  this  state  and  that  of  concussion.  The  history  of  the 
case  will,  in  general,  suffice  to  establish  a  distinction,  but  this  cannot 
always  be  obtained.  It  is  commonly  said  that  the  odor  of  the  breath 
will  enable  a  surgeon  to  detect  intoxication;  but  it  is  obvious  that  a 
man  may  meet  with  concussion  after  having  drunk  liquor  insufficient 
to  cause  intoxication,  or  concussion  may  take  place  while  he  is  in- 
toxicated— a  combination  which  frequently  occurs.  Under  such 
circumstances  we  must  wait  for  time  to  develop  the  real  nature  of 
the  case.  Concussion  may  be  so  slight  as  sometimes  closely  to  re- 
semble intoxication,  and  from  the  absence  of  all  marks  of  violence 
to  the  head  and  the  existence  of  a  spirituous  odor  in  the  breath,  the 
medical  examiner  might  be  easily  deceived.  If  there  be  no  percep- 
tible odor  in  the  breath,  the  presumption  is  that  the  symptoms  are 
not  due  to  intoxication.  On  the  other  hand,  intoxication  may  be  so 
great  as  to  give  rise  to  the  apprehension  of  fatal  consequences,  and 
the  coexistence  of  a  mark  of  violence  on  the  head  might  lead  to 
error  in  the  formation  of  an  opinion.  What  is  the  line  of  conduct 
to  be  pursued  on  such  occasions?  The  examiner  should  weigh  all 
the  circumstances,  and  if  there  be  one  cause  for  the  symptoms  more 
probable  than  another,  he  should  adopt  it :  if  there  be  any  doubt, 
this  should  be  stated  to  the  court. 

There  is  nothing  in  the  state  of  the  brain  in  a  dead  body,  which 
will  enable  a  practitioner  to  distinguish  whether  concussion  or  intoxi- 
cation had  existed  and  had  been  the  cause  of  the  symptoms.  The 
vessels  may  be  congested  in  both  cases.  The  discovery  of  an  alco- 
holic liquid  in  the  stomach  might  lead  to  a  presumption  that  deceased 


INJURIES    TO    THE    BRAIX.  279 

had  been  intoxicated,  while  marks  of  violence  on  the  head  might 
favor  the  view  that  he  had  suffered  from  concussion.  When  both 
conditions  are  found,  the  examination  of  the  body  cannot  lead  to  a 
solution  of  the  question.  The  answer  must  then  depend  on  the  spe- 
cial circumstances  proved,  and,  if  procurable,  on  the  nature  of  the 
symptoms  preceding  death.  It  is  to  be  feared  that  medical  witnesses 
are  not  sufficiently  careful,  on  these  occasions,  to  determine  whether 
there  are  signs  of  intoxication  about  an  injured  person.  Subsequent 
proceedings  may  render  this  a  material  part  of  the  inquiry. 

Extravasation  or  Effusion  of  Blood. — A  blow  on  the  head  may  de- 
stroy life  by  causing  an  effusion  of  blood  either  on  the  surface  or  in 
the  substance  of  the  brain.  In  pugilistic  combats,  when  a  person  is 
thus  struck,  he  commonly  falls,  and  death  may  take  place  in  a  few 
minutes.  On  inspection,  blood  may  be  found  effused  either  at  the 
base  or  in  the  ventricles  of  the  brain,  and  the  question  will  present 
itself — Did  the  injury  which  caused  death  arise  from  a  blow  or  a  fall? 
(See  page  218.)  A  heavy  blow  on  the  head  may  cause  fatal  effusion 
of  blood,  but  on  these  occasions  the  effusion  commonly  arises  from 
the  violent  concussion  which  the  injured  person  sustains  by  the  fall. 
A  medical  witness  will  therefore  in  general  be  compelled  to  admit 
that  the  fatal  effusion  might  have  taken  place  either  from  a  blow  or 
a  fall.  If  the  fall  has  resulted  from  accident  and  not  from  a  blow, 
this  will,  of  course,  absolve  the  accused  from  responsibility  for  the 
fatal  results.  This  subject  has  important  applications  in  legal  medi- 
cine, for  this  is  one  of  the  most  common  causes  of  death  from  inju- 
ries to  the  head,  and  there  are  generally  many  cases  of  this  descrip- 
tion tried  at  the  assizes.  Effusion  may  occur  from  violence,  with  or 
without  fracture,  and  it  may  take  place  without  being  accompanied 
by  any  external  marks  of  injury. 

In  cases  of  injuries  to  the  head  proving  fatal  by  effusion  of  blood 
on  the  brain,  a  person  may  recover  from  the  first  effects  of  the  vio- 
lence, and  apparently  be  going  on  well,  when  he  will  suddenly 
become  worse  and  die.  Effusion  takes  place  slowly  at  first — it  may 
be  arrested  by  the  effects  of  stupor  from  concussion,  by  a  portion  of 
the  blood  coagulating  around  the  ruptured  orifices  of  the  vessels,  or 
by  some  other  mechanical  impediment  to  its  escape;  but  after  a 
longer  or  shorter  period,  especially  if  the  person  be  excited  or  dis- 
turbed, the  bleeding  will  recur  and  destroy  life  by  producing  com- 
pression of  the  brain.  How  many  hours  or  days  are  required  in 
order  that  such  an  increased  effusion  should  take  place  after  an 
accident,  it  is  impossible  to  say;  but  in  severe  cases,  it  is  generally 
observed  to  follow  the  injury  within  a  short  time.  Sir  Astley  Cooper 
has  related  the  case  of  a  gentleman  who  was  thrown  out  of  a  chaise, 
and  fell  upon  his  head  with  such  violence  as  to  stun  him  in  the  first 
instance.  After  a  short  time  he  recovered  his  senses,  and  felt  so 
much  better,  that  he  entered  the  chaise  again,  and  was  driven  to  his 
father's  house  by  a  companion.  lie  attempted  to  pass  off  the  acci- 
dent as  of  a  trivial  nature,  but  lie  soon  began  to  feel  heavy  and 
drowsy,  so  that  he  was  obliged  to  go  to  bed.  His  symptoms  became 
more  alarming,  and  he  died  in  about  an  hour,  as  it  afterwards  ap- 


280  EFFUSION    OF    BLOOD. 

peared,  from  effusion  of  blood  on  the  brain.  When  the  brain  has 
sustained  laceration  from  violence,  in  addition  to  insensibility,  con- 
vulsions are  frequently  observed. 

Effusion  of  Blood  from  Disease  or  Violence. — Blood  may  be  found 
effused  in  various  situations  within  the  interior  of  the  skull ;  and 
the  cause  of  the  effusion  may  be  either  disease  or  violence.  The 
skill  of  a  medical  jurist  is  often  required  to  determine  which  of  these 
causes  is  the  more  probable,  as  where,  for  instance,  a  pugilist  has 
died,  after  having  received  severe  injuries  to  the  head,  and  his  adver- 
sary is  tried  on  a  charge  of  manslaughter.  On  these  occasions  it  is 
often  urged  in  the  defence,  that  the  bleeding  might  have  arisen 
either  from  a  diseased  state  of  the  vessels  of  the  brain,  or,  if  the 
evidence  render  it  probable  that  the  blow  was  the  cause ;  that  the 
effects  of  the  blow  were  aggravated  by  a  diseased  condition  of  the 
vessels,  or  by  the  excitement  into  which  the  deceased  was  thrown, 
either  from  the  effects  of  intoxication  or  passion.  When  the  brain 
is  not  lacerated  by  violence,  the  blood  is  effused  either  on  the  sur- 
face of  the  hemispheres,  between  the  membranes,  or  at  the  base. 
When  the  effusion  is  caused  by  violence,  the  effused  blood  is  not 
always  found  under  the  spot  where  the  blow  was  inflicted,  but  occa- 
sionally, by  counter-stroke  on  the  surface  of  the  brain,  directly 
opposite  to  it ;  a  case  which  a  medical  witness  has  frequently  been 
required  to  explain  on  trials,  and  which  depends  on  the  same  cause 
as  fracture  by  counter-stroke,  i.  e.  on  a  separation  of  parts  (lacera- 
tion of  the  brain,  effusion  of  blood,  or  even  fracture  of  the  bones) 
at  the  point  of  the  skull  directly  opposite  to  that  which  sustains  the 
violence.  Thus,  fracture  of  the  base  of  the  skull  is  frequently  the 
result  of  severe  violence  applied  to  the  top  of  the  head  (vertex). 
Effusions  of  blood  from  a  diseased  state  of  the  vessels  more  com- 
monly take  place  in  the  substance  of  the  brain,  but  they  sometimes 
occur  on  the  surface  of  the  organ  as  a  result  of  mere  excitement  or 
over-exertion  of  the  muscular  powers.  A  diseased  condition  of  the 
vessels,  and  probably  a  softening  of  the  substance  of  the  brain,  will 
on  these  occasions  be  apparent  on  inspection. 

If  the  effusion  depend  on  disease,  the  arteries  around  may  be  found 
in  a  diseased  condition,  or  the  brain  itself  may  be  found  softened  and 
disorganized.  The  state  of  the  brain  and  its  vessels  should  be  closely 
examined  in  all  cases  of  alleged  violence,  since  hemorrhage  may 
take  place  either  from  excitement  or  slight  blows,  whenever  this 
diseased  condition  exists.  It  has  occasionally  happened,  especial  lv 
in  old  persons,  that  the  person  has  dropped  down  dead  without  a 
blow  being  struck,  and  that  death  has  been  wrongly  imputed  to  vio- 
lence. Cerebral  hemorrhage  from  disease  rarely  occurs  in  persons 
under  forty  years  of  age.  Frequent  intemperance  and  violent  pas- 
sion may,  however,  easily  create  a  tendency  to  it  in  younger  per- 
sons. As  an  effect  of  violence  it  may  take  place  in  persons  of 
all  ages,  but  when  the  marks  of  violence  are  slight,  a  witness  must 
exercise  great  caution  before  he  alleges  that  the  effusion  was  pro- 
duced by  a  blow,  especially  when  it  is  found  that  the  deceased  was 
of  intemperate  habits. 


INJUEIES    TO    THE    BRAIN.  281 

Another  condition  besides  intoxication  and  passion  has  been  said 
to  favor  a  rupture  of  vessels  and  an  effusion  of  blood  on  the  brain — 
namely,  a  thickened  state  of  the  substance  of  the  left  ventricle  of  the 
heart.  According  to  some  pathologists,  this  morbid  condition  favors 
the  occurrence  of  cerebral  hemorrhage  by  the  force  with  which  the 
ventricle  propels  the  blood  to  the  brain.  Unless  the  brain  is  soft- 
ened and  the  vessels  are  diseased,  it  is,  however,  doubtful  whether 
this  condition  of  the  heart  would  have  much  influence. 

As  a  summary  of  these  remarks,  we  may  say  that  in  effusions  of 
blood  from  violence,  the  blood  generally  issues  from  a  vessel  which 
is  plainly  seen  to  be  torn,  as  the  middle  artery  of  the  brain  or  the 
lateral  sinus.  The  effused  blood  is  commonly  found  on  the  surface 
of  the  brain,  and  not  in  its  substance,  unless  the  organ  be  lacerated. 
When  situated  between  the  dura  mater  (outer  membrane)  and  the 
skull,  but  especially  when  immediately  below  the  seat  of  violence 
or  directly  opposite  to  it  by  counter- stroke,  this  is  strong  evidence, 
cseteris  paribus,  that  it  has  proceeded  from  a  blow.  When  there  is 
a  fracture  of  the  skull,  the  presumption  of  the  extravasation  being 
due  to  violence  is  great ;  because  this  is  not  only  a  sufficient,  but  an 
obvious  cause,  while  the  idea  of  its  having  proceeded  from  disease 
only  is  remote  and  speculative.  When,  besides  these  conditions, 
there  is  no  remarkable  congestion  of  the  brain  in  other  spots,  when 
the  substance  of  the  brain  is  firm,  and  the  vessels  are  to  all  appear- 
ance free  from  disease,  we  have  the  strongest  reason  to  believe  that 
the  effusion  must  have  been  due  to  violence,  and  to  no  other  cause 
whatever. 

The  evidence  given  on  some  trials,  when  the  main  question  has 
turned  upon  the  cause  of  an  effusion  of  blood  on  the  brain,  in  the 
case  of  a  person  who  has  sustained  violent  injuries  to  the  head,  has 
rather  tended  to  reflect  disgrace  on  medical  science.  It  has  been 
made  to  appear  from  the  mouth  of  the  medical  witness,  either  directly 
or  by  implication,  that  no  sort  of  mechanical  violence  applied  to  the 
head  of  a  man  in  a  state  of  drunkenness  or  passion — of  one  whose 
cerebral  vessels  were  probably  diseased — or  the  substance  of  whose 
heart  might  be  thickened — could  have  had  any  effect  in  producing  a 
fatal  extravasation  found  in  the  head  after  death !  In  spite  of  an 
individual  having  received  a  violent  blow  with  a  bludgeon,  sufficient 
to  have  killed  a  stoat  and  vigorous  man,  or  of  his  having  been  thrown 
with  considerable  force  with  his  head  against  a  stone-floor,  an  un- 
qualified admission  is  often  made,  that  excitement  alone,  or  drunk- 
enness alone,  would  account  for  the  effusion  without  reference  to  the 
blow  !  In  putting  the  most  favorable  construction  upon  these  cases, 
when  we  have  clear  evidence  of  great  violence  having  been  used  to 
the  head,  with  the  presence  of  the  usual  post-mortem  appearances, 
our  opinion  should  be  that  the  excitement  or  drunkenness  might 
have  predisposed  to,  but  was  not  the  immediate  cause  of,  the  cere- 
bral hemorrhage.  There  seems  to  be  no  good  reason  for  assuming 
that  apoplexy  from  natural  causes  always  occurs  by  a  peculiar  coin- 
cidence, just  at  the  time  that  a  person  receives  a  violent  blow  with  a 
bludgeon  on  the  head,  or  for  giving  to  the  assailant  the  benefit  of 


282  EFFUSION    OF    BLOOD    FROM    DISEASE. 

this  hypothetical  explanation.  A  mere  inspection  of  the  body  does 
not  always  lead  to  the  discovery  of  the  cause  of  an  effusion  on  the 
brain.  The  violence  causing  an  effusion  of  blood  may  have  been 
slight,  and  unless  attention  is  particularly  directed  to  the  subject,  it 
may  be  overlooked.  The  condition  of  the  effused  blood  should  be 
accurately  noticed,  in  order  to  determine  whether  it  presents  any 
marks  indicative  of  its  being  recent  or  of  old  standing. 

Spontaneous  effusions  or  effusions  from  disease  are  not  easily  dis- 
tinguished from  those  which  are  the  result  of  violence  to  the  head. 
Dr.  Wilks  has  pointed  out  that  in  most  instances  of  severe  injury 
attended  with  effusion  of  blood,  the  structure  of  the  brain  is  found 
bruised.  In  meningeal  apoplexy  (apoplexy  of  the  membranes)  the 
source  of  the  blood  is  a  vein  of  the  pia  mater  or  inner  membrane, 
and  sometimes  a  large  arterial  trunk.  The  difficulty  chiefly  arises 
in  those  cases  in  which  effusion  is  found  after  slight  violence  and 
there  is,  at  the  same  time,  disease  of  the  bloodvessels  of  the  brain. 
Dr.  Wilks  gives  the  result  of  several  inspections  in  which  effusion 
was  owing  to  disease,  to  violence,  and  to  a  mixed  condition.  (See 
"  Guy's  Hospital  Reports,"  1859,  p.  120.) 

Effusion  of  Blood  from  Excitement. — When  engaged  in  the  investi- 
gation of  these  cases,  it  is  always  a  fair  matter  of  inquiry  whether 
the  violence,  upon  the  evidence,  was  not  of  itself  sufficiently  great  to 
account  for  the  effusion  without  the  supposition  of  coexisting  disease 
or  excitement.  Admitting  that  the  rupture  of  a  bloodvessel,  and 
the  extensive  effusion  of  blood  on  the  brain,  may  take  place  from 
simple  excitement  and  passion,  yet  this  is  an  event  comparatively 
rare,  at  least  in  the  young  and  healthy,  while  nothing  is  more  com- 
mon than  that  these  results  should  follow  violent  injuries  to  the  head 
whatever  the  age  or  condition  of  the  person.  A  medical  witness 
should  remember  that  on  these  occasions,  if  he  is  unable  to  say  posi- 
tive^ whether  the  effusion  was  due  to  the  excitement  or  the  blows, 
he  will  satisfy  the  court  if  he  only  state  clearly  that  which  is,  in  his 
own  mind,  the  more  probable  cause  of  death;  and  by  weighing  all 
the  circumstances  of  the  case  beforehand,  he  will  rarely  fail  to  find 
that  one  cause  was  more  probable  than  the  other.  Thus,  if  a  man, 
excited  by  passion  and  intoxication,  is  struck  on  the  head,  and  the 
blow  is  slight — such  as  an  unaffected  person  would  probably  have 
sustained  without  injury — yet  in  this  case  insensibility  and  death  fol- 
low, and,  on  examination,  a  quantity  of  blood  is  found  effused  in  the 
substance  of  the  brain,  can  it  be  a  matter  of  doubt  with  the  practi- 
tioner that  the  effusion  was  chiefly  due  to  the  excitement  under  which 
the  deceased  was  laboring  ?  To  take  a  converse  instance  :  a  man 
engaged  in  a  personal  conflict  with  another,  is  struck  most  violently 
on  the  head,  or  falls  with  great  force  on  this  part  of  his  body ;  on 
inspection  it  is  found  that  death  has  arisen  from  effusion  of  blood  on 
the  surface  of  the  brain,  and  it  would  be  no  unexpected  consequence 
of  the  violence  inflicted,  that  a  similar  appearance  should  be  met 
with  in  an  individual  calm  and  unexcited.  Can  the  practitioner  hesi- 
tate to  say,  under  these  circumstances,  that  the  blow  would  satis- 
factorily account  for  the  effusion,  without  reference  to  any  coexisting 


EFFUSIONS  OF  BLOOD  ON  THE  BRAIN.        283 

causes  of  excitement  ?  These  may  be  allowed  to  have  their  influence 
in  giving  an  increased  tendency  to  cerebral  hemorrhage,  or  in  aggra- 
vating the  consequences  of  the  blow,  but  no  further. 

In  these  criminal  investigations,  when  a  witness  is  examined  in 
chief,  he  asserts,  perhaps,  that  the  effusion  of  blood  was  owing  to  a 
blow  inflicted  on  the  head.  The  counsel  who  cross-examines  him, 
then  puts  the  leading  question,  whether  vessels  may  not  be  ruptured 
by  excitement;  he  answers,  without  any  qualification,  in  the  affirma- 
tive, and  thus  produces  an  impression  on  the  minds  of  the  jury  that 
excitement  may  have  caused  the  rupture  of  the  vessel  in  the  particu- 
lar case  on  which  he  is  being  examined.  This  is,  of  course,  the  sort 
of  answer  which  a  prisoner's  counsel  wishes  to  extract  from  a  wit- 
ness ;  and  the  effect  produced  by  it  on  the  court  is  not  always  re- 
moved, even  by  a  careful  re-examination.  The  counsel  for  the 
defence  is  well  aware  that  in  a  case  of  this  description,  his  only 
chance  of  obtaining  an  acquittal  is  to  throw  a  degree  of  doubt  on 
the  medical  evidence,  and  to  render  it  probable  to  a  jury  that  the 
death  of  the  deceased  party  was  due  to  some  other  cause  than  the 
blow  inflicted  by  the  prisoner.  As  leading  questions  are  allowed  to 
be  put  to  any  extent  in  a  cross-examination,  the  answer  in  the  mono- 
syllable "  yes'1  or  "  no,"  generally  carries  with  it  much  more  than 
the  medical  witness  intends.  It  may  be  very  proper  that  a  skilful 
barrister  should  exercise  his  talents  in  this  way,  but  a  medical  wit- 
ness has  to  remember  that  he  is  sworn  to  state  the  whole  truth. 
A  qualified  answer  should  be  given  to  what  is  really  a  general 
question  ;  and,  supposing  his  opinion  to  be  already  formed  on 
the  subject  on  which  his  evidence  is  required,  he  should  not,  un- 
less it  be  strictly  consistent  with  his  own  views,  allow  his  answer  to 
a  general  question  to  be  made  applicable  to  a  particular  case.  If  then 
asked,  in  cross-examination,  whether  a  vessel  might  not  be  ruptured 
and  blood  extravasated  by  mere  excitement,  he  should  answer  that 
such  an  effect  might  undoubtedly  follow ;  but  that  it  was  his  opinion 
— and  I  am  here  supposing  that  his  opinion  has  been  found  upon  a 
deliberate  examination  of  all  the  medical  facts — that  excitement  was 
not  the  cause  of  rupture  and  extravasation  in  the  case  in  question. 
A  witness  has,  it  appears  to  me,  a  right  to  insist  that  his  evidence 
shall  pass  to  the  jury  without  having  any  designed  ambiguity  at- 
tached to  it.  It  may  be  said  that  the  remedy  for  an  evil  of  this  kind 
is  the  re-examination  of  the  witness ;  but  I  am  satisfied  from  the 
reports  of  many  cases  before  me,  that  the  point  is  overlooked.  Be- 
sides one  cannot  understand  why  a  piece  of  sophistry  and  equivoca- 
tion is  to  be  left  to  a  chance  exposure ;  the  case  would  then  rest  not 
upon  sound  medical  evidence,  but  upon  the  relative  degree  of  inge- 
nuity and  ability  displayed  by  the  counsel  for  the  prosecution  and 
defence. 

Date  of  Effusions. — Recent  effusions  of  blood  are  recognized  by 
their  red  color,  and  the  consistency  and  appearance  of  the  clot  or 
coagulum.  After  some  days  the  clots  acquire  a  chocolate  or  brown 
color,  and  this  passes  gradually  into  an  ochreous  tint,  which  may  be 
met  with  in  from  twelve  to  twenty-five  days  after  the  violence  (see 


284  DATE    OF    EFFUSIOXS. 

cases  by  Dr.  TVilks,  p.  265).  Coagula  of  effused  blood  also  undergo 
changes  in  structure  and  consistency  ;  when  old  they  are  firmer,  and 
there  is  much  lymph,  which  is  sometimes  disposed  in  membranous 
layers  of  a  fibrous  structure,  and  these  are  adherent  to  the  dura 
mater  and  the  brain.  The  surface  of  this  organ  sometimes  presents 
a  mark  indicative  of  pressure. 

When  a  medical  man  is  required  to  give  an  opinion  of  the  date  of 
an  effusion  found  on  the  brain,  great  caution  is  required.  A  surgeon 
may  not  be  able  to  fix  the  precise  date,  but  it  may  be  in  his  power 
to  say  whether  the  blood  has  been  effused  for  a  few  days,  weeks,  or 
months. 

When  a  blow  on  the  head  is  of  a  heavy,  bruising  kind,  the  whole 
substance  of  the  skull  may  be  fractured  without  a  division  of  the 
skin.  There  is  one  remarkable  circumstance  connected  with  frac- 
tures accompanied  by  depression  of  bone,  which  here  requires  to  be 
mentioned — namely,  that  the  person  has  been  sensible  so  long  as  the 
foreign  substance  which  produced  the  fracture  and  depression  re- 
mained wedged  in  the  brain,  and  that  insensibility  and  other  fatal 
symptoms  began  to  manifest  themselves  only  after  its  removal.  This 
being  admitted,  it  may  be  urged  in  defence,  that  death  was  really 
caused  by  medical  interference.  But  it  is  a  sufficient  answer  to 
state,  that  the  wounded  person  must  have  died  from  inflammation  of 
the  brain  if  the  foreign  body  had  been  allowed  to  remain :  and  that 
it  is  consistent  with  the  soundest  principles  of  practice  to  remove  all 
such  foreign  substances  without  delay.  In  fractures  of  the  skull, 
with  depression,  it  may  become  a  question  whether  the  surgeon 
raised  the  depressed  portion  of  bone  so  soon  as  he  ought  to  have 
done. 

In  reference  to  persons  found  dead  with  severe  injuries  to  the 
head  attended  with  fracture  and  effusion  of  blood  on  the  brain,  a 
medical  man  may  be  required  to  say  whether  such  an  amount  of 
violence  is  or  is  not  consistent  with  the  retention  of  muscular  exer- 
tion, and  power  of  locomotion  by  the  deceased.  For  instance,  a  man 
may  fall  from  a  height,  and  produce  a  severe  compound  fracture  of 
the  skull.  He  may,  nevertheless,  be  able  to  rise  and  walk  some 
distance  before  he  falls  dead.  Under  these  circumstances  there 
might  be  a  strong  disposition  to  assert  that  the  deceased  must  have 
been  murdered — the  injuries  being  such  that  they  could  not  have 
been  produced  by  himself,  there  being  at  the  same  time  no  weapon 
near,  and  no  elevated  spot  from  which  he  could  have  fallen.  The 
discovery,  after  death,  of  severe  injury  to  the  head,  with  great  effu- 
sion of  blood  on  the  brain,  must  not,  however,  lead  a  surgeon  to 
suppose  that  the  person  who  sustained  the  violence  had  been  imme- 
diately incapacitated.  There  are  various  cases  recorded  which  show 
that  a  power  to  move  has  been  retained  under  conditions  which 
might  be  supposed  to  render  a  person  incapable  of  moving  from  the 
spot.  Full  allowance  must  be  made  on  those  occasions  for  the  pos- 
sible exercise  of  locomotion  by  the  deceased.  Although  a  large 
quantity  of  blood  may  be  found  after  death  pressing  on  the  substance 


WOUNDS    OF    THE    FACE.  285 

of  the  brain,  it  does  not  follow  that  this  effusion  and  pressure  were 
the  immediate  result  of  the  violence. 

Wounds  of  the  Brain. — Wounds  of  the  brain  sometimes  prove  in- 
stantaneously mortal,  even  when  slight,  while  in  other  cases,  reco- 
veries take  place  from  contused  or  punctured  wounds  of  this  organ, 
contrary  to  all  expectation.  When  a  person  survives  the  first  effects 
of  the  injury,  there  are  two  sources  of  danger  which  await  him :  1. 
The  production  of  fungus  from  the  exposed  portion  of  the  brain ; 
and  2.  Inflammation  and  its  consequences.  The  process  of  inflam- 
mation, it  must  be  remembered,  is  very  slowly  established  in  this 
organ  ;  it  may  not  manifest  itself  until  from  three  to  ten  weeks  after 
the  injury.  In  one  remarkable  case,  where  a  child  was  accidentally 
shot  through  the  brain,  the  ball  having  traversed  both  hemispheres, 
no  symptoms  of  cerebral  inflammation  manifested  themselves  for 
twenty-six  days.  The  child  died  on  the  twenty-ninth  day.  ("Med. 
Gaz."  vol.  39,  p.  41.) 

Wounds  of  the  Face. — When  wounds  of  the  face  are  of  any  extent 
they  are  usually  followed  by  great  deformity ;  and  when  they  pene- 
trate the  cavities  in  which  the  organs  of  the  senses  are  situated,  they 
often  prove  fatal,  either  by  involving  the  brain  and  its  membranes, 
or  by  giving  rise  to  inflammation  of  this  organ.  Wounds  of  the 
eyebrows  are  not  of  so  simple  a  nature  as  might  at  first  sight  be 
supposed.  Besides  being  attended  by  deformity  when  they  heal, 
they  are  liable  to  cause  during  the  process  of  healing,  serious  dis- 
orders of  the  neighboring  parts.  Amaurosis  and  neuralgia  are  re- 
corded among  the  secondary  and  not  unusual  consequences  of  such 
wounds,  when  the  supra-orbitar  nerve  has  become  implicated.  Under 
certain  conditions  of  the  body,  there  may  be  inflammation  of  the 
parts  within  the  orbit,  extending  by  contiguity  to  the  membranes  of 
the  brain,  and  proving  fatal  by  leading  to  the  formation  of  matter 
within  that  organ.  Amaurosis  in  the  right  eye  has  been  known  to 
occur  from  a  contused  wound,  not  of  a  violent  nature,  on  the  right 
eyebrow.  Wounds  apparently  confined  to  the  external  parts  of  the 
face  frequently  conceal  deep-seated  mischief.  A  sharp  instrument 
penetrating  the  eyelid,  and  passing  upwards  with  any  force,  will 
produce  fracture  of  the  orbitar  plate  of  the  frontal  bone,  which  is 
known  to  be  extremely  thin,  and  even  injure  the  brain  beyond. 

Deformity  as  a  Consequence  of  Wounds  of  the  Face. — Wounds  of  the 
face  when  at  all  extensive,  are  always  followed,  in  healing,  by 
greater  or  less  deformity.  A  medical  witness  may,  perhaps,  find 
these  questions  put  to  him  in  relation  to  them :  Is  the  wound  likely 
to  be  attended  with  deformity  ?  Could  such  a  wound  of  the  face 
heal  without  deformity  ?  or,  Could  the  deformity,  if  it  exist,  have 
been  produced  by  any  other  cause  than  the  wound  ?  These  questions 
are  of  some  importance.  A  person  may  allege  that  he  was  severely 
wounded  in  the  face,  when  the  medical  witness,  on  examination, 
may  find  no  trace  of  such  a  wound  as  that  described.  Again,  a 
person  may  seek  damages  from  another  in  a  civil  action,  by  alleging 
that  a  particular  deformity  was  produced  by  a  wound,  when  the 


286  THE    SPIXE.      FRACTURES    OP    THE    VERTEBRAE. 

medical  witness  may  be  able  to  trace  its  origin  to  disease,  or  to  some 
accidental  cause. 

Injuries  to  the  Spixe. 

Injuries  to  the  spine  and  spinal  marrow  seldom  require  medico- 
legal investigation  ;  but  tliis  organ  is  liable  to  concussion  from  blows, 
to  compression  from  fracture  of  the  vertebrae  or  the  effusion  of  blood, 
with  all  the  secondary  consequences  attending  such  accidents.  Con- 
cussion of  the  spinal  marrow  commonly  produces  paralysis,  affecting 
the  bladder,  rectum,  or  lower  limbs.  These  symptoms  may  not 
appear  at  once,  but  come  on  after  some  hours  or  days.  After  death 
no  traces  of  mechanical  injury  may  be  discovered.  Blows  on  the 
spine,  unattended  with  fracture  or  dislocation,  may,  according  to  the 
observation  of  Sir  B.  Brodie,  be  followed  by  inflammation  and 
softening  of  the  spinal  marrow.  A  slight  injury  has  thus  been 
known  to  cause  death,  by  giving  rise  to  inflammation  of  the  spinal 
marrow.  This  organ  is  also  liable  to  compression  from  slight  causes, 
and  death  may  occur  from  paralysis  of  the  nerves  of  respiration. 

Fractures  of  the  Vertebrse. — These  fractures  are  generally  attended 
by  displacement,  and  thus  produce  compression  of  the  spinal  mar- 
row. They  are  the  more  rapidly  fatal,  in  proportion  as  the  injury 
is  high  up  in  the  vertebral  column.  The  whole  of  the  body  becomes 
paralyzed  below  the  seat  of  injury,  by  the  compression  of  the  spinal 
marrow.  If  the  seat  of  compression  is  above  the  fourth  cervical 
vertebra,  death  is  commonly  immediate :  asphyxia  results  from 
paralysis  of  the  nerves  which  supply  the  diaphragm,  and  which  are 
necessary  to  respiration.  In  falls  on  the  summit  of  the  head  from  a 
height,  it  sometimes  happens,  not  only  that  the  skull  is  extensively 
fractured,  but  that  the  dentiform  process  of  the  second  vertebra  is 
broken  off,  owing  to  the  head  being  doubled  under  the  bod}*.  This 
injury  to  the  second  vertebra  may  be  the  cause  of  death.  From 
a  case  related  by  the  late  Mr.  Phillips,  it  would  appear  that  this 
accident  is  not  always  attended  by  fatal  compression  of  the  spinal 
marrow.  ("  Ed.  M.  &  S.  J."  Jan.  1838.)  In  one  instance  the  person 
survived  fifteen  months  (ib.  Oct.  1845,  p.  527);  and  in  another,  in 
which  the  fracture  was  caused  by  the  patient  turning  in  bed  while 
his  head  was  pressed  on  the  pillow,  death  did  not  take  place  for  six- 
teen months.  (Copland,  "  Diet.  Pr.  Med.,"  Paralysis.)  On  several 
criminal  trials,  this  injury  was  proved  to  have  been  the  cause  of 
death :  and  in  a  case  tried  at  Glasgow  (the  King  against  Beid,  p.  27), 
it  became  a  material  question,  how  far  such  a  fracture  might  result 
from  disease.  It  may  happen  that  caries  of  the  bone,  or  disease  of 
the  transverse  ligament  will  cause  a  separation  of  the  dentiform  pro- 
cess from  the  second  cervical  vertebra.  The  state  of  the  bone  in 
these  alleged  fatal  accidents  should,  therefore,  be  closely  examined. 
In  fractures  of  the  vertebrse,  a  person  is  generally  so  disabled,  what- 
ever may  be  the  situation  of  the  fracture,  that  he  cannot  walk  or 
exert  himself. 

Injuries  to  the  spine  and  its  contents  are  generally  the  result  of 
falls  or  blows,  either  on  the  head  or  the  lower  part  of  the  column. 


WOUNDS    OF    THE    CHEST.  287 

The  secondary  consequences  of  these  injuries  are  sometimes  so 
insidious  as  to  disarm  suspicion,  and  death  may  take  place  quite  un- 
expectedly some  weeks  after  the  accident.  Spicula  of  bone,  sepa- 
rated by  fractures,  may  remain  adherent  for  some  time ;  and,  by  a 
sudden  turn  of  the  head,  be  forced  off,  and  destroy  life  by  penetrat- 
ing the  spinal  marrow,  at  a  long  period  after  the  infliction  of  the 
injury.  This  has  been  known  to  happen  in  fractures  involving  the 
margin  of  the  foramen  magnum,  and  in  such  cases  death  is  imme- 
diate. The  spinal  marrow  has  been  in  some  instances  wounded  in 
its  upper  part  by  sharp-pointed  instruments  introduced  between  the 
vertebrae.  Death  is  an  instantaneous  result  when  the  wound  is 
above  the  third  cervical  vertebra :  there  is  no  part  of  the  spine 
where  a  weapon  can  so  easily  penetrate  as  this,  especially  if  the 
neck  be  slightly  bent  forward.  The  external  wound  thus  made  may 
be  very  small,  and  if  produced  with  any  obliquity  by  drawing  aside 
the  integuments,  it  might  be  easily  overlooked,  or  it  might  be  set 
down  as  superficial. 


CHAPTER   XXXI. 

"Wounds  of  the  chest. — wounds  and  euptuees  of  the  lungs 
and  heaet. — wounds  of  labge  bloodvessels. — wounds  and 
euptuees  of  the  diapheagm. — dibection  of  wounds  of  the 
chest. — wounds  of  the  abdomen. — death  fbom  blows  on  the 
cavity. — euptuees  of  the  livee,  gall-bladder,  spleen,  kid- 
neys, intestines,  stomach,  and  ueinaey  bladdee. — wounds 
of  the  genital  oegans. 

Wounds  of  the  Chest. — Wounds  of  the  chest  have  been  divided 
into  those  which  are  confined  to  the  parietes  or  walls  and  those 
which  penetrate  the  cavity.  Incised  or  punctured  wounds  of  the 
parietes  of  the  chest  are  rarely  followed  by  dangerous  consequences. 
The  bleeding  is  not  considerable,  and  is  generally  arrested  without 
much  difficulty.  They  heal  either  by  adhesion  or  suppuration,  and 
unless  their  effects  are  aggravated  by  incidental  circumstances,  the 
person  recovers.  Contusions  or  contused  wounds  of  the  chest  are, 
however,  far  more  dangerous,  and  the  danger  is  always  in  a  ratio  to 
the  degree  of  violence  used.  Such  injuries  when  severe,  are  ordi- 
narily accompanied  by  fractures  of  the  ribs  or  sternum — by  a  rupture 
of  the  viscera  within  the  cavity,  including  the  diaphragm — by  profuse 
bleeding — or,  as  an  after-effect,  by  inflammation  of  the  lungs,  with  or 
without  suppuration.  Fractures  of  the  ribs  are  dangerous  for  several 
reasons :  the  bones  may  be  splintered  and  driven  inwards,  thereby 
wounding  the  lungs  and  causing  hemorrhage,  or  leading  to  inflam- 
mation of  the  pleura  or  lungs.  In  fractures  of  the  upper  ribs,  the 
prognosis  is  less  favorable  than  in  those  of  the  lower,  because  com- 


2S3        WOUNDS  OF  THE  LUNGS  AND  HEAET. 

monly  a  much  greater  degree  of  violence  is  required  to  produce  the 
fracture.  A  simple  fracture  of  the  sternum  or  chest-bone  without 
displacement  of  the  bone,  is  rarely  attended  with  danger,  unless  the 
concussion  has  at  the  same  time  produced  mischief  internally,  which 
will  be  known  by  the  symptoms.  When,  however,  the  bone  is 
depressed  as  well  as  fractured,  the  viscera  behind  may  be  mortally 
injured.  In  a  case  of  depressed  fracture  of  the  sternum,  recorded 
by  M.  Sanson,  the  person  died  after  the  lapse  of  thirteen  days;  and 
on  inspection,  it  was  found  that  the  fractured  portion  of  bone  had 
produced  a  traverse  wound  of  the  heart  about  an  inch  in  length. 
The  cavities  of  the  organ  had  not  been  penetrated,  but  the  piece  of 
bone  was  exactly  adapted  to  the  depression  produced  by  it  on  the 
parietes.  (Devergie,  "  Med.  Leg."  vol.  2,  p.  243.)  A  witness  will 
frequently  be  required  to  take  into  consideration  the  effects  of  con- 
tusions on  the  thorax,  with  or  without  fracture,  in  cases  of  death 
from  pugilistic  combats,  which  formerly  gave  rise  to  numerous  trials 
on  charges  of  manslaughter.  Wounds  penetrating  into  the  cavity 
of  the  chest  are  generally  dangerous,  even  when  slight,  in  conse- 
quence of  the  numerous  accidents  with  which  they  are  liable  to  be 
complicated.  In  these  wounds,  the  lungs  are  most  commonly  in- 
jured ;  but,  according  to  the  direction  of  the  weapon,  the  heart,  or 
the  great  vessels  connected  with  it,  as  well  as  the  oesophagus  (gullet) 
or  thoracic  duct,  may  share  in  the  mischief. 

Wounds  of  the  Lungs. — The  immediate  cause  of  danger  from 
wounds  of  these  organs  is  the  consequent  hemorrhage,  which  is  pro- 
fuse in  proportion  to  the  depth  of  the  wound  and  the  size  of  the 
vessels  wounded.  Should  the  weapon  divide  any  of  the  trunks  of 
the  pulmonary  veins,  the  individual  may  speedily  sink.  The  degree 
of  hemorrhage  cannot  be  determined  by  the  quantity  of  blood  which 
escapes  from  the  wound ;  for  it  may  flow  internally,  and  collect 
within  the  cavity  of  the  pleura,  impeding  respiration.  This  is  espe- 
cially to  be  apprehended  when  the  external  orifice  of  the  wound  is 
small  and  oblique,  and  one  of  the  intercostal  arteries  has  been 
touched  by  the  weapon.  A  wound  of  the  lung  is  generally  known, 
among  other  symptoms,  by  the  frothiness  and  florid  color  of  the 
blood  which  issues  from  the  orifice,  as  well  as  by  the  expectoration 
of  blood.  The  lungs  may  sustain  serious  injury  from  a  blow  or  fall, 
and  yet  there  may  be  no  external  marks  of  violence  or  symptoms 
indicative  of  danger  for  some  hours.  During  the  convalescence  of 
a  person  who  has  survived  the  first  effects  of  a  penetrating  wound 
of  the  chest,  the  surgeon  should  observe  whether  death,  when  it 
occurs,  may  not  have  been  caused  either  by  imprudence  on  the  part 
of  the  patient,  or  by  abuse  of  regimen  or  other  misconduct ;  for  cir- 
cumstances of  this  nature  may  be  occasionally  treated  as  mitigatory 
on  the  trial  of  the  assailant.  It  is  properly  recommended  that  in 
all  cases  where  a  person  is  progressing  to  recovery,  a  relaxation  of 
the  antiphlogistic  regimen  should  be  made  with  great  circumspec- 
tion. Too  much  nourishment,  too  frequent  talking,  or  any  exertion, 
are  circumstances  that  may  cause  a  renewal  of  the  bleeding  and 
extravasation. 


WOUNDS    OF    THE    HEART.  289 

Wounds  of  the  Heart. — Wounds  of  the  heart  are  among  the  most 
fatal  of  penetrating  A\rounds  of  the  chest.  It  was  formerly  considered 
that  all  wounds  of  this  organ  were  necessarily  and  instantly  mortal. 
Undoubtedly,  when  either  of  the  cavities  is  laid  open  to  a  large 
extent,  the  bleeding  is  so  profuse  on  the  withdrawal  of  the  weapon, 
that  death  must  be  immediate.  But  when  the  wound  is  small,  and 
penetrates  into  the  cavities  of  the  heart  obliquely,  life  may  be  pro- 
longed for  a  considerable  period ;  and  cases  are  on  record  in  which 
it  is  probable  that  such  wounds  would  have  healed,  and  the  patients 
have  finally  recovered,  but  for  the  supervention  of  other  diseases 
which  destroy  life. 

[Numerous  examples  of  wounds  of  the  heart  not  directly  fatal  are 
cited  by  Beck  (ii.  329-332)  and  by  Stille  ("  Wh.  and  Stille',"  2d  ed. 
p.  580).  We  know  of  at  least  three  others,  occurring  in  Philadelphia, 
not  noted  in  these  works,  in  which  the  victim  was  proved  to  have 
walked  several  steps  after  having  been  wounded  in  the  heart.  See 
"Proc.  of  Path.  Soc.  of  Philad.,"  in  "N.  A.  Med.-Chir.  Eev.,"  March, 
1859,  p.  299;  also  "New  York  Med.  Times,"  April,  1855,  for  the 
case  of  Poole,  referred  to  above  from  Dr.  Darling;  and  in  the  same 
journal  (May,  1855),  "Statistical  Observations  on  Wounds  of  the 
Heart,  and  on  their  relations  to  Forensic  Med.:"  with  a  table  of 
forty-two  recorded  cases,  by  Dr.  Purple;  also  "Am.  Journ.  Med. 
Sciences,"  July,  1861,  p.  293,  for  a  case  of  bullet  in  the  wall  of  the 
heart  for  twenty  years.  See,  further,  a  paper  "  On  Wounds  of  the 
Heart,"  by  Dr.  Jno.  Eedman  Coxe,  "Am.  Journ.  Med.  Sci.,"  Aug. 
1829,  307;  and  "  Archiv.  Gener.  de  Med.,"  Sept.  1839,  for  a  valuable 
paper  "  On  Penetrating  Wounds  of  the  Heart,"  by  M.  Jobert  De 
Lamballe.  Two  cases  have  recently  occurred  at  the  Pennsylvania 
Hospital  at  Philadelphia,  which  are  worth  noting.  One  is  that  of  a 
negro,  set.  18,  who  was  admitted,  in  a  very  prostrate  condition,  at  5 
o'clock  P.  M.  on  Friday,  May  31,  1861,  a  half  an  hour  after  having 
received  a  penetrating  wound  of  the  chest  inflicted  with  a  dirk-knife. 
He  soon  rallied  somewhat  in  strength,  and  was  able  to  sit  up  in  bedy 
but  suffered  much  from  dyspnoea  until  some  three  or  four  hours 
before  his  death,  which  took  place  rather  unexpectedly,  at  6  o'clock 
A.  M.  the  following  Wednesday,  just  four  days  and  fourteen  hours 
after  the  reception  of  the  wound.  A  post-mortem  examination  proved 
that  the  instrument  had  grazed  the  lung,  without  opening  its  cellular 
tissue,  and  had  penetrated  the  left  ventricle  at  its  apex,  making  a 
transverse  wound  a  quarter  of  an  inch  in  length  and  not  valvular. 
The  left  lung  had  collapsed,  and  the  pleural  cavity  of  that  side  con- 
tained a  considerable  amount  of  bloody  serum.  The  pericardium, 
although  open  at  the  wound,  was  distended  with  blood,  and  the 
wounded  ventricle  presented  a  small  heart-clot,  which  covered  and 
partially  closed  the  wound.  The  other  case  is  that  of  Chas.  Keen, 
white  man,  set.  40,  who  was  stabbed  by  a  lunatic,  with  a  pair  of 
tailor's  shears,  on  the  28th  of  July,  1859,  and  was  at  once  brought 
to  the  Pennsylvania  Hospital.  He  suffered  greatly  from  palpitation 
of  the  heart,  prostration,  and  difficulty  of  breathing,  but  improved 
so  much  during  the  first  ten  days,  that  our  diagnosis  of  a  wound  of 
19 


290  WOUNDS    OF    THE    HEART. 

the  heart  was  beginning  to  be  unsettled.  The  dyspnoea,  prostration, 
and  disturbance  of  the  heart,  however,  returned,  and  he  was  evi- 
dently in  a  hopeless  condition,  when,  on  the  12th  of  August,  he  and 
his  family  insisted  on  his  being  taken  to  his  own  house.  He  was 
accordingly  carried  at  least  a  mile  on  a  settee,  in  a  city  rail  car,  and 
died  about  twelve  hours  after  leaving  the  hospital,  on  the  13th  of 
the  month,  sixteen  days  after  the  infliction  of  the  wound.  At  the 
inspection  made  by  the  coroner's  examiner  for  the  inquest,  Dr.  S.  P. 
Brown,  he  ascertained  that  "the  left  auricle  had  been  punctured  in  its 
upper  part,  the  heart  completely  encased  in  plasma,  the  pericardium 
filled  with  serum,  and  the  left  lung  had  partially  collapsed." — H.] 

It  was  the  opinion  of  Dupuj^tren,  that  these  injuries  were  not 
necessarily  fatal,  although  I  believe,  with  one  exception,  there  is  no 
case  on  record  in  which  a  person  has  recovered  from  a  penetrating- 
wound  of  the  cavities  of  the  heart.  ("Ed.  M.  and  S.  J."  Oct.  1844, 
557;  also  "Ann.  d'Hyg."  1846,  t.  1,  p.  212.)  There  are  few,  proba- 
bly, who  will  be  inclined  to  consider  them  curable;  a  remote  possi- 
bility of  simple  wounds  healing,  and  of  the  patient  recovering,  may 
be  admitted,  but  until  some  clear  instances  of  recovery  from  pene- 
trating wounds  of  the  cavities  are  reported,  the  majority  of  practi- 
tioners will  continue  to  look  upon  them  as  fatal.  From  a  series  of 
cases  collected  by  MM.  Ollivier  and  Sanson,  it  appears  that  out  of 
twenty-nine  instances  of  penetrating  wounds  of  the  heart,  only  two 
proved  fatal  within  forty-eight  hours.  In  the  others  death  took  place 
at  the  varying  periods  of  from  four  to  twenty-eight  days  after  the 
infliction  of  the  wound.  (Devergie,  "Med.  Leg."  vol.  2,  p.  253.) 
These  differences  in  the  time  at  which  death  occurs,  as  well  as  the 
fact  that  wounds  of  the  heart  do  not  instantly  destroy  life,  have  been 
ascribed  to  the  peculiar  disposition  of  the  muscular  fibres  of  the 
organ,  and  to  the  manner  in  which  they  are  penetrated  by  a  weapon. 
It  appears  from  the  observations  of  M.  Ollivier  and  others,  that  the 
right  cavities  of  the  heart  are  more  frequently  wounded  than  the 
left,  and  of  these  the  right  ventricle  is  most  commonly  the  seat  of 
injury.  Out  of  sixty-four  cases  of  wounds  of  this  organ,  twenty- 
nine  were  situated  in  the  right  ventricle,  twelve  in  the  left  ventricle, 
nine  in  the  two  ventricles,  three  in  the  right  auricle,  and  one  in  the 
left  auricle.  These  differences  are  readily  accounted  for  by  the  re- 
lative situation  of  the  cavities.  It  appears  also,  that  wounds  of  the 
right  ventricle  are  not  only  the  most  frequent,  but  of  all  others  they 
are  the  most  rapidly  fatal.  It  is  considered  that  the  suddenness  of 
death  in  severe  wounds  of  the  cavities  of  this  organ,  is  to  be  ascribed 
not  merely  to  the  loss  of  blood,  but  to  the  degree  of  compression 
which  the  heart  experiences  from  that  which  escapes  into  the  bag  of 
the  pericardium.  In  reference  to  the  direction  of  penetrating  wounds 
of  the  chest,  it  may  be  proper  to  state  that  the  base  of  the  heart  cor- 
responds to  the  upper  margin  of  the  third  rib  on  the  left  side ;  and 
the  apex  to  the  lower  margin  of  the  fifth  rib  on  the  same  side. 

A  penetrating  wound  of  the  heart  was  formerly  considered  to  be 
instantaneously  mortal,  and  the  usual  medical  opinion  at  coroners' 
inquests  was,  that  a  person  so  wounded,  must  have  dropped  down 


RUPTURES    OF    THE    HEART.  291 

dead  on  the  spot.  More  accurate  observations  have,  however,  shown 
that  this  is  an  erroneous,  and  in  medico-legal  practice,  a  highly  dan- 
gerous doctrine.  The  Due  de  Bern',  who  was  murdered  in  Paris  in 
1820,  survived  eight  hours  after  having  received  a  wound  of  the  left 
ventricle.  Other  and  more  remarkable  instances  of  survivorship 
have  been  recorded;  and  it  may  be  stated,  that,  although  in  a  surgi- 
cal view,  a  question  of  this  kind  is  of  little  importance,  the  case  is 
very  different  in  legal  medicine.  Upon  it  may  depend  the  decision 
of  questions  relative  to  suicide,  murder,  or  justifiable  homicide. 
When  the  cavities  of  the  heart,  especially  the  auricles,  are  exten- 
sively laid  open,  death  is  likely  to  be  an  immediate  result;  but  per- 
sons who  have  sustained  wounds  of  this  organ  have  frequently  lived 
sufficiently  long  to  exercise  a  power  of  volition  and  locomotion.  In 
reference  to  penetrating  wounds  (stabs)  little  or  no  blood  probably 
escapes  from  the  heart  in  the  first  instance,  but  it  may  afterwards 
ooze  gently,  or  suddenly  burst  out  in  fatal  quantity.  It  must  not, 
therefore,  be  supposed,  when  a  person  is  found  dead  with  a  wound 
of  the  heart,  attended  with  abundant  hemorrhage,  either  that  the 
flow  of  blood  took  place  in  an  instant,  or  that  the  person  died  im- 
mediately and  was  utterly  incapable  of  exercising  any  voluntary 
power. 

The  heart  is  liable  to  be  ruptured  either  from  disease  or  accident. 
In  the  latter  case,  the  organ  generally  gives  way  towards  the  base, 
and  through  one  of  its  cavities  on  the  right  side.  Dr.  Hope  asserts 
that  in  ruptures  from  natural  causes,  it  is  the  left  side  of  the  heart, 
and  particularly  the  left  ventricle,  in  which  a  rupture  is  most  fre- 
quently found.  The  sj-mptoms  are  sudden  pain,  collapse,  cramps, 
cold  extremities,  and  rapid  death.  According  to  the  circumstances 
under  which  they  occur,  cases  of  rupture  from  disease  may  excite  a 
suspicion  of  death  from  violence.  Sometimes  the  substance  of  the 
heart  may  be  found  to  have  undergone  fatty  degeneration.  As  a 
medico-legal  subject,  it  is  worthy  of  note,  that  when  this  alarming 
accident  proceeds  from  blows  or  falls,  it  is  not  always  accompanied 
by  marks  of  external  violence — or  any  fracture  or  other  injury  to 
the  exterior  of  the  chest.  The  natural  causes  of  rupture  of  the 
heart  are  violent  mental  emotions,  such  as  anger,  fright,  terror,  par- 
oxysms of  passion,  sudden  or  excessive  muscular  efforts,  or  violent 
physical  exertions  in  constrained  positions.  The  heart,  like  any 
other  muscle,  may  also  give  way  from  its  own  powerful  contraction. 
AVli en  the  heart  is  in  a  diseased  condition,  any  slight  causes  of  ex- 
citement are  sufficient  to  produce  rupture  and  sudden  death.  The 
mere  exercise  of  walking  may  thus  give  rise  to  fatal  consequences. 

Wounds  of  Arteries  and  Veins. — Wounds  of  the  large  arterial  and 
venous  trunks,  around  the  heart,  must  be  considered  as  mortal : 
death  is  generally  instantaneous  from  the  sudden  and  profuse  bleed- 
in-  which  attends  them.  With  regard  to  these  fatal  effusions  of  blood 
within  the  chest,  as  well  as  in  the  other  great  cavities,  it  may  be 
proper  to  mention  that,  from  whatever  vessel  or  vessels  the  blood 
may  have  issued,  it  is  not  commonly  found  coagulated  to  any  extent. 
The  greater  part  of  it  generally  preserves  the  liquid  state:  and  it  is 


292  WOUNDS    OF    LARGE    ARTERIES. 

rare  that  so  much  as  one-half  of  the  quantity  effused  is  met  with  in 
the  form  of  coagulum.  These  effusions  of  blood  in  the  chest  may 
be  sometimes  traced  to  wounds  of  the  intercostal  and  the  internal 
mammary  arteries,  or  of  the  vena  azygos. 

Wounds  of  the  carotid  arteries  have  been  considered  elsewhere  in 
reference  to  wounds  of  the  throat.  Questions  relative  to  the  power 
of  locomotion  perhaps  more  frequently  occur  with  respect  to  wounds 
of  these  bloodvessels  of  the  neck  than  of  the  heart — suicide  and 
murder  being  more  commonly  perpetrated  by  the  infliction  of  such 
wounds.  Wounds  of  the  carotid  arteries  are  often  pronounced  in- 
stantaneously mortal.  A  witness  may  deliberately  state  that  the 
person  could  not  possibly  have  survived  an  instant.  This  is  a  very 
hazardous  opinion,  for  it  occasionally  comes  out,  on  inquiry,  that  if 
such  a  wound  had  been  instantaneously  mortal,  then,  in  defiance  of 
rational  probability,  or  of  the  strongest  presumptive  evidence  to  the 
contrary,  the  deceased  must  have  been  murdered  !  A  medical  opinion 
of  this  kind  has  not  only  been  refuted  by  circumstances,  but  by  the 
evidence  of  eye-witnesses.  A  medical  witness  is  then  compelled  to 
admit  that  his  rules  for  judging  of  the  mortality  of  wounds  are 
erroneous,  and  that  the  person  may  have  survived  for  a  longer  or 
shorter  period.  There  are  several  cases  on  record  which  show  that 
wounds  involving  the  common  carotid  artery  and  its  branches,  as 
well  as  the  internal  jugular  vein,  do  not  prevent  a  person  from  exer- 
cising voluntary  power,  and  even  running  a  certain  distance.  There 
is  another  circumstance  which  requires  notice  in  relation  to  severe 
wounds  in  the  throat — namely,  that  although  a  person  may  have  the 
power  of  locomotion,  he  may  not  be  able  to  use  his  voice  so  as  to 
call  for  assistance.  It  sometimes  excites  surprise  at  an  inquest,  how 
a  murder  may,  in  this  way,  be  quietly  committed  without  persons 
in  an  adjoining  room  hearing  any  noise ;  but  the  fact  is  well  known 
medically,  that  when  the  windpipe  is  divided,  as  it  generally  is  on 
these  occasions,  the  voice  is  lost. 

In  reference  to  severe  wounds  involving  bloodvessels,  while  we 
may  allow  that  persons  may  survive  for  a  sufficient  time  to  perform 
various  acts  of  volition  and  locomotion,  yet  the  presence  of  a  mor- 
tal wound,  especially  when  of  a  nature  to  be  accompanied  by  a  great 
loss  of  blood,  must  prevent  all  struggling  or  violent  exertion  on  the 
part  of  the  wounded  person ;  such  exertion  we  must  consider  to  be 
quite  incompatible  with  his  condition.  A  medical  jurist  may  thus 
have  it  in  his  power  to  determine  whether  a  mortal  wound  found  on 
the  deceased  has  or  has  not  been  inflicted  for  the  purpose  of  murder. 
Of  wounds  of  other  bloodvessels,  whether  arteries  or  veins,  it  is  un- 
necessary to  make  any  further  remark.  Death  is  generally  owing 
to  loss  of  blood,  and  the  bleeding  from  a  comparatively  small  vessel 
may  prove  fatal,  according  to  its  size,  situation,  and  the  state  of  the 
wounded  person. 

Death  from  the  Entrance  of  Air  into  Wounded  Veins. — In  wounds  of 
veins  there  is  an  occasional  and  a  peculiar  cause  of  death  which  re- 
quires a  remark,  namely,  the  entrance  of  air  by  the  open  mouth  of 
the  divided  vessel. 


RUPTURES    OF    THE    DIAPHRAGM.  293 

It  has  been  long  known  that  air  injected  into  the  jugular  vein 
would  destroy  life  by  interfering  with  the  functions  of  the  heart ; 
but  the  exact  nature  of  this  accident,  as  it  occurs  in  operations,  is 
not  well  understood.  (Ferguson's  "  Surgery,"  p.  444.)  According 
to  some,  the  air  rushes  into  the  cavity  of  the  vessel  owing  to  atmos- 
pheric pressure  during  the  expansion  of  the  heart,  while  others  be- 
lieve it  to  be  dependent  on  aspiration  in  the  act  of  breathing :  but 
in  some  alleged  cases  of  this  kind,  death  has  been  probably  caused 
by  Joss  of  blood.  When  the  bleeding  is  slight,  and  the  hissing 
sound  is  heard  at  the  time  of  the  incision,  it  may  fairly  be  ascribed 
to  the  entrance  of  air.  This  opinion  would  be  confirmed  by  the 
discovery  of  a  frothy  state  of  the  blood  in  the  right  cavities  of  the 
heart. 

Wounds  and  Ruptures  of  the  Diaphragm. — The  diaphragm,  or  mus- 
cular partition  between  the  chest  and  abdomen,  is  liable  to  be  wounded 
either  by  weapons  which  penetrate  the  cavity  of  the  chest  or  abdo- 
men, or  by  the  ribs  when  fractured  by  violent  blows  or  falls ;  but, 
under  any  circumstances,  wounds  of  this  muscle  are  not  likely  to 
occur  without  implicating  other  important  organs  that  are  in  contact 
with  it.  It  is  scarcely  possible,  therefore,  to  estimate  the  danger  of 
these  injuries  abstractedly,  as  a  medical  opinion  must  materially 
depend  on  the  concomitant  mischief  to  the  adjoining  viscera.  Slight 
penetrating  wounds  of  the  diaphragm  may  heal  like  those  of  other 
muscular  parts:  and  cases  of  this  kind  are  on  record.  There  is, 
however,  especially  when  the  wound  is  of  a  lacerated  kind,  a  con- 
secutive source  of  mischief  which  no  remedial  means  can  avert — 
namely,  that  after  the  wound  has,  to  all  appearance,  healed,  the  life 
of  a  person  may  be  cut  short  by  the  strangulation  of  a  portion  of 
the  stomach  or  bowels  in  the  half-cicatrized  aperture.  In  a  case  of 
this  description,  when  death  occurs  at  a  long  period  after  the  inflic- 
tion of  a  wound,  the  witness  may  probably  be  required  to  say — 
Whether  the  wound  was  the  cause  of  death  ?  or  whether  there  were 
any  other  circumstances  which  would  have  caused  or  facilitated  the 
production  of  a  hernia.  The  degree  of  culpability  of  an  aggressor 
may  materially  depend  upon  the  answers  returned  to  these  questions. 
Phrenic  hernia,  as  this  form  of  internal  rupture  is  termed,  is  not  by 
any  means  an  unusual  or  unexpected  fatal  consequence  of  a  wound 
of  the  diaphragm ;  and  therefore  it  would  appear  at  first  sight,  that 
death,  at  whatever  period  this  event  may  occur,  should  be  referred 
to  the  original  wound.  But  the  case  may  present  some  difficulties, 
as  it  is  possible  that  a  slight  blow  on  the  stomach,  received  subse- 
quently to  the  wound,  or  even  any  violent  exertion  on  the  part  of 
the  deceased,  might  have  produced  the  fatal  strangulation.  A  per- 
son may  survive  with  a  large  phrenic  hernia  for  a  considerable  period, 
and  die  from  some  other  cause.  It  has  been  stated  that  a  person  is 
completely  incapacitated  and  rendered  incapable  of  exertion  or  loco- 
motion by  a  rupture  of  the  diaphragm.  This  statement,  however, 
has  been  based  on  limited  observation.  The  general  effect  of  such 
an  injury  is  to  incapacitate  a  person,  but  cases  arc  recorded  in  which, 


294  WOUNDS    OF    THE    ABDOMEN. 

in  spite  of  the  rupture,  a  person  has  possessed  the  power  of  moving 
and  walking  to  a  considerable  distance. 

The  most  serious  injuries  to  the  diaphragm  are  unquestionably 
those  which  are  produced  by  violent  contusions  or  falls  on  the  abdo- 
men, at  a  time  when  the  stomach  and  intestines  are  distended.  In 
these  cases  the  muscular  fibres  may  be  ruptured  to  a  greater  or  less 
extent ;  but  the  bleeding  is  not  considerable,  rarely  exceeding  two, 
three,  or  four  ounces.  A  uniform  result  of  these  ruptures,  when  ex- 
tensive, is  a  protrusion  of  the  stomach  into  the  chest,  with  sometimes 
a  rupture  of  the  coats  of  this  organ  and  extravasation  of  its  contents. 
Severe  lacerations  of  the  diaphragm  are  more  readily  produced 
during  the  act  of  inspiration  than  during  expiration — the  fibres  of 
the  muscles  being  then  stretched,  and  receiving,  while  in  this  state 
of  tension,  the  whole  of  the  force.  According  to  Devergie,  the  rup- 
ture most  frequently  takes  place  in  the  central  tendinous  structure, 
where  it  is  united  with  the  left  muscular  portion  above  the  crura. 
He  has  remarked  that  it  occurs  more  commonly  on  the  left  side  than 
on  the  right.  (Op.  cit.  vol.  2,  p.  250.)  It  has  been  supposed  that 
death  would  be  an  immediate  consequence  of  this  accident ;  but  this 
view  is  not  supported  by  facts.  la  a  case  of  extensive  rupture  of 
the  diaphragm,  related  by  Devergie,  in  which  the  stomach  and  colon 
were  found  in  the  chest,  the  person  lived  nine  months  after  the  only 
accident  that  could  have  produced  it,  and  then  died  from  another 
cause.  Besides  the  stomach,  it  sometimes  happens  that  the  liver, 
spleen,  or  intestines  pass  through  the  opening,  and,  like  it,  these 
organs  are  liable  to  become  strangulated :  the  lungs  are  at  the  same 
time  so  compressed  that  respiration  is  stopped,  and  asphyxia  or  suf- 
focation may  be  an  immediate  result. 

Direction  of  Wotinds  in  the  Chest. — In  judging  of  the  direction  taken 
by  wounds  which  traverse  the  chest  from  front  to  back,  it  is  necessarv 
to  remember  the  great  difference  that  exists  in  the  level  of  the  same 
rib  anteriorly  and  posteriorly.  This  must  be  especially  attended  to 
when  we  are  called  upon  to  state  the  direction  of  a  traversing  wound 
from  the  description  of  it  given  by  another.  The  point  here  referred 
to  had  an  important  bearing  in  the  case  of  a  fatal  gunshot  wound, 
which  was  the  subject  of  a  criminal  charge  some  years  since.  (Henke's 
"  Zeitschrift,"  1836.)  It  must  not  be  forgotten  that  a  wound  imme- 
diately below  the  chest  bone,  will  in  its  fore  part  involve  the  viscera 
of  the  abdomen — in  the  back  part  those  of  the  chest,  and  in  its  central 
part  it  will  traverse  the  diaphragm. 

Wounds  of  the  Parietes  of  the  Abdomen. — Incised  and  punctured 
wounds,  which  affect  the  parietes  or  coverings  of  the  abdomen,  with- 
out penetrating  the  cavity,  are  not  quite  of  so  simple  a  nature  as 
might  at  first  sight  be  imagined.  The  danger  is  immediate  if  the 
epigastric  artery  be  wounded;  for  a  fatal  hemorrhage  will,  in  some 
instances,  take  place  from  a  wound  of  this  small  vessel.  Among 
the  sources  of  danger  from  superficial  wounds,  is  inflammation,  fol- 
lowed by  suppuration  beneath  the  tendinous  membrane  which  covers 
the  abdominal  muscles.  The  matter  formed  is  very  liable  t<>  accu- 
mulate within  the  sheath  of  the  muscles,  and  this  may  prove  fatal 


WOUNDS    OF    THE    ABDOMEN.  295 

unless  proper  treatment  be  adopted.  The  inflammation  will  some- 
times extend  to  the  peritoneum,  and  thus  rapidly  destroy  life.  As 
improper  medical  treatment  may,  in  either  of  these  cases,  cause  a 
superficial  wound  of  the  abdomen  to  take  a  fatal  termination — so 
when  a  person  stands  charged  with  having  inflicted  such  a  wound, 
it  will  be  necessary  for  a  medical  witness  to  consider  how  far  the 
consequences  of  the  act  of  the  prisoner  have  been  aggravated  by 
wilful  neglect  or  unskiliulness.  But  when  these  wounds  take  a 
favorable  course  and  heal,  there  is  an  after  effect  to  be  dreaded, 
namely,  a  protrusion  of  the  viscera  at  the  cicatrized  spot,  constituting 
ventral  hernia.  When  the  wound  has  involved  the  muscular  fibres 
transversely  to  their  course,  the  cicatrix  which  follows  is  commonly 
far  less  capable  of  resisting  the  pressure  of  the  viscera  within,  than 
any  other  parts  of  the  parietes.  A  hernia  may  take  place,  and  this, 
like  other  herniae,  if  neglected,  is  liable  to  become  strangulated,  and 
lead  to  the  destruction  of  life.  The  walls  of  the  abdomen,  owing  to 
the  protrusion  of  this  cavity,  are  easily  penetrated  by  pointed  instru- 
ments, and  it  requires  but  a  slight  force  to  traverse  them  completely 
and  wound  the  intestines.  A  slight  wound  may  thus  prove  fatal  by 
causing  peritoneal  inflammation. 

Contusions  are  attended  generally  with  far  more  serious  effects  on 
the  cavity  of  the  abdomen  than  on  the  chest.  This  arises  from  the 
coverings  of  the  abdomen  having  less  power  to  resist  external  shocks. 
In  the  first  place,  death  may  be  the  immediate  result  of  a  blow  in 
the  upper  and  central  portions ;  no  particular  morbid  changes  may 
be  apparent  on  inspection,  and  the  violence  may  have  been  so  slight 
as  not  to  have  produced  any  ecchymosed  mark  on  the  skin.  Death 
has  been  ascribed  in  these  cases  to  a  fatal  shock  transmitted  to  the 
system  through  a  violent  impression  produced  on  the  nerve-centre — 
called  the  solar  plexus.  Some  remarks  have  already  been  made  on 
sudden  death  from  blows  on  this  part  of  the  abdomen.  Travers, 
Alison,  Watson,  Cooper,  and  other  writers  on  surgical  injuries,  have 
referred  to  cases  of  this  kind  as  of  not  unfrequent  occurrence.  They 
are  of  considerable  importance  in  a  medico-legal  point  of  view,  as, 
in  the  absence  of  marks  of  physical  injury  in  the  part  struck,  a  jury 
might  be  led  to  doubt  whether  the  blow  could  have  been  the  cause 
of  death.  Some  surgeons  have  thought  that  these  cases  have  not 
been  accurately  observed,  and  that  in  those  which  terminate  fatally, 
a  more  careful  inspection  would  probably  have  shown  visible  changes 
in  the  organic  structures.  The  fact,  however,  remains :  persons  have 
died  soon  after  receiving  severe  blows  on  the  upper  part  of  the  ab- 
.  domen,  and  the  medical  men  who  have  examined  the  bodies  for  the 
express  purpose  of  detecting  physical  injuries,  have  not  found  any 
to  record.  Moreover  they  have  not  found  in  any  part  of  the  body  a 
natural  cause  of  sudden  death.  Blows  on  the  abdomen,  when  they 
do  not  destroy  life  by  shock,  may  cause  death  by  inducing  peritoneal 
inflammation.  Violence  of  a  severe  kind  applied  to  the  abdomen  is 
not  always  indicated  by  ecchymosis  or  injury  to  the  skin.  Effusions 
of  blood  in  the  sheaths  or  tendinous  coverings  of  the  muscles,  may 
or  may  not  be  indicative  of  violence.     One  fact  must  here  be  borne 


296  EUPTURES    OF    THE    LIVER. 

in  mind,  to  prevent  mistakes  in  examining  a  body  after  death, 
namely,  that  blood  may  be  found  copiously  effused  in  and  around 
the  abdominal  muscles,  quite  irrespective  of  the  application  of  vio- 
lence. (Reid's  "  Physiological  Researches,"  p.  511.)  The  absence 
of  ecchymosis,  or  abrasion  of  the  skin,  in  these  cases,  is  sufficient  to 
show  that  such  extensive  effusions  are  not  caused  by  violence.  Blows 
adequate  to  produce  a  laceration  of  the  vessels  and  hemorrhage, 
would  most  probably  be  attended  with  ecchymosis — and  some  visi- 
ble injury  to  the  skin.  At  any  rate  when  such  marks  of  violence 
are  not  visible,  and  there  is  no  evidence  of  a  blow  having  been 
struck,  a  witness  would  act  wisely  in  declining  to  attribute  the  mere 
effusion  of  blood  to  the  act  of  another  person.  Deeply  penetrating 
wounds  of  the  abdomen  are  generally  fatal  by  reason  of  the  injury 
done  to  the  intestines  and  other  organs. 

Ruptures  of  the  Liver, — Blows  on  the  abdomen  may  prove  fatal  by 
causing  a  rupture  of  the  liver  or  other  viscera,  with  extravasation 
of  blood :  and  as  it  has  been  elsewhere  stated,  these  serious  injuries 
may  occur  without  being  attended  with  any  marks  of  external  vio- 
lence. Of  all  the  internal  organs,  the  liver  and  spleen  are  the  most 
exposed  to  rupture,  owing  to  their  compact  structure,  which  pre- 
vents them  from  yielding  to  a  sudden  shock,  like  the  stomach  and 
intestines.  Ruptures  of  the  liver  may  occur  from  falls  or  blows ; 
but  this  organ  may  be  ruptured  merely  by  a  sudden  action  of  the 
abdominal  muscles.  Ruptures  of  the  liver  generally  seen  on  the 
convex  surface  and  anterior  margin,  seldom  extending  through  the 
whole  substance  of  the  organ,  but  consisting  of  fissures,  varying 
from  one  to  two  inches  in  depth.  The  right  lobe,  from  its  size,  is 
more  usually  affected  than  the  left.  Their  usual  direction  is  from 
before  backwards,  with  a  slight  obliquity ;  they  rarely  interest  the 
liver  transversely.  The  lacerated  edges  are  not  much  separated, 
while  the  surfaces  present  a  granular  appearance.  But  little  blood 
is  met  with  in  the  laceration ;  it  is  commonly  found  effused  in  the 
lower  part  of  the  cavity  of  the  peritoneum,  or  in  the  hollow  of  the 
pelvis,  and  is  only  in  part  coagulated.  Ruptures  of  the  liver,  unless 
they  run  far  backwards  and  involve  the  vena  cava  or  portal  vein, 
are  not  in  general  attended  with  any  considerable  effusion  of  blood ; 
but  the  bleeding,  should  this  vessel  be  implicated,  is  sufficient  to 
cause  the  instant  destruction  of  life.  Under  other  circumstances,  a 
person  may  survive  some  hours,  as  the  blood  may  escape  only  slowly, 
or  it  may  be  suddenly  effused  in  fatal  quantity  after  some  hours  or 
days,  as  a  result  of  violent  exertion  or  of  fresh  violence  applied  to 
the  abdomen.  Ruptures  of  the  liver  generally  prove  fatal  within 
forty-eight  hours.  One  case  has  been  related  in  which  the  person 
survived  for  eight  days :  and  a  case  occurred  to  Dr.  Wilks  in  which 
a  person  in  Guy's  Hospital  survived  this  serious  accident  ten  days. 

Wounds  and  ruptures  of  the  gall-bladder  are  necessarily  attended 
with  the  effusion  of  bile.  This  irritant  fluid  finds  its  way  into  the 
cavity  of  the  abdomen,  and  the  person  dies  from  peritonitis. 

Rupture  of  the  Spleen. — Rupture  of  the  spleen  may  occur  either 
from  violence  or  disease,  and  it  would  appear  that  a  slight  degree  oi" 


RUPTURES    OF    THE    BLADDER.  297 

violence  may  in  some  cases  cause  a  rupture  of  this  organ,  without 
any  marks  of  injury  appearing  externally. 

Rupture  of  the  Kidneys. — The  kidneys  are  occasionally  ruptured 
from  violence ;  but  this  appears  to  be  a  rare  accident.  A  rupture  of 
the  kidney  may  be  produced  without  causing  any  prominent  symp- 
toms, and  prove  fatal  in  a  few  hours.  It  may  be  remarked  generally 
that  ruptures  of  the  liver,  spleen,  and  kidneys,  unless  attended  with 
immediate  and  copious  bleeding,  are  not  inconsistent  with  a  person 
having  the  power  to  move  and  walk.  In  a  case  which  occurred  at 
Guy's  Hospital,  a  man  had  retained  the  power  of  walking  for  some 
distance,  although  on  inspection  after  death,  one  kidney  was  found 
torn  in  halves  from  an  accident. 

Ruptures  and  Wounds  of  the  Intestines. — Ruptures  of  the  intestines 
sometimes  occur  from  disease ;  and,  in  a  case  of  rupture  alleged  to 
have  been  produced  by  violence,  we  must  always  take  this  possible 
objection  to  our  opinion  into  account.  The  ruptured  part  of  the 
bowel  should  be  carefully  examined,  in  order  to  see  whether  there 
are  any  signs  of  ulceration  or  softening  about  it.  If  not,  and  there 
is  clear  evidence  of  violence  having  been  used,  it  is  impossible  to 
admit  this  speculative  objection.  If  with  the  proof  of  violence  there 
should  also  be  a  diseased  condition  of  the  bowel,  we  may  be  required 
to  say  whether  this  did  not  create  a  greater  liability  to  rupture — a 
point  which  must  be  generally  conceded. 

Punctured  wounds,  which  merely  touch  the  bowels  without  lay- 
ing open  the  cavity,  are  liable  to  cause  death  by  peritonitis.  These 
injuries  to  the  intestines  sometimes  destroy  life  by  shock;  there  is 
but  little  blood  effused,  and  the  wounded  person  dies  before  perito- 
nitis can  be  set  up.  Severe  wounds  to  the  intestines  may,  however, 
be  inflicted  almost  without  the  consciousness  of  the  individual,  and 
the  wounded  person  may  be  able  to  walk  a  considerable  distance. 
("  Med.  Gaz."  vol.  46,  p.  24.) 

Wounds  and  Ruptures  of  the  Stomach. — Wounds  and  ruptures  of 
the  stomach  may  cause  death  by  shock ;  ruptures  commonly  give 
rise  to  severe  pain,  which  of  itself  is  sufficient  to  bring  about  rapid 
dissolution.  It  is  proper  to  state,  however,  that  the  stomach  may  be 
ruptured  from  spontaneous  causes,  as  in  cases  of  ulceration  as  a  re- 
sult of  disease ;  but  sometimes  there  is  no  morbid  cause  apparent. 

Ruptures  of  the  Bladder. — This  injury,  which  has  on  several  occa- 
sions given  rise  to  medico-legal  discussion,  is  frequently  the  result 
of  blows  on  the  lower  part  of  the  abdomen.  The  principal  ques- 
tions in  reference  to  the  accident  are :  Was  the  rupture  the  result 
of  wilful  violence  or  of  an  accidental  fall  ?  or  did  it  proceed  from 
spontaneous  causes,  as  from  over-distension  ?  The  spot  in  which 
rupture  commonly  takes  place,  is  in  the  upper  and  back  part,  where 
the  bladder  is  covered  by  the  peritoneum.  The  aperture  is  some- 
times large,  at  others  small ;  but  the  effect  is  that  the  urine  is  effused, 
and  death  takes  place  sooner  or  later  from  peritoneal  inflammation. 
It  is  commonly  stated  that  ruptures,  when  attended  with  extravasa- 
tion of  urine  into  the  peritoneal  cavity,  are  uniformly  fatal ;  but  if 
the  rupture  occurs  in  the   under  part  of  the  bladder,  or  the  urine 


298  RUPTURES    OF    THE    BLADDER. 

funis  its  way  into  the  cellular  tissue,  the  medical  opinion  is  not  so  un- 
favorable. The  usual  period  at  which  death  occurs  from  this  acci- 
dent is  in  from  three  to  seven  days;  but  Mr.  Ellis  met  with  a  case  in 
which  the  person  did  not  die  until  the  fifteenth  day.  The  cause  of 
death  is  obviously  peritoneal  inflammation;  but  a  person  may  die 
suddenly  from  this  injury  as  a  simple  result  of  shock. 

When  ruptures  of  the  bladder  are  produced  by  blows  they  are 
rarely  accompanied  by  marks  of  ecchymosis,  or  of  injury  to  the  skin. 
Thus,  then,  there  may  be  no  means  of  distinguishing,  by  external 
examination,  whether  a  rupture  was  really  due  to  violence  or  to 
spontaneous  causes.  They  who  are  unacquainted  with  this  fact, 
might  be  disposed  to  refer  the  rupture  to  disease,  on  the  supposition 
that  violence  should  always  be  indicated  by  some  visible  external 
injury;  but  there  are  numerous  cases  on  record  which  show  that  this 
view  is  erroneous. 

As  an  attempt  may  be  made,  in  cases  in  which  death  has  resulted 
from  this  injury,  to  refer  rupture  of  this  organ  to  natural  rouses,  it 
may  be  observed  that  this  is  an  unusual  occurrence ;  a  rupture  is 
almost  always  the  result  of  violence  directly  applied  to  the  part 
while  the  organ  is  in  a  distended  state.  A  spontaneous  rupture  may, 
however,  occur:  1.  When  there  is  paralysis,  with  a  want  of  power 
to  expel  the  urine.  2.  When  the  bladder  is  ulcerated  or  otherwise 
diseased.  3.  When  there  is  an  obstruction  in  the  urethra  from 
stricture  or  other  causes.  The  causes  of  spontaneous  rupture  are 
easily  recognizable  by  ascertaining  the  previous  condition  of  the  de- 
ceased, or  examining  the  bladder  and  urethra  after  death.  If  a  man 
were  in  good  health  prior  to  being  struck;  if  he  suddenly  felt  intense 
pain,  could  not  pass  his  urine  afterwards,  and  died  from  an  attack  of 
peritonitis  in  five  or  six  days  ;  if,  after  death,  the  bladder  was  found 
lacerated,  but  this  organ  and  the  urethra  were  otherwise  in  a  healthy 
condition,  there  can  be  no  doubt  that  the  blow  must  have  been  the 
sole  cause  of  rupture  and  death.  In  such  a  case,  to  attribute  the 
rupture  to  spontaneous  or  natural  causes  would  be  equal  to  denying 
all  kind  of  causation.  As  to  the  absence  of  marks  of  violence  ex- 
ternally, this  would  be  a  difficulty  only  to  those  who  had  not  pre- 
viously made  themselves  acquainted  with  the  facts  attending  this  and 
other  accidents  affecting  the  viscera  of  the  abdomen  (p.  215).  Never- 
theless, a  medical  witness  must  be  prepared  to  hear  the  same  line 
of  defence  continually  brought  forward,  as  it  is  always  the  object  of 
a  counsel  to  make  the  best  of  a  case  for  the  prisoner.  With  medical 
facts,  opinions,  and  doctrines  he  does  not  concern  himself,  so  long  as 
tln-y  do  not  serve  his  purpose.  A  diseased  state  of  the  bladder  might 
probably  diminish  the  responsibility  of  an  accused  person  for  the 
consequences ;  therefore  the  state  of  this  organ  should  be  closely 
looked  to  on  these  occasions.  A  distended  state  of  the  organ  can  be 
no  mitigatory  circumstance,  since  it  is  only  when  the  bladder  is  in 
this  condition  that  rupture  is  liable  to  occur.  This  can  hardly  be 
regarded  as  an  abnormal  condition  of  the  organ.  An  accidental  fell 
forwards  over  a  hard  surface  when  the  bladder  is  distended  with 
urine  may  lead  to  rupture.     The  person  generally  experiences  intense 


WOUNDS    OF    THE    GENITAL    ORGANS.  299 

pain  in  the  lower  part  of  the  abdomen,  and  there  is  an  inability  to 
pass  the  nrine.  Although  a  man  is  liable  to  be  rendered  powerless 
on  sustaining  a  rupture  of  the  bladder  from  a  heavy  blow  or  fall, 
there  are  several  well  authenticated  cases  on  record  which  prove  that 
a  man  may  walk  some  distance,  and  move  about  even  for  two  or 
three  hours  afterwards. 

In  punctured  and  incised  wounds  of  the  bladder,  the  urine  is  im- 
mediately extravasated,  but  in  gunshot  wounds,  the  extravasation 
does  not  commonly  take  place  until  the  sloughs  have  separated. 
Thus,  life  may  be  protracted  longer  in  cases  of  gunshot  than  under 
other  wounds  of  the  bladder.  For  the  discovery  of  extravasated 
liquids  or  blood,  in  wounds  and  other  injuries  to  the  abdominal  vis- 
cera, we  must  look  to  the  cavity  of  the  pelvis,  as  it  is  here  that,  for 
obvious  reasons,  such  liquids  have  a  tendency  to  collect. 

Wounds  of  the  Genital  Organs. — Wounds  of  these  organs  do  not 
often  require  the  attention  of  a  medical  jurist ;  such  wounds,  whether 
in  the  male  or  female,  may,  however,  prove  fatal  to  life  by  excessive 
bleeding.  Self-castration  or  mutilation  is  sometimes  observed 
among  male  lunatics  and  idiots.  When  timely  assistance  is  rendered 
a  fatal  result  may  be  averted.  Incised,  lacerated,  or  even  contused 
wounds  on  the  female  genitals,  may  prove  fatal  by  loss  of  blood, 
not  from  the  wound  involving  any  large  vessel,  but  from  the  numer- 
ous small  vessels  which  are  divided.  When  deeply  incised  wounds 
are  inflicted  upon  the  genital  organs  of  either  sex,  the  fact  of  their 
existence  in  such  a  situation,  at  once  proves  wilful  and  deliberate 
malice  on  the  part  of  the  assailant.  Accident  is  wholly  out  of  the 
question,  and  suicide  is  improbable,  except  in  cases  of  confirmed 
idiocy  and  lunacy.  Such  wounds  require  to  be  carefully  examined ; 
for  the  proof  of  the  kind  of  wound,  when  fatal,  may  be  tantamount 
to  a  proof  of  murder.  A  practitioner  may  be  sometimes  required 
to  determine  whether  wounds  affecting  the  female  organs  have  re- 
sulted from  accident,  have  been  self-inflicted,  or  inflicted  by  others 
with  homicidal  intention.  The  remarks  elsewhere  made  on  the  sub- 
ject of  imputed  wounds  will  apply  to  cases  of  this  description.  [In 
the  Oyer  and  Terminer  of  Meigs  County,  Ohio,  February  Term, 
1866,  Mary  Broderick  was  indicted  for  having  caused  the  death  of  her 
husband  by  "  purposely  and  maliciously  with  her  right  hand  grasp- 
ing and  wrenching  the  penis  of  the  said  Patrick  Broderick  with  intent 
to  inflict  a  mortal  wound :  by  means  whereof,  the  urethra,  with  the 
corpus  spongiosum  and  corpus  cavernosum,  was  broken  and  severed, 
and  from  the  effects  thereof  the  said  Patrick  Broderick  died  on  the 
eleventh  day  thereafter."  The  defendant  was  found  guilty  of  man- 
slaughter by  the  j  ury.  A  motion  for  a  new  trial  was  made,  which  had 
not  when  the  case  was  reported  been  disposed  of.  See  "  Cincinnati 
Journal  of  Medicine,"  July,  1866,  p.  316,  where  this  case  is  reported, 
together  with  instances  of  similar  injury  resulting  from  accident,  in 
an  article  by  Dr.  Geo.  C.  Blackman. — P.] 

Contused  wounds  on  the  female  genitals  may  prove  fatal,  Try  the 
laceration  of  parts  leading  to  great  loss  of  blood.  Several  trials 
for  manslaughter  have  taken  place,  in  which  this  was  proved  to 


300  FRACTURES.      CAUSES. 

have  been  the  cause  of  death.  There  may  be  such  a  loss  of  blood 
iu  these  cases  as  to  destroy  life,  although  no  large  bloodvessel  is 
implicated  in  the  injury.  A  contused  wound  on  the  vulva  may 
occasionally  present  an  ambiguous  appearance  and  be  mistaken  for 
an  incised  wound.  When  the  soft  parts  of  the  body  are  struck  by 
a  blow  or  kick,  if  there  is  a  bony  surface  beneath,  a  longitudinal 
rent  may  appear  as  a  result  of  the  force  being  received  by  the  bone. 
A  kick  on  the  vulva,  or  a  fall  on  this  part,  may  produce  a  similar 
injury,  and  unless  carefully  examined,  may  lead  to  the  inference  that 
a  weapon  has  been  used  for  its  production.  It  is  well  known  that 
some  females  are  subject  to  frequent  discharges  of  blood  from  the 
genital  organs  from  natural  causes.  When  the  bleeding  immediately 
follows  a  blow,  and  the  woman  has  not  been  subject  to  such  a  dis- 
charge, the  fair  presumption  is  that  violence  was  the  cause  :  but  when 
the  flow  of  blood  appears  only  a  long  time  after  the  alleged  violence, 
of  which  no  traces  can  be  seen,  it  is  most  probably  due  to  natural 
causes. 

It  may  be  alleged  in  defence,  that  the  injuries  found  on  the  body 
were  inflicted  after  death,  and  not  while  the  deceased  was  living. 
Kicks  or  blows  on  the  vulva,  if  they  destroy  life  at  all,  cause  death 
by  copious  effusion  of  blood.  Violence  to  this  part  after  death 
would  not  produce  such  an  effusion  as  would  account  for  death. 
There  are  also  other  distinguishing  characters  which  have  been  else- 
where pointed  out. 


CHAPTER     XXXII. 

Fractures. — produced  by  a  blow  with  a  weapon  or  by  a  fall. 
— brittleness  of  the  bones. — fractures  caused  by  slight 
muscular  exertion. — ix  the  living  axd  dead  body. — has  a 
boxe  ever  beex  fractured? — locomotion. —  dislocations 
from  violexce  or  natural  causes. — medical  opinions. — 
actions  for  malapraxis. 

Fractures. 

Fractures  of  the  bones  have  some  important  bearings  in  relation 
to  medical  jurisprudence.  They  may  result  from  falls,  blows,  or 
the  spontaneous  action  of  muscles. 

Causes. — Questions  are  sometimes  put  as  to  whether  a  particular 
fracture  was  caused  by  an  accidental  fall  or  a  blow  ;  and  if  by  a  blow, 
whether  by  the  use  of  a  weapon  or  not.  It  is  obvious  that  the 
answers  must  be  regulated  by  the  circumstances  of  each  case.  Iu 
examining  a  fracture,  it  is  important  to  determine,  if  possible, 
whether  a  weapon  has  or  has  not  been  used,  and  this  may  be  some- 
times ascertained  by  the  state  of  the  parts.     It  is  a  common  defence, 


SPONTANEOUS    FRACTURES.  301 

on  these  occasions,  to  attribute  the  fracture  to  an  accidental  fall. 
Fractures  more  readily  occur  from  equal  degrees  of  force  in  the  old, 
than  in  the  young,  and  in  the  young  rather  than  in  the  adult ;  because 
it  is  at  the  adult  period  of  life  that  the  bones  possess  their  maximum 
degree  of  firmness  and  solidity.  The  bones  of  aged  persons  are 
sometimes  very  brittle,  and  slight  violence  will  then  produce  fracture. 
This  has  been  regarded  as  an  extenuating  circumstance,  when  the 
fracture  produced  by  a  slight  blow  was  followed  by  death.  Certain 
diseases,  such  as  syphilis,  arthritis,  cancer,  scurvy,  and  rachitis, 
render  bones  more  fragile ;  but  they  are  sometimes  preternaturally 
brittle  in  apparently  healthy  persons,  and  this  brittleness  appears  to 
be  hereditary.  In  such  cases,  a  defence  might  fairly  rest  upon  an 
abnormal  condition  of  the  bones,  if  the  violence  producing  the  frac- 
ture was  slight.  Several  trials  have  taken  place  in  which  this  brittle- 
ness of  the  bones  became  a  subject  of  inquiry.  In  a  case  of  fractured 
skull  leading  to  death  from  inflammation  of  the  brain,  it  was  proved 
that  the  bones  of  the  skull  were  occasionally  thin  and  brittle,  and 
this  led  to  a  mitigation  of  punishment.  The  orbitar  plate  of  the 
frontal  bone  is  very  thin,  and  it  may  be  fractured  by  a  blow  on  the 
eye.  Death  may  under  these  circumstances  result  from  infiamma 
tion  of  the  brain. 

Spontaneous  Fractures. — In  a  case  in  which  there  is  no  appearance 
of  disease,  a  fracture  may  be  ascribed  to  spontaneous  causes.  Thus 
bones  have  been  fractured  by  moderate  muscular  exertion.  The 
elbow  (olecranon),  heel-bone  (os  calcis),  and  knee-pan  (patella)  are 
particularly  exposed  to  this  accident.  The  long  bones  are  seldom 
the  subject  of  an  accident  of  this  kind ;  but  the  arm  (os  humeri)  in 
a  healthy  man  has  been  broken  by  the  simple  muscular  exertion  of 
throwing  a  cricket-ball.  ("Medical  Gazette,'1  vol.  16,  659.)  Mr. 
May  reports  the  case  of  a  young  lady,  who  fractured  the  neck  of 
the  scapula  by  suddenly  throwing  a  necklace  round  her  neck.  ("  Med. 
Gaz.,"  Oct.  1842.)  In  July,  1858,  a  gentleman,  ast.  40,  was  in  the 
act  of  bowling  at  cricket,  when  on  delivering  the  ball  he  and  some 
bystanders  heard  distinctly  a  sharp  crack  like  the  breaking  of  a  dry 
piece  of  wood.  He  fell  to  the  ground  as  if  he  had  been  shot.  The 
thigh-bone  was  found  to  be  fractured,  and  evidently  from  muscular 
exertion  only.  No  person  can  meet  with  an  accident  of  this  kind 
without  being  instantly  conscious  of  it.  It  is  probable  that  in  these 
instances,  if  there  were  any  opportunity  of  examining  the  bone,  it 
would  be  found  to  have  undergone  some  chemical  change  in  its  com- 
position, which  had  rendered  it  brittle.  In  fractures  arising  from 
this  cause  there  will  be  no  abrasion  of  the  skin,  nor  any  appearance 
to  indicate  that  a  blow  has  been  struck ;  while  the  marks  of  a  blow 
would,  of  course,  remove  all  idea  of  the  fracture  having  had  a  spon- 
taneous origin.  It  is  most  unusual  that  the  ribs  should  be  fractured 
from  muscular  exertion ;  but  a  case  occurred  to  Dr.  Groninger,  which 
shows  that  this  accident  may  really  occur.  It  is  only  of  medico- 
legal importance,  inasmuch  as  the  injury  might  be  ascribed  to  vio- 
lence :  but  the  absence  of  any  external  appearance  indicative  of  a 
blow  would  render  it  probable  that  this  was  not  the  cause. 


302  RECENT    AND    OLD    FRACTURES. 

Fractures  are  not  dangerous  to  life,  unless,  when  of  a  compound 
nature,  they  occur  in  old  persons,  or  in  those  who  are  debilitated  by 
disease  or  dissipated  habits.  They  may  then  cause  death  by  induc- 
ing irritative  fevers,  erysipelas,  gangrene,  tetanus,  pyaemia,  or  deli- 
rium tremens. 

Fractures  in  the  Living  and  Dead  Body.— It  is  not  always  easy  to 
say  whether  a  fracture  has  been  produced  before  or  after  death.  A 
fracture  produced  shortly  after  death,  while  the  body  is  warm,  and 
another  produced  shortly  before  death,  will  present  similar  charac- 
ters, except  that  in  the  former  case  there  might  be  less  blood  effused. 
A  fracture  caused  ten  or  twelve  hours  before  death  would  be  indi- 
cated by  a  copious  effusion  of  blood  into  the  surrounding  parts  and 
between  the  fractured  edges  of  the  bones,  as  well  as  by  the  lacera- 
tion of  the  muscles;  or  if  for  a  longer  period  before  death,  there 
may  be  the  marks  of  inflammation.  Fractures  caused  several  hours 
after  death  are  not  accompanied  by  an  effusion  of  blood.  A  medical 
witness  may  be  asked,  How  long  did  the  deceased  survive  after  receiv- 
ing the  fracture  ?  This  is  a  question  which  can  be  decided  only  by 
an  examination  of  the  fractured  part.  Unless  the  person  has  sur- 
vived eighteen  or  twenty-four  hours,  there  are  commonly  no  appreci- 
able changes.  After  this  time,  lymph  is  poured  out  from  the  sur- 
rounding structures.  This  slowly  becomes  hard  from  the  deposition 
of  phosphate  of  lime,  and  forms  what  is  called  a  "  callus."  In  the 
process  of  time,  the  callus  acquires  all  the  hardness  of  the  original 
bone.  The  death  of  a  person  may  take  place  during  these  changes, 
and  a  medical  man  may  then  have  to  state  the  period  at  which  the 
fracture  probably  happened,  in  order  to  connect  the  violence  with 
the  act  of  a  particular  person.  Unfortunately,  we  have  no  satisfac- 
tory data,  if  we  except  the  extreme  stages  of  this  process  of  repair, 
upon  which  to  ground  an  opinion.  "We  can  say  whether  a  person 
lived  for  a  long  or  a  short  time  after  receiving  a  fracture,  but  to 
specify  the  exact  time  is  clearly  impossible ;  since  this  process  of 
restoration  in  bone  varies  according  to  age,  constitution,  and  many 
other  circumstances.  In  young  persons,  bones  unite  rapidly,  in  the 
old  slowly  ;  in  the  diseased  and  unhealthy,  the  process  of  union  is 
slow,  and  sometimes  does  not  take  place  at  all.  In  those  who  are  at 
the  time  affected  with  a  mortal  disease  there  is  no  attempt  at  repara- 
tion. According  to  Villerme,  the  callus  assumes  a  cartilaginous 
structure  in  from  sixteen  to  twenty-five  days  ;  and  it  becomes  ossified 
in  a  period  varying  from  three  weeks  to  three  months.  It  requires, 
however,  a  period  of  from  six  to  eight  months  for  the  callus  to  acquire 
all  the  hardness,  firmness,  and  power  of  resisting  shocks  possessed 
by  the  original  bone.  A  force  applied  to  a  recently  united  bone 
will  break  it  through  the  callus  or  bond  of  union,  while  after  the 
period  stated,  the  bone  will  break  as  readily  through  any  other  part. 
It  is  generalby  assumed,  that  the  period  required  for  the  union  of  a 
simple  fracture,  is,  for  the  thigh-bone,  six  weeks  ,  for  the  tibia  (leg), 
five  weeks;  for  the  os  humeri  (arm),  four  weeks  ;  and  for  the  ulna 
and  radius  (forearm),  three  weeks  ;  for  the  ribs  about  the  same  period: 
but  cases  have  been  known  in  which  the  ribs  had  not  perfectly  united 


DISLOCATIONS.  803 

in  two  months,  and  in  some  fractures  of  the  other  bones,  it  was  found 
that  union  had  not  taken  place  in  four  months.  In  a  case  which  oc- 
curred to  Dr.  Eeid,  a  fracture  of  the  tibia,  the  principal  bone  of  the 
leg,  healed  in  three  weeks. 

Has  a  Bone  ever  been  Fractured? — This  question  is  sometimes  put 
in  reference  to  the  living  body.  It  is  well  known  that  a  bone  seldom 
unites  so  evenly  that  the  point  of  ossific  union  is  not  indicated  by  a 
node  or  projection.  Some  bones  are  so  exposed  as  to  be  well  placed 
for  this  examination,  as  the  radius,  the  clavicle,  and  tibia — these 
being  but  little  covered  by  skin ;  in  others  the  detection  is  diffi- 
cult. It  is  impossible  for  us  to  say  when  the  fracture  took  place ; 
it  may  have  been  for  six  months  or  six  years — as,  after  the  former 
period,  the  bone  undergoes  no  perceptible  change.  These  facts  are 
of  importance  in  relation  to  the  dead  as  well  as  to  the  living ;  since 
they  will  enable  us  to  answer  questions  respecting  the  identity  of 
skeletons  found  under  suspicious  circumstances :  and  here  medical 
evidence  may  take  a  wider  range,  for  a  fracture  in  any  bone  may  be 
discovered,  if  not  by  external  examination,  at  least  by  sawing  the 
bone  longitudinally  through  the  suspected  broken  part,  when,  should 
the  suspicion  be  correct,  the  bony  shell  will  be  found  thicker  and 
less  regular  in  the  situation  of  the  united  fracture  than  in  the  other 
parts.  So,  in  such  cases,  it  will  be  easy  to  say  whether  a  fracture  is 
recent  or  of  old  standing. 

Locomotion. — With  respect  to  the  power  of  locomotion  after  a  frac- 
ture, it  may  be  observed,  that  when  the  injury  is  in  the  arm  or  in 
the  ribs — unless  many  of  the  ribs  are  broken  or  the  fractures  are  on 
both  sides — a  person  may  be  able  to  move  about,  although  he  is  un- 
fitted for  struggling  or  making  great  exertion.  Fractures  of  the  leg 
generally  incapacitate  persons  from  moving  except  to  short  distances. 
[The  best  American  authority  on  this  and  all  other  questions  rela- 
ting to  fractures  and  dislocations,  is  the  "  Treatise  on  Fractures  and 
Dislocations,"  by  Dr.  Frank  II.  Hamilton.  See  also  the  excellent 
American  translation  by  Dr.  John  H.  Packard,  of  the  classical  work 
of  Malgaigne  "On  Fractures." — H.] 

Dislocations. 

Dislocations  are  not  frequent  in  the  old  or  in  those  persons  whose 
bones  are  brittle.  They  rarely  form  a  subject  for  medico-legal  in- 
vestigation. A  witness  is  liable  to  be  asked,  what  degree  of  force, 
and  acting  in  which  direction,  would  produce  a  dislocation — ques- 
tions not  difficult  to  answer.  They  are  not  dangerous  to  life,  unless 
of  a  compound  nature,  when  death  may  take  place  from  secondary 
causes.  A  dislocation  which  has  occurred  in  the  living  body  may  be 
known  after  death  by  a  laceration  of  the  soft  parts  in  the  neighbor- 
hood of  the  joint,  and  by  the  copious  effusion  and  coagulation  of 
blood.  If  of  old  standing,  a  dislocation  would  be  identified  by  the 
cicatrices  in  surrounding  structures.  Dislocations  may  occur  from 
natural  causes,  as  from  disease  and  destruction  of  the  ligaments  in  a 
joint ;  also  from  violent  muscular  spasm  during  an  epileptic  con- 


304  DETECTION*    OF    FRACTURES. 

vulsion.  Dr.  Dymock  met  with  an  instances  of  dislocation  of  the 
shoulder  forwards  during  puerperal  convulsions.  ("Ed.  Med.  and 
Surg.  Journal,"  April,  1843 ;  see  also  "  Lancet,"  April,  1845,  p.  44<  >.  | 
A  power  of  locomotion  may  exist,  except  when  the  injury  is  in  the 
lower  limbs ;  but  it  has  been  observed,  that  for  some  time  after  a 
dislocation  of  the  hip-joint,  considerable  power  over  the  limb  re- 
mains ;  it  is  only  after  a  few  hours  that  the  limb  becomes  fixed 
in  one  position.  Exertion  with  the  dislocated  member  is  in  all 
cases  out  of  the  question. 

Detection  of  Fractures.  [Malapraxis?) — There  are  certain  fractures 
of  an  obscure  kind  which  closely  resemble  dislocations.  This  has 
been  pointed  out  by  Sir  A.  Cooper,  in  relation  to  fractures  of  the 
anatomical  neck  of  the  os  humeri  (arm-bone).  ("Guy's  Hosp.  Rep." 
No.  9,  p.  272.)  This  accident  might  easily  be  mistaken  for  a  dislo- 
cation of  the  shoulder.  ("Med.  Graz."  vol.  36,  p.  38.)  In  attempting 
to  reduce  the  bone,  the  head  continually  falls  back  into  the  axilla. 
In  such  a  case  an  action  for  malapraxis  might  be  brought  against  a 
surgeon,  and  heavy  damages  recovered.  It  could  only  be  by  a  dis- 
section of  the  part  after  death  that  the  real  nature  of  the  case  would 
be  ascertained.  It  is  requisite,  therefore,  that  great  caution  should 
be  used  in  giving  an  opinion.  The  same  observations  apply  to  frac- 
tures of  the  neck  of  the  thigh-bone,  although  with  less  force,  because 
this  is  a  more  common  accident.  It  is  well-known  that  fractures 
and  dislocations,  when  cured,  are  often  attended  with  some  slight 
'A  formity  of  the  limb,  or  with  some  impairment  of  its  functions.  This 
result  is  occasionally  inevitable  under  the  best  treatment ;  but  it  is 
commonly  set  down  as  a  sign  of  unskilfulness  in  the  medical  attend- 
ant. An  action  for  malapraxis  is  instituted,  and  in  spite  of  good 
evidence  in  his  favor,  the  surgeon  is  sometimes  heavily  fined  for  a 
result  which  could  not  be  avoided.  There  is  often  great  injustice 
in  these  proceedings,  and  the  mischief  can  only  be  remedied  by  re- 
ferring the  facts  to  a  competent  medical  tribunal,  which  alone  should 
be  empowered  to  decide  whether  or  not  unskilfulness  had  really 
been  shown  in  the  management  of  a  case.  The  system  of  allowing 
each  party  to  select  his  own  medical  witnesses  invariably  leads  to  a 
conflict  of  opinion  and  evidence. 

[The  proof  of  ordinary  care  and  skill  and  judgment  exercised  in 
the  treatment  of  a  case  is  a  sufficient  defence  in  law  against  a  claim 
for  damages  on  account  of  alleged  malpractice ;  but  it  is  too  apt  to 
fail  with  the  juries  in  this  country,  and  will  not  protect  the  victim 
of  a  prosecution  from  its  attendant  expenses.  Although  our  judges, 
in  many  instances,  have  done  their  best  to  secure  just  verdicts,  the 
juries  are  notoriously  stupid  and  unjust;  so  that  the  only  real  secu- 
rity to  the  attending  surgeon  is  in  an  indemnity  bond  against  all  con- 
sequent prosecution,  to  be  previously  assumed  by  the  patient. — H.] 


GUNSHOT    WOUNDS.  305 


CHAPTER   XXXII T. 

Gunshot  wounds. — in  the  living  and  dead  body. — was  the  piece 
fired  near  or  from  a  distance? — accidental,  suicidal,  or 
homicidal  wounds. — position  of  the  wounded  person  when 
shot. — wounds  from  small-shot. — wounds  from  wadding  and 
gunpowder. 

Gunshot  wounds  are  of  the  contused  kind,  but  they  differ  from 
other  wounds  in  the  fact  that  the  vitality  of  the  parts  struck  by  the 
projectile  is  destroyed,  and  this  leads  ultimately  to  a  process  of 
sloughing. 

The  medico-legal  questions  which  arise  out  of  gunshot 'wounds, 
are  similar  to  those  which  have  been  examined  in  relation  to  other 
wounds.  They  are  dangerous  to  life,  especially  when  they  penetrate 
or  traverse  any  of  the  great  cavities  of  the  body.  Death  may  take 
place  directly,  either  from  loss  of  blood  or  from  shock ;  although 
immediate  or  copious  bleeding  is  not  a  common  character  of  these 
injuries.  Death  from  shock  is  occasionally  witnessed.  Indirectly, 
these  wounds  are  attended  with  much  danger ;  sloughing  generally 
takes  place  uniformly  throughout  the  whole  of  the  parts  perforated, 
and  inflammation  or  fatal  bleeding  may  cut  short  life.  If  the  person 
survives  the  first  effects,  he  may  die  at  almost  any  period  from  sup- 
purative fever,  erysipelas,  gangrene,  or  from  the  results  of  operations 
absolutely  required  for  his  treatment.  Gunshot  wounds  may  thus 
destroy  life  after  long  periods  of  time. 

A  medical  witness  may  be  asked  whether  the  wound  was  inflicted 
before  or  after  death.  It  is  by  no  means  easy  to  answer  this  question, 
unless  the  bullet  has  injured  some  vessel,  when  the  effusion  of  blood 
and  the  formation  of  coagula  will  indicate  that  the  person  was  living 
when  it  was  received.  If  a  gunshot  wound  has  been  produced  in  a 
dead  body,  no  blood  will  be  effused  unless  the  bullet  strikes  a  large 
vein. 

Was  the  Piece  fired  near  or  from  a  Distance? — A  gunshot  wound 
produced  by  the  muzzle  of  a  piece  being  placed  near  to  the  surface 
of  the  body,  has  the  following  character :  There  may  be  two  aper- 
tures, the  one  of  entrance  and  the  other  of  exit;  but  it  sometimes 
happens  that  the  bullet  lodges  and  does  not  pass  out.  The  edges  of 
the  aperture  of  entrance  are  generally  torn  and  lacerated,  and  appear 
blackened,  as  if  they  had  been  burnt :  this  arises  from  the  heat  and 
flame  of  the  gunpowder  at  the  moment  of  explosion.  The  skin  is 
often  ecchymosed,  and  is  much  discolored  by  the  powder:  the  clothes 
covering  the  body  are  blackened  by  the  discharge,  and  sometimes 
ignited  by  the  flame.  If  the  muzzle  of  the  piece  was  not  in  imme- 
20 


306  GUNSHOT    WOUNDS. 

diate  contact  with  the  part  struck,  the  wound  is  rounded :  but  if  there 
has  been  direct  contact,  the  skin,  besides  being  burnt,  is  torn  and 
much  lacerated.  The  bleeding  is  usually  slight,  and  when  it  occurs 
it  is  more  commonly  observed  from  the  orifice  of  exit  than  from  that 
of  entrace.  It  should  be  remarked  that  the  aperture  of  entrance  is 
round  only  when  the  bullet  strikes  point  blank  or  nearly  so.  If  it 
should  strike  obliquely,  the  orifice  will  have  more  or  less  of  an 
oval  or  valvular  form ;  and  by  an  observation  of  this  kind  we  may 
sometimes  determine  the  relative  position  of  the  assailant  with  re- 
spect to  a  wounded  person.  Supposing  the  bullet  to  have  been  fired 
from  a  moderate  distance,  but  so  near  as  to  have  had  sufficient  mo- 
mentum to  traverse  the  body,  then  the  appearance  of  the  wound  will 
be  different.  The  orifice  of  entrance  will  be  well  defined,  round  or 
oval,  according  to  the  circumstance — the  skin  slightly  depressed — 
the  edges  presenting  a  faintly  bruised  appearance ;  but  the  surround- 
ing parts  are  neither  blackened  nor  burnt,  and  they  do  not  present 
any  marks  of  bleeding.  In  these  cases  the  orifice  of  exit  is  large, 
irregular,  the  edges  somewhat  everted,  and  the  skin  lacerated,  but 
free  from  any  appearances  of  blackness  or  burning :  it  is  generally 
three  or  four  times  as  large  as  the  entrance-aperture.  The  orifice  of 
entrance  is,  however,  generally  large  and  irregular  when  the  bullet 
strikes  near  the  extremity  of  its  range.  Under  common  circum- 
stances, the  entrance-aperture  may  have  the  appearance  of  being- 
smaller  than  the  projectile,  owing  to  the  elasticity  of  the  living  skin. 
("  Ann.  de'Hyg."  1889,  t.  2,  p.  319.)  It  is  the  same  with  the  aperture 
in  the  dress,  when  this  is  formed  of  an  elastic  material.  According 
to  Dupuytren,  the  hole  in  the  dress  is  always  smaller  than  that  made 
by  a  bullet  in  the  skin.  These  points  should  be  remembered  in 
fitting  projectiles  to  wounds  which  they  are  supposed  to  have  pro- 
duced. 

The  question  whether  a  piece  was  fired  near  to,  or  at  a  distance  from, 
the  wounded  person,  may  be  of  some  importance  either  on  a  charge 
of  homicide,  or  of  alleged  suicide.  Two  persons  may  quarrel,  one 
having  a  loaded  weapon  in  his  hand,  which  he  may  allege  to  have 
been  accidentally  discharged,  and  to  have  killed  the  deceased.  If 
the  allegation  is  true,  we  ought  to  find  on  the  body  the  marks  of  a 
near  wound :  if,  however,  its  characters  were  such  that  it  had  obvi- 
ously been  produced  from  a  distance,  and  therefore  after  the  quarrel, 
medical  proof  of  the  fact  might  imply  malice  and  involve  the  accused 
in  a  charge  of  murder.  It  has  been  said  that  when  a  bullet  is  fired 
near,  it  commonly  traverses  the  body ;  and  therefore  it  has  been 
rather  hastily  assumed,  that  when  there  is  only  one  external  wound, 
and  the  bullet  has  lodged  in  the  body,  this  is  a  proof  that  the  piece 
has  been  fired  from  a  distance.  This  inference  is,  however,  erroneous. 
A  bullet  may  be  fired  close  to  a  person  and  yet  not  traverse  the 
body,  either  from  its  impulsive  force  not  being  sufficiently  great,  or 
from  its  meeting  a  great  resistance  in  its  course.  Many  eases  might 
be  cited  to  show,  that  in  the  near  wounds  produced  by  suicides  and 
murderers,  the  bullets  have  not  always  traversed  the  body.  In  sui- 
cide, when  the  piece  is  discharged  into  the  mouth,  the  projectile  often 


SUICIDAL    AND    ACCIDENTAL.  307 

lodges  in  some  part  of  the  head.  It  is  not  in  the  power  of  a  witness 
to  say,  from  the  mere  fact  of  a  bullet  lodging  or  traversing,  whether 
the  assassin  was  far  off  or  near,  at  the  time  the  deceased  was  wounded. 
The  latter  point  may  be  sometimes  readily  determined  by  the  marks 
of  injury  and  burning  about  the  skin  and  dress.  When  a  gun  or 
pistol  is  discharged  at  the  distance  of  three  or  four  yards  from  the 
person,  it  will  not,  of  course,  produce  those  marks  of  blackening, 
burning,  and  bruising  on  the  skin  which  are  found  when  the  muzzle 
is  within  a  few  inches  of  the  body.  A  wound  which  does  not  pre- 
sent these  appearances  may  remove  the  suspicion  of  suicide,  and 
create  a  strong  presumption  of  homicide.  Dr.  Lachese  found  that 
in  firing  a  gun  at  the  distance  of  four  feet,  the  skin  was  only  par- 
tially blackened.  It  would  be  very  important  in  a  case  of  this  kind 
to  notice  the  direction  of  the  wound  as  well  as  the  relative  position 
of  the  assailant  and  assailed,  as  stated  by  witnesses  or  deduced  from 
circumstances. 

When  a  ball  traverses  the  body,  it  sometimes  happens  that  the  two 
apertures  are  opposite  to  each  other,  although  the  ball  may  not  have 
taken  a  rectilinear  course  between  them,  but  have  been  variously 
deflected  by  the  subjacent  soft  parts.  This  deflection  of  a  ball  from 
a  rectilinear  course  is  met  with  in  those  cases  in  which  it  happens  to 
strike  obliquely  a  curved  surface,  and  it  is  found  that  when  the  ball 
enters  and  does  not  pass  out,  its  course  is  often  circuitous,  so  that 
it  is  not  always  easy  to  say  in  what  part  of  the  body  it  will  be 
found. 

A  witness  maybe  asked — When  was  the  gunshot  wound  inflicted  and 
how  long  did  the  wounded  person  survive  after  receiving  it  ?  Like 
other  wounds,  a  gunshot  wound  undergoes  no  change  for  eight  or  ten 
hours  after  its  infliction.  Our  judgment  in  reference  to  these  ques- 
tions may  be  assisted  by  observing  the  parts  which  are  involved, 
although  we  cannot  always  infer  from  the  quantity  of  blood  found 
near  to  a  body  that  the  bleeding  was  an  immediate  consequence  of  the 
wound,  or  that  the  whole  of  the  blood  was  effused  at  once.  We  can- 
not, then,  always  affirm  that  the  deceased  could  not  have  moved  or 
exerted  himself  in  some  degree,  after  receiving  it.  The  exertion 
thus  made  subsequently  to  his  being  wounded,  may  have  actually 
caused  the  fatal  bleeding. 

Suicidal  or  Homicidal  Gunshot  Wounds. — When  it  is  doubtful 
whether  the  wound  was  the  result  of  suicide  or  homicide,  the  point 
may  be  sometimes  determined  by  paying  attention  to  its  situation  and 
direction.  Suicidal  gunshot  wounds  are  almost  always  directed  to  a 
vital  part — to  the  heart  or  to  the  brain  ;  they  possess  those  charac- 
ters which  belong  to  wounds  inflicted  near  to  the  body.  The  skin  is 
discolored  or  burnt,  the  wound  wide  and  lacerated,  the  hand  which 
discharged  the  weapon  often  blackened,  and  sometimes  still  grasping 
the  pistol.  The  ball  may  or  may  not  have  traversed,  as  this  will  de- 
pend on  the  momentum  which  it  derived  from  the  charge,  and  the 
resistance  that  it  experienced. 

Accidental  gunshot  wounds  bear  the  characters  of  near  wounds ; 
they  may  touch  vital  parts,  but,  if  the  body  has  not  been  disturbed,, 


308  WOUNDS    FROM    SMALL-SHOT. 

the  presence  or  absence  of  design  in  the  infliction  of  a  wound  is  com- 
monly made  apparent  by  the  relative  position  of  the  body  and  the 
weapon.  They  frequently  arise  from  persons  drawing  the  charges 
of  guns  or  pistols  with  the  muzzles  pointed  towards  them,  and  they 
are  then  situated  in  front ;  at  other  times  they  are  produced  by  per- 
sons pulling  towards  them  through  hedges,  or  dragging  after  them, 
loaded  guns.  In  the  latter  case  the  wound  is  behind,  and  it  may 
strongly  resemble  a  homicidal  wound,  although  the  circumstances 
under  which  the  body  is  found  generally  suffice  to  explain  the  mat- 
ter. (See  "  Ann.  d'Hyg."  1860, 1. 1,  p.  443.)  In  suicide  there  is  com- 
monly strong  evidence  of  design;  in  accident  all  evidence  of  design 
is  wanting.  Suicides  sometimes  make  use  of  extraordinary  weapons, 
or  use  weapons  in  an  extraordinary  manner. 

Position  of  the  Wounded  Person  when  Shot. — Did  the  deceased  re- 
ceive the  shot  while  standing,  falling,  or  lying  down  ?  Was  the 
piece,  when  discharged,  pointed  from  the  shoulder  ?  These  questions 
can  only  be  answered  by  reference  to  the  particular  circumstances  of 
the  case.  In  general,  when  a  person  is  sh6t  while  standing,  and  the 
piece  is  pointed  from  the  shoulder,  the  wound  is  more  or  less  trans- 
verse ;  but  due  allowance  must  be  made  for  the  deflection  of  balls 
after  penetration.  Was  the  deceased  shot  while  running  away,  or 
when  approaching  the  person  who  fired  ?  This  question  is  answered 
by  observing,  in  the  case  of  a  traversing  wound,  in  which  alone  any 
difficulty  can  arise,  whether  the  entrance-orifice  be  situated  in  front 
or  behind. 

Wounds  from  Small-Shot. — Death  is  sometimes  occasioned  by  small- 
shot,  and  here  several  medico-legal  questions  present  themselves. 
Small-shot  may  act  in  two  ways :  1.  It  either  strikes  without  spread- 
ing, in  which  case  the  discharge  is  always  near  the  person,  and  its 
action  is  much  more  dangerous  than  that  of  a  single  ball,  because  it 
produces  extensive  lacerations;  or  2.  It  strikes  after  it  has  spread, 
and  here  the  discharge  must  have  been  distant  and  comparatively 
little  mischief  is  done.  Dr.  Lachese  ascertained,  by  many  experi- 
ments on  dead  bodies,  that  in  order  to  produce  with  small-shot,  a 
round  opening  somewhat  resembling  that  produced  by  a  bullet,  the 
discharge  should  take  place  point-blank  at  the  distance  of  about  ten 
or  twelve  inches  from  the  surface  of  the  body.  When  the  distance 
was  from  twelve  to  eighteen  inches,  the  opening  made  was  irregular, 
and  the  borders  were  much  lacerated ;  at  thirty-six  inches,  a  central 
opening  was  entirely  lost,  and  the  surface  of  the  body  was  covered 
with  shot.  The  effect  after  this  was  found  to  depend  on  the  distance, 
the  goodness  of  the  gun,  and  the  strength  of  the  charge  ("  Ann.  d'Hyg." 
1836,  p.  386) ;  but  the  shot  is,  in  general,  much  scattered  over  the 
surface  of  the  body.  From  these  results  we  may  form  an  opinion  of 
the  distance  at  which  the  piece  was  fired. 

It  is  difficult  to  conceive  that  small-shot  can,  under  any  circum- 
stances, produce  a  single  entrance-wound,  having  some  appearance  of 
circularity  about  it,  without  at  the  same  time  singeing  or  burning 
the  skin  or  dress.  The  difficulty  of  laying  down  any  general  rules 
respecting  the  wounds  produced  by  small-shot  at  their  entrance  and 


WOUNDS    FROM    WADDING    AND    GUNPOWDER.  309 

exit,  will  be  apparent  from  the  following  facts,  communicated  to  me 
recently  by  two  medical  gentlemen.  A  boy  was  shot  in  the  neck  by 
the  accidental  discharge  of  his  gun,  loaded  with  an  ounce  of  No.  8 
shot.  He  died  instantly.  He  was  leaning  forwards  on  the  muzzle, 
so  that  it  was  nearly  in  contact  with  the  skin  of  the  neck.  A  large 
round  hole  was  produced,  one  inch  and  a  half  in  diameter,  the  edges 
of  which  were  slightly  blackened  with  powder.  The  exit-aperture 
which  was  at  the  back  of  the  neck  a  little  to  the  left  of  the  third 
cervical  vertebra,  was  a  mere  slit  in  the  skin,  scarcely  an  inch  long, 
with  the  long  diameter  placed  vertically.  The  smallness  of  this 
aperture  may  have  been  owing  to  the  greater  part  of  the  charge  be- 
ing lodged  in  that  body.  The  entrance-aperture,  although  rounded, 
was  too  large  to  be  mistaken  for  a  bullet-wound ;  it  was  evidently  a 
near  wound,  from  the  blackening  of  the  edges.  On  the  other  hand, 
Dr.  Lowe  informs  me  that  in  some  experiments  performed  by  his 
brother,  it  was  found  that  a  round  aperture  might  be  produced  by  a 
discharge  of  small-shot  at  a  much  greater  distance  from  the  object 
than  that  assigned  by  Dr.  Lachese.  Admitting  such  exceptional  in- 
stances, and  assuming  the  general  correctness  of  the  inferences  drawn 
by  Dr.  Lachese,  from  the  results  of  his  experiments  in  discharging 
small-shot  at  dead  bodies  placed  at  different  distances,  it  does  not  seem 
probable  that  a  wound  from  small-shot  can,  under  any  circumstances, 
be  mistaken  for  one  produced  by  a  leaden  bullet.  A  discharge  of 
small-shot,  in  contact  with  the  skin  or  close  to  it,  will  however  pro- 
duce, not  a  round  opening,  but  a  severe  lacerated  wound. 

Small-shot  is  rarely  observed  to  traverse  the  body  entirely  unless 
discharged  so  near  as  to  make  a  clean  round  opening;  but  a  single 
pellet  reaching  the  body  may  destroy  life.  There  may  be  no  exit- 
aperture,  or  it  may  be  smaller  than  that  of  entrance.  Such  minute 
wounds  might  be  easily  overlooked  in  the  examination  of  a  dead 
body.  Small -shot,  even  when  wounding  only  the  skin  of  the  back 
superficially,  has  been  known  to  cause  death  by  tetanus. 

Wounds  from  Wadding  and  Gunpowder. — It  matters  not  with  what 
the  piece  is  charged — it  is  capable,  when  fired  near,  of  producing  a 
wound  which  may  prove  fatal.  Thus  a  gun  loaded  with  wadding, 
or  even  with  gunpowder  only,  may  cause  death.  In  these  cases,  an 
impulsive  force  is  given  by  the  explosion,  and  the  substance  becomes 
a  dangerous  projectile.  The  lighter  the  projectile — the  shorter  the 
distance  to  which  it  is  carried;  but  when  discharged  near  to  the 
body,  it  may  produce  a  fatal  penetrating  wound.  A  portion  of  the 
dress  may  be  carried  into  the  wound,  and  lead  to  death  from  bleed- 
ing :  or  if  the  wounded  person  recover  from  the  first  effects,  he  may 
subsequently  sink  under  an  attack  of  tetanus  or  erysipelas.  It  is 
unfortunate  that  so  much  ignorance  prevails  on  this  point:  for  fatal 
accidents  frequently  occur  from  persons  discharging  guns  at  others 
in  sport — an  act  which  they  think  they  may  perform  without  danger, 
because  they  are  not  loaded  with  ball  or  shot. 

It  has  been  observed,  that  persons  in  attempting  to  commit  suicide 
have  occasionally  forgotten  to  put  a  bullet  into  the  pistol ;  never- 


310  EXAMINATION    OF    FIRE-ARMS. 

theless,  the  discharge  of  a  piece  into  the  mouth  has  sufficed,  from  the 
effect  of  the  wadding  only,  to  produce  a  considerable  destruction  of 
parts,  and  to  cause  a  serious  loss  of  blood.  Fatal  accidents  have 
frequently  taken  place  from  the  discharge  of  wadding  from  cannon 
during  reviews.  It  is  not  easy  to  say  at  what  distance  a  weapon 
thus  charged  with  wadding  and  powder  would  cease  to  produce  mis- 
chief, since  this  must  depend  on  the  impulsive  force  given  by  the 
powder,  and  on  the  size  of  the  piece.  Dr.  Lachese  has  ascertained 
by  experiment,  that  a  piece  charged  with  gunpowder,  is  capable  of 
producing  a  penetrating  wound  somewhat  resembling  that  caused  by 
small-shot,  when  the  piece  is  large,  strongly  charged,  and  fired  within 
six  inches  of  the  surface  of  the  body.  ("Ann.  d'Hyg."  1836,  p.  368.) 
This  arises  from  a  portion  of  the  powder  always  escaping  combus- 
tion at  the  time  of  discharge,  and  each  grain  then  acts  like  a  pellet 
of  small-shot.  Under  any  circumstances,  a  discharge  of  powder 
only  contuses  the  skin,  producing  ecchymosis,  and  often  lacerating 
it,  if  the  piece  be  fired  near.  The  dress  is  burnt  and  the  skin  scorched 
from  the  globe  of  flame  formed  by  the  combustion  of  the  powder ; 
many  particles  of  gunpowder  may  be  actually  driven  into  the  true 
skin.  All  the  substances  here  spoken  of  are  considered  to  be  pro- 
jectiles ;  and  the  weapons  are  held  in  law  to  be  loaded  arms,  so  long 
as  they  are  capable  of  producing  bodily  injury  at  the  distance  from 
which  the  piece  containing  them  is  discharged.  It  may  therefore 
become  a  question  as  to  the  distance  at  which  these  light  projectiles 
cease  to  be  harmless.  The  answer  must  be  governed  by  circum- 
stances; but  it  will  in  all  cases  materially  depend  on  the  strength  of 
the  charge.  Dr.  Swift,  U.  S.,  has  performed  some  experiments  with 
a  pistol  loaded  with  gunpowder  and  wadding^  in  order  to  determine 
the  effect  of  discharges  at  different  distances.  At  twelve  inches  dis- 
tance from  a  dead  body,  he  found  that  the  clothes  were  lacerated  and 
the  skin  abraded,  but  the  wadding  did  not  penetrate;  at  six  inches, 
the  clothes  were  lacerated,  and  the  wadding  penetrated  to  the  depth 
of  half  an  inch ;  at  two  inches,  the  wound  produced,  which  was  two 
inches  deep,  was  ragged  and  blackened ;  at  one  and  a  half  inch  from 
the  chest,  the  wadding  passed  into  the  cavity  between  the  ribs,  and 
in  a  second  experiment  it  carried  away  a  portion  of  a  rib.  ("  Med. 
Gaz."  vol.  40,  p.  734.)  These  results  confirm  those  obtained  by  Dr. 
Lachese. 

Examination  of  Fire-arms. — An  attempt  has  been  made  by  French 
medical  jurists  to  determine  for  how  long  a  period  a  gun  or  pistol 
found  near  a  dead  body,  may  have  been  discharged ;  but  it  is  out  of 
our  power  to  lay  down  any  precise  rules  on  such  a  subject.  All 
that  we  can  say  is,  a  quantity  of  sulphide  of  potassium,  mixed  with 
charcoal,  is  left  adhering  to  the  barrel  of  the  piece,  when  recently 
discharged;  and  this  is  indicated  by  its  forming  a  strong  alkaline 
solution  with  water,  evolving  an  odor  of  sulphuretted  hydrogen,  and 
giving  a  deep-brown  precipitate  with  a  solution  of  acetate  of  lead. 
After  some  hours  or  days,  according  to  the  degree  of  exposure  to 
air  and  moisture,  the  saline  residue  becomes  converted  into  sulphate 


BURNS    AND    SCALDS.  311 

of  potash,  forming  a  neutral  solution  with  water,  and  giving  a  white 
precipitate  with  acetate  of  lead.  If  a  considerable  time  has  elapsed 
since  the  piece  was  discharged,  oxide  of  iron  with  traces  of  sulphate 
may  be  found.  (See  "Ann.  d'Hyg."  1834,  458;  1839,  197;  1842, 
368.) 


CHAPTEK    XXXIV. 

Death  from  burns  and  scalds. — symptoms. — stupor. — cause 
of  death. — post-mortem  appearances. — burns  on  the  dead 
body. — accident,  homicide,  or  suicide. — wounds  caused  by 
fire. — scalding. — burns  by  corrosive  liquids. 

Burns  and  Scalds. — A  bur?i  is  an  injury  produced  by  the  appli- 
cation of  a  heated  substance  to  the  surface  of  the  body ;  while  a  scald 
results  from  the  application  of  a  liquid  at  or  near  its  boiling  point, 
under  the  same  circumstances.  There  seems  to  be  no  real  distinction 
between  a  burn  and  a  scald  in  reference  to  the  effects  produced  on 
the  body :  the  injury  resulting  from  boiling  mercury  or  melted  lead 
might  take  either  appellation.  Nevertheless,  as  a  matter  of  medical 
evidence,  it  may  be  important  to  state  whether  the  injury  found  on  a 
body  was  caused  by  such  a  liquid  as  boiling  water,  or  by  a  heated 
solid.  If  the  former,  the  injury  might  be  ascribed  to  accident;  if 
the  latter,  to  criminal  design.  A  scald  produced  by  boiling  water 
would  be  indicated  by  a  sodden  state  of  the  skin  and  flesh,  but  there 
would  be  no  destruction  of  substance.  In  a  burn  by  a  heated  solid, 
the  parts  may  be  more  or  less  destroyed,  or  even  charred :  the  cuticle 
may  be  found  blackened,  dry,  almost  of  a  horny  consistency,  and 
presenting  a  shrivelled  appearance.  This  distinction,  however,  would 
only  apply  to  scalds  from  water.  A  scald  from  melted  lead  (620°) 
could  not  be  distinguished  from  a  burn  produced  by  a  solid  heated 
to  the  same  temperature.  Some  of  the  oils  boil  at  500°,  and  they 
produce  by  contact  with  the  skin,  burns  as  severe  as  those  caused 
by  melted  metals.  Burns  from  flame  such  as  that  of  gas  are  indi- 
cated by  extensive  scorching  of  the  skin,  while  burns  from  gun- 
powder are  known  not  only  by  the  scorching,  but  by  the  small 
particles  of  unburnt  carbon  which  are  imbedded  in  the  skin. 

Neither  a  burn  nor  a  scald  appears  to  be  considered  as  a  wound 
in  law ;  but  in  the  statute  of  wounding  they  are  included  among 
bodily  injuries  dangerous  to  life.  Burns  and  scalds  may  be  regarded 
as  dangerous  in  proportion  to  the  extent  of  surface  (of  skin)  which 
they  cover,  as  well  as  the  depth  to  which  they  extend.  The  extent 
of  surface  involved  in  a  superficial  burn,  as  a  result  of  exposure  to 
flame,  is  of  greater  importance  than  the  entire  destruction  of  a  small 
part  of  the  body  through  an  intensely  heated  solid.  AVhen  the  burn 
is  extensive,  death  may  ensue  either  from  the  severity  of  the  pain 


312  CAUSE    OF    DEATH.      APPEARANCES. 

produced,  or  from  a  sympathetic  shock  to  the  nervous  system. 
Death  takes  place  rapidly  from  burns  in  children  and  nervous  females : 
but  in  adults  and  old  persons,  there  is  a  better  chance  of  recovery. 

Cause  of  Death. — In  some  instances,  especially  in  children,  stupor 
and  insensibility  have  rapidly  supervened,  owing  to  sympathy  with 
the  brain ;  and  these  symptoms  have  been  followed  by  coma  and 
death.  Of  the  cause  of  death  in  persons  exposed  to  fire  but  little 
need  be  said.  In  large  conflagrations  persons  are  frequently  simply 
suffocated,  from  the  want  of  proper  air  or  the  respiration  of  the 
products  of  combustion — carbonic  acid  or  carbonic  oxide.  The 
former  darkens  the  blood ;  the  latter  renders  it  lighter  in  color.  In 
other  cases,  where  a  large  volume  of  flame  suddenly  falls  upon  the 
body  and  the  person  is  still  able  to  breathe,  the  fatal  effect  may  be 
due  to  shock — a  sudden  and  violent  impression  on  the  nervous  sys- 
tem. A  person  may  recover  from  the  first  effects  of  severe  burns, 
but  ultimately  sink  from  exhaustion  or  from  an  attack  of  tetanus. 
("  Mod.  Times  and  Gaz.,"  April,  26,  1854,  p.  406.) 

Post-mortem  Appearances. — In  examining  the  body  of  a  person 
found  burnt,  all  matters  connected  with  sex  and  identity  should  be 
first  duly  observed.  Dr.  Grunbaum  has  reported  a  case  in  which  he 
was  required  to  examine  certain  carbonized  remains  in  which,  in 
spite  of  the  destruction  of  the  sexual  organs,  he  was  able  to  deter- 
mine the  sex.  (Horn's  "  Yierteljahrschrift,"  Oct.  1864.)  "When  a 
body  has  been  entirely  consumed  by  fire  the  presence  of  a  large 
quantity  of  phosphate  of  lime  in  the  ashes  would  indicate  animal 
remains.  The  bones  are  never  completely  destroyed ;  they  become 
white,  and  portions  of  them  retain  their  form  under  the  action  of  a 
most  intense  fire. 

When  death  has  been  caused  by  severe  pain,  no  changes  have 
been  detected  in  the  dead  bodj- ;  but,  in  some  fatal  cases,  it  has  been 
found  on  inspection  that  there  were  patches  of  redness  on  the  bron- 
chial mucous  membrane,  as  well  as  on  the  alimentary  canal.  The 
brain  has  been  found  gorged,  and  the  ventricles  have  contained  an 
abundance  of  serosity.  The  serous  liquids  of  the  pericardium  and 
pleura  have  also  been  in  larger  quantity  than  natural.  In  short, 
besides  congestion,  there  is  generally  abundant  serous  effusion  in 
one  of  the  three  great  cavities,  especially  in  the  head.  This  arises 
from  the  sudden  reflux  of  blood  into  the  interior,  as  an  effect  of  the 
local  injury.  In  deaths  from  fires  in  houses  the  persons  are  usually 
suffocated,  and  there  are  the  appearances  of  this  kind  of  death  (see 
Suffocatiox.)  In  a  case  in  which  a  woman  died  on  the  thirteenth 
day  from  a  superficial  burn  involving  the  skin  of  the  lower  part  of 
her  body,  the  stomach  was  found  inflamed  at  its  greater  extremity. 
and  the  duodenum  at  its  lower  portion — the  mucous  folds  of  the 
intestines  having  a  scarlet  color.  The  other  intestines  as  far  as  the 
caecum  were  also  more  or  less  inflamed.  ("  Amer.  Jour.  Med.  Sci- 
ences," Jan.  1861,  p.  137.)  If  the  person  survives  the  first  effects, 
he  may  die  from  inflammation,  suppuration,  gangrene,  irritation,  or 
fever,  or  he  may  be  worn  out  by  exhaustion. 


BURNS    ON    THE    LIVING    AND    DEAD    BODY.  313 

Did  the  Burning  of  the  Body  take  place  before  or  after  Death? — 
Vesication. — The  production  of  vesication  or  of  blisters  containing 
serum,  is  commonly  regarded  as  an  essential  character  of  a  burn 
which  has  been  produced  during  life,  but  it  is  not  a  necessary  or  in- 
variable effect  of  a  burn  on  the  living  body.  Vesication  is  especially 
observed  in  scalds,  or  in  those  cases  in  which  the  skin  has  been  burnt 
by  flame  or  by  the  ignition  of  the  clothes,  provided  the  cuticle  has 
not  been  destroyed.  It  is  not  so  commonly  observed  in  burns  pro- 
duced by  intensely  heated  solids.  In  vesication,  the  cuticle  is  raised 
from  the  true  skin  beneath,  and  is  converted  into  one  or  more  blis- 
ters containing  serum  or  a  serous  liquid,  while  the  skin  around  is  of 
a  deep-red  color.  It  is  uncertain  as  to  the  time  at  which  it  appears ; 
it  may  be  produced  in  a  few  minutes,  or  sometimes  not  for  several 
hours ;  hence  death  may  take  place  before  vesication  occurs,  and  the 
non-discovery  of  this  condition  does  not  warrant  the  opinion  that 
the  burn  could  not  have  taken  place  during  life.  If  the  cuticle  is 
removed  from  a  vesicated  part  of  the  living  body,  the  skin  beneath 
will  become  intensely  reddened,  but  if  the  cuticle  is  stripped  off  a 
dead  body,  the  skin  will  become  hard,  dry,  and  of  a  horny-yellow 
color;  it  does  not  acquire  the  intense  scarlet  injection  which  is 
acquired  by  the  living  skin  when  vesicated  and  exposed. 

In  cases  in  which  persons,  while  living,  have  suffered  from  gen- 
eral dropsy,  it  has  been  found,  on  the  application  of  heat  to  their 
bodies  after  death,  blisters  containing  serum  or  a  serous  liquid  have 
been  formed ;  hence,  in  drawing  a  conclusion  from  the  examination 
of  burns  on  the  body  of  a  person  affected  with  general  dropsy,  it  is 
necessary  to  be  cautious.  In  such  cases  it  would  not  be  possible, 
from  the  mere  presence  of  serous  blisters,  to  say  whether  the  burn 
took  place  before  or  after  death.  The  late  Dr.  Wright  found  in  his 
experiments  on  the  dead  body,  that  if  a  sufficient  heat  were  applied 
to  within  half  an  hour  or  longer  after  death,  blisters  containing 
serum  were  sooner  or  later  produced..  In  short,  as  long  as  the  body 
was  warm  and  the  joints  were  flexible,  the  effects  of  fire  were  simi- 
lar to  those  observed  on  the  living.  Other  experimentalists  have 
found  that  blisters  were  produced,  but  they  did  not  contain  serum. 
The  result  no  doubt  depends  on  the  time  after  death  at  which  the 
experiment  is  performed. 

Accident  has  enabled  me  to  describe  the  results  within  a  very 
short  period  after  death.  The  body  of  a  drowned  man,  within  a  few 
minutes  after  the  accident,  was  removed  from  the  water  and  placed 
in  a  warm  (hot?)  bath.  It  was  found  impossible  to  resuscitate  him, 
but  owing  to  the  great  heat  of  the  water,  portions  of  the  cuticle 
came  off,  when  the  body  was  removed.  On  inspection  there  were 
several  vesications  filled  with  bloody  serum  over  a  considerable  por- 
tion of  the  skin,  especially  of  the  extremities.  There  was  no  ana- 
sarca here  to  account  for  their  production;  and  the  fact  of  their 
occurrence  appears  to  bear  out  the  view  of  Dr.  Wright,  that  the  pro- 
duction of  a  serous  blister  on  a  dead  body  depends  on  the  amount  of 
latent  organic  life  remaining  in  it.  In  this  case  the  man  was  pulse- 
less, and  to  all  appearance  dead,  when  placed  in  the  hot  bath  ;  hence 


311      BURNS  ON  THE  LIVING  AND  DEAD  BODY. 

the  effects  of  hot  water  on  the  living  and  recently  dead  body,  so  far 
as  the  production  of  serous  blisters  is  concerned,  are  similar.  Dr. 
Chambers  has  lately  published  the  results  of  numerous  experiments 
on  the  effects  of  burns  on  the  living  and  dead  body.  These  have 
been  made  on  the  bodies  of  persons,  from  the  moment  of  death  until 
twenty  hours  after  dissolution,  and  some  were  performed  before 
death.  The  general  results  of  his  researches  are — that  vesications, 
or  blisters,  may  be  produced  by  burns  both  on  the  living  and  dead 
body ;  that  they  are  produced  at  a  lower  temperature  in  the  living 
than  in  the  dead ;  that  in  the  living  a  burn  produces  great  capillary 
congestion,  with  the  effusion  of  serum  in  the  blisters,  and  that  this 
serum  when  heated,  or  treated  with  nitric  acid,  sets  into  a  nearly 
solid  coagulum.  The  blisters  produced  in  a  dead  body,  even  a  few 
minutes  after  death,  contain  a  thin  watery  serum,  which  is  only  ren- 
dered opaline  or  milky  by  heat  and  the  action  of  nitric  acid.  ("Ann. 
dTIyg.,"  1859,  vol.  1,  p.  342.)  When  the  body  is  cold  and  rigid, 
blisters  containing  air  or  vapor  alone  are  produced. 

In  burns,  especially  in  those  produced  by  red-hot  solids,  other 
effects  besides  vesication  follow.  The  edge  of  the  skin  immediately 
around  the  part  burnt  is  commonly  of  a  dead  white,  and  close  to 
.this  is  a  deep  red  line,  gradually  shaded  off  into  the  surrounding  skin, 
which  is  reddened.  The  diffused  redness  is  removable  by  pressure, 
and  disappears  with  life;  the  red  line  here  referred  to,  however,  is 
not  removable  by  pressure,  and  is  persistent  after  death.  This  line 
of  redness  is  not  always  met  with  in  severe  burns,  and  when  a  per- 
son survives  one  or  two  days,  its  production  appears  to  depend  upon 
a  power  of  reaction  in  the  system.  Thus,  then,  its  absence  furnishes 
no  proof  of  the  burn  having  been  produced  after  death,  for  it  is  not 
a  necessary  accompaniment  of  a  burn  during  life.  Dr.  Wright  con- 
sidered that  in  a  low  state  of  vitality  a  line  of  redness  might  not  be 
produced  by  a  severe  burn  on  the  living  body,  and  that  more  certain 
reliance  may  be  placed  on  the. red  marks  found  beneath  the  blisters 
and  crusts  of  vital  burns.  These  latter  were  well  marked  when  he 
found  the  line  of  redness  itself  indistinct.  (Op.  cit.,  p.  25.)  The 
researches  of  Dr.  Chambert  confirm  this  view.  In  a  burn  on  a  living 
person,  if  the  skin  has  not  been  entirely  charred  and  destro\'ed,  the 
cutis  will  present  a  dotted  or  pointed  redness — -these  dots  or  points 
corresponding  to  the  sudiparous  (perspiratory)  and  hair-follicles. 
After  complete  death,  a  burn  does  not  produce  any  such  effect :  the 
cutis  is  of  a  dead-white  on  its  surface  and  in  its  substance.  In  one 
experiment  performed  ten  minutes  after  death,  there  was  no  redness 
of  the  skin,  either  beneath  the  blisters  or  in  the  surrounding  parts. 
("  Ann.  dTIyg.,"  1859,  vol.  1,  p.  368.)  This  reddened  or  congested 
state  of  the  bare  skin  is  more  constant  than  any  other  appearance, 
and  forms  at  present  the  best  criterion  of  the  infliction  of  a  burn  on 
the  living  body.  The  conclusions  which,  it  appears  to  me.  we  may 
draw  from  the  foregoing  statements,  are:  1.  That,  as  a  general  rule, 
when  Ave  discover  blisters  with  effusion  of  serum,  or  a  line  of  red- 
ness, or  both,  and  a  reddened  or  congested  state  oi'  the  skin,  about  a 
burnt  part  of  the  body,  we  are  justified  in  saying  that  the  burn  has 


ACCIDENTAL    AND    HOMICIDAL    BURNS.  315 

occurred  during  life.  2.  That  when  these  appearances  are  not  met 
with,  it  by  no  means  follows  that  the  burn  had  not  been  produced 
in  the  living  body. 

When  several  bums  are  found  on  a  dead  body,  it  may  be  a  ques- 
tion whether  they  were  all  produced  at  the  same  time.  This  is  a 
point  which  can  be  determined  only  by  observing  whether  any  of 
them  present  signs  of  gangrenous  separation,  of  suppuration,  granu- 
lation or  other  changes  that  take  place  in  a  living  body  after  acci- 
dents of  this  kind.  The  witness  may  be  asked,  How  long  did  the 
deceased  survive  the  burn  ?  A  person  may  die  in  a  few  minutes  or 
live  some  hours  after  receiving  a  most  extensive  burn  ;  and  yet  there 
will  be  no  change  in  the  part  burnt,  to  indicate  Avhen  death  actually 
took  place.  There  may  have  been  no  time  for  inflammation  or  its 
consequences  to  become  established.  Suppuration  generally  follows 
vesication,  and  in  severe  cases  it  may  occur  on  the  second  or  third 
day ;  ,  but  often  not  until  a  later  period.  In  regard  to  gangrene,  this 
takes  place  when  the  vitality  of  a  part  burned  is  destroyed.  The 
time  of  its  occurrence  is  uncertain,  but  it  sometimes  very  speedil\- 
follows  the  accident. 

The  subject  of  scalding  scarcely  requires  a  separate  notice.  A 
scald  from  boiling  water  would,  when  recent,  be  indicated  by  the 
production  of  serous  blisters,  or  a  sodden  state  of  the  skin,  which 
appears  white  and  soft.  The  living  structures  are  not  charred  or 
destroyed  as  by  the  application  of  a  red-hot  solid. 

Accident,  Homicide,  or  Suicide. — It  is  rare  that  murder  is  perpe- 
trated by  burning :  the  dead  body  is  either  burnt  for  the  purpose  of 
entirely  destroying  it,  or  the  clothes  are  fired  soon  after  a  person 
has  been  killed,  in  order  to  conceal  wounds  or  other  violent  means 
of  death,  and  to  make  it  appear  as  if  the  deceased  had  been  acci- 
dentally destroyed  by  fire.  Death  by  burning  is  either  the  result  of 
accident  or  homicide,  most  commonly  the  former ;  but  medical  evi- 
dence may  give  rise  to  a  suspicion  of  murder  under  two  circum- 
stances: 1.  When  it  is  evident  that  several  parts  of  the  body  have 
been  fired  at  the  same  time,  and  the  burns  are  such  as  not  readily  to 
be  explained  by  the  same  accident,  or  by  the  accidental  ignition  of 
the  clothes.  2.  When  there  are  marks  of  homicidal  violence  on  the 
body ;  but  these  marks,  if  we  except  fractures  of  the  bones,  may  be 
easily  effaced  when  the  burn  is  extensive. 

Time  required  for  the  Burning  of  a  Dead  Body. — It  may  be  a 
medico-legal  question  whether,  on  discovering  a  body  much  burnt, 
it  could  be  determined  from  its  appearance  how  long  a  period  it 
would  require  to  produce  the  amount  of  destruction  observed.  An 
answer  to  such  a  question  may  be  necessary,  in  order  to  connect  a 
person  with  the  perpetration  of  an  alleged  crime,  but  the  question 
does  not  admit  of  a  precise  answer.  A  conjecture  only  can  be 
formed  from  the  facts  proved  in  each  particular  case.  The  human 
body  contains  a  large  proportion  of  water  (72  per  cent.);  this  gives 
to  the  soft  structures  a  power  of  resisting  combustion.  At  tin'  same 
time  there  is  a  quantity  of  fal  in  the  body,  varying  in  different  parts, 
but  amounting  to  an  average  of  about  live  per  cent.     The  hit  or  oil 


316  ALLEGED    SPONTANEOUS    COMBUSTION. 

tends  to  increase  its  combustibility,  and  this  is  still  further  increased 
if  the  body  is  placed  on  any  combustible  article  which  can  imbibe 
the  oil,  such  as  a  rug  or  deal  floor.  The  nature  of  the  dress  will  also 
make  a  difference.  Under  a  strong  and  active  flame,  which  might 
subsequently  burn  out  before  the  discovery  of  the  body,  there  would 
be  a  degree  of  destruction  in  half  an  hour  which  a  more  slow  and 
smothered  combustion  would  not  effect  in  several  hours.  It  is  from 
a  want  of  due  consideration  of  these  facts  that  some  of  the  older 
medico-legal  writers  have  given  support  to  the  hypothesis  of  sponta- 
neous combustion.  It  has  been  supposed  that  in  certain  cases  the  dead 
body  has  been  more  destroyed  than  seemed  consistent  with  the  fact 
of  ordinary  combustion  from  articles  of  dress  or  furniture;  but  this 
arose  from  want  of  sufficient  experience  on  the  effects  of  heat  on 
the  body.  Then,  as  the  means  by  which  the  dress  of  a  person  had 
become  ignited  were  generally  destroyed  with  the  body,  it  was 
thought  that  a  human  being  might,  under  certain  conditions,  be 
consumed  by  fire  spontaneously  generated  within  him.  This  ex- 
travagant hypothesis,  which  is  on  a  par  with  the  belief  in  witchcraft, 
and  requires  an  equal  amount  of  credulity  to  receive  it,  has,  how- 
ever, found  advocates  in  modern  times.  [Dickens  destroys  one  of 
his  characters  (Krook,  in  "Bleak  House")  by  spontaneous  combus- 
tion; add  Marryat,  in  "Jacob  Faithful,"  disposes  of  the  mother  of 
his  hero  in  the  same  manner. — P.]  In  March,  1850,  a  man  named 
Stauff  was  tried  at  Darmstadt  for  the  murder  of  the  Countess  of 
Goerlitz.  He  had  assaulted  the  deceased  in  her  chamber,  and  then 
set  fire  to  the  furniture  with  a  view  to  conceal  his  crime.  The  body 
and  dress  were  partially  consumed.  As  the  means  by  which  the  fire 
was  applied  were  not  at  once  apparent,  and  the  assassin  had  locked 
the  doors  of  the  room,  some  medical  men  took  up  the  theory  that 
the  deceased  had  died  from  spontaneous  combustion. 

The  facts  of  the  case  were  referred  to  Prof.  Liebig  and  Bischoff,  of 
Giessen ;  and  their  report  was  issued  in  March,  1850,  at  which  date 
the  man  Stauff  was  put  on  his  trial.  They  found  no  difficulty  in 
concluding  that  a  murder  had  been  perpetrated,  and  the  body  wil- 
fully burnt  after  death  for  the  purpose  of  concealing  the  crime.  There 
was  some  doubt  whether  the  deceased  had  died  from  strangulation, 
or  from  violence  to  the  head.  Stauff  was  convicted  chiefly  upon 
circumstantial  evidence.  He  subsequently  confessed  that  the  Countess 
had  entered  her  room  as  he  was  in  the  act  of  committing  a  robbery. 
A  struggle  took  place :  he  seized  her  by  the  throat,  strangled  her, 
and  afterwards  placed  the  body  in  a  chair,  piling  around  it  combus- 
tible articles  of  furniture.  He  set  fire  to  these  with  the  view  of  de- 
stroying the  proofs  of  his  crime.  It  was  observed  that  the  tongue 
of  the  deceased  was  protruded,  as  it  is  in  violent  strangulation,  and 
that  in  its  charred  state  it  retained  the  position  given  to  it  by  the 
act  of  murder.  Other  instances  of  alleged  spontaneous  combustion, 
if  properly  investigated,  would  have  turned  out  to  be  cases  of  acci- 
dental or  homicidal  burning. 

Spontaneous  combustion  may  take  place  in  some  kinds  of  vegetable 
and  mineral  substances,  but  not  in  the  animal  body,  living  or  dead. 


INJURIES    PRODUCED    BY    CORROSIVE    LIQUIDS.         317 

Corrosive  Liquids. — Among  the  cases  in  which  medical  evidence  is 
sometimes  required,  are  those  of  throwing  mineral  acids,  alkalies,  or 
other  corrosive  liquids  on  the  person.  This  crime  was  at  one  time 
prevalent,  and  until  the  recent  alteration  in  the  criminal  law  there 
was  no  adequate  punishment  for  it  (24  &  25  Vict.  c.  100,  s.  29).  On 
one  occasion,  an  assailant  escaped  a  charge  of  felony,  because  it  could 
not  be  considered,  in  law,  that  sulphuric  acid  was  capable  of  producing 
a  ivound — the  man  having  been  indicted  for  wounding !  This  case 
clearly  showed  a  strong  necessity  for  some  legal  definition  of  a  wound, 
as  well  as  the  uncertainty  of  medical  opinions :  for  while  one  surgeon 
considered  that  the  injury  produced  was  a  wound,  another  thought 
that  it  was  not.  The  judges  decided  that  it  was  not  a  wound  within 
the  meaning  of  the  Act.  The  statute  above  mentioned,  while  it 
punishes  the  offence,  omits  all  reference  to  a  definition  of  the  word 
wound.  The  nature  of  the  liquid  thrown  is  merely  defined,  in  gen- 
eral terms,  to  be  "  any  corrosive  fluid  or  any  destructive  substance" 
— a  point  which  will  require  medical  evidence  for  its  elucidation. 

In  common  language,  and  according  to  the  statute,  the  injury  thus 
produced  by  a  mineral  acid  such  as  oil  of  vitriol,  is  called  a  burn, 
but  it  is  wholly  different  in  its  origin,  as  well  as  in  its  progress.  I 
do  not  know  that  there  has  been  a  single  instance  in  which  such  an 
injury  has  directly  destroyed  life ;  but  great  deformity  and  actual 
blindness  have  resulted.  A  medical  man  is  sometimes  required  to 
distinguish  these  injuries  from  burns  and  scalds  :  this  may  be  easily 
done,  in  the  first  instance  by  the  appearance  of  the  part  injured,  as 
well  as  by  the  description  of  the  first  symptoms.  The  stain  is  brown 
when  sulphuric  acid  has  been  used,  and  yellow  when  nitric  or  muri- 
atic acid  has  been  employed.  The  eschar  or  destroyed  part  is  soft 
and  not  dry  as  in  a  burn  from  a  heated  solid.  The  skin  touched  by 
a  concentrated  acid  is  destroyed  and  sloughs  away,  to  the  extent  of 
the  part  on  which  the  corrosive  liquid  was  applied,  leaving  a  suppu- 
rating and  granulating  surface.  There  is  no  capillary  congestion  or 
redness  of  the  skin  around  the  injury  as  in  a  burn;  but  the  color  of 
the  injured  part  may  throw  some  light  upon  the  nature  of  the  corro- 
sive substance  used.  Thus,  while  oil  of  vitriol  (sulphuric  acid) 
produces  dark-brown  stains,  aqua-fortis  (nitric  acid)  produces  yellow 
or  yellow-brown  stains  on  the  skin.  Articles  of  dress  are  also  dif- 
ferently colored  by  these  acids.  The  period  at  which  a  person  may 
recover  from  an  injury  of  this  kind  depends  on  its  degree  and  extent, 
as  well  as  on  the  part  affected  by  the  corrosive  liquid.  Although  a 
person  may  not  die  from  the  direct  effects  of  the  acid,  yet  in  certain 
irritable  constitutions  the  inflammation  which  follows  in  deep-seated 
parts  may  prove  fatal.  In  infants,  or  delicate  nervous  females,  an 
extensive  injury  thus  produced  may  readily  destroy  life.  In  one  in- 
stance, sulphuric  acid  thrown  on  the  face  produced  inflammation  of 
the  eye,  for  which  bleeding  was  prescribed.  The  person  died  of 
phlebitis  (inflammation  of  the  vein),  as  the  result  of  this  bleeding. 
The  nature  of  the  acid  may  be  determined  by  applying  wetted  linen 
to  the  part  when  the  injury  is  recent,  and  examining  the  liquid  thus 
absorbed.     In  general,  however,  evidence  is  readily  obtained  by 


318         INJURIES    PRODUCED    BY    CORROSIVE    LIQUIDS. 

examining  the  spots  or  stains  left  on  articles  of  clothing  or  furniture. 
Oil  of  vitriol  is  most  commonly  used.  The  caustic  alkalies  may  be 
used  under  these  circumstances,  as  well  as  numerous  other  liquids, 
on  which  the  only  medical  opinion  required  would  be,  whether  the 
article  employed  should  or  should  not  be  considered  as  a  corrosive 
liquid  or  a  destructive  substance.  To  constitute  a  felony,  it  is  not 
now  necessary  that  the  person  should  have  sustained,  from  the  act  of 
throwing,  any  bodily  injury.  Unless  vital  reaction  has  taken  place, 
there  are  no  means  of  distinguishing  the  effects  of  a  corrosive  liquid 
on  the  living  from  those  produced  on  the  dead  body.  ("Ann. 
d'llyg."  1859,  vol.  1,  p.  396.) 

The  mineral  acids  are  sometimes  used  in  other  ways  for  the  de- 
struction of  life.  In  June,  1833,  a  man  poured  a  quantity  of  strong 
nitric  acid  into  the  ear  of  his  wife  while  she  was  lying  asleep.  She 
awoke  suddenly  with  a  violent  pain  in  the  ear,  which  continued  for 
three  days,  whereby  she  became  weak  and  exhausted.  Soon  after- 
wards there  was  copious  bleeding,  and  a  portion  of  membrane  escaped. 
She  lost  the  use  of  her  right  arm,  and  became  completly  deaf.  Sup- 
puration took  place  from  the  ear,  and  blood  escaped  daily.  She 
gradually  sank,  and  died  six  weeks  after  the  injury,  the  right  half 
of  the  body  being  convulsed  before  death.  On  inspection,  a  portion 
of  the  external  ear  was  wanting,  and  the  ear  passage  was  much 
wider  than  natural.  The  brain,  near  the  petrous  portion  of  the  tem- 
poral bone,  was  softened,  and  the  bone  itself  diseased  (carious).  The 
injury  had  led  to  death  indirectly  bv  producing  disease  of  the  brain. 
("Med.  Gaz."  vol.  17,  p.  89.) 

In  a  case  tried  at  Aberdeen,  the  evidence  proved  that  a  woman 
had  poured  oil  of  vitriol  down  the  throat  of  her  husband,  while  he 
was  lying  asleep  with  his  mouth  open.  She  was  convicted  of  the 
murder.  In  a  more  recent  case,  a  woman  killed  her  husband  by 
pouring  a  solution  of  corrosive-sublimate  down  his  throat  while  he 
was  sleeping.  These,  however,  were  treated  as  cases  of  poisoning, 
as  death  did  not  depend  on  the  local  or  external  mischief  produced 
by  the  corrosive  agent  employed. 


DEATH    FROM    DROWNING.  319 


ASPHYXIA. 


DROWNING. 


CHAPTER    XXXY. 

Cause  of  death. — secondary  causes. — post-mortem  appear- 
ances.— MEDICAL  PROOFS  OF  DEATH  FROM  DROWNING. — SPECIFIC 
GRAVITY  OF  THE  BODY. — CO-INCIDENTAL  CAUSES  OF  DEATH. — 
MARKS  OF  VIOLENCE. — ACCIDENTAL  FRACTURES. — HOMICIDAL  AND 
SUICIDAL  DROWNING. 

Under  the  term  Asphyxia  or  Apncea  are  included  those  forms  of 
violent  death  in  which  the  act  of  respiration  is  primarily  arrested 
(p.  55).  These  comprise  death  from  drowning,  hanging,  strangula- 
tion, and  suffocation,  and  in  this  section  the  fatal  effects  of  lightning, 
cold,  and  starvation  will  be  considered. 

Asphyxia  is  induced  in  drowning  owing  to  a  physical  impediment 
to  the  introduction  of  air  into  the  lungs.  The  medium  in  which  the 
person  is  immersed  acts  mechanically,  and  even  more  effectually  than 
a  rope  or  ligature  round  the  neck ;  for  although  air  escapes  from  the 
lungs,  and  water  penetrates  into  the  minute  air-tubes,  yet  no  air  can 
enter  to  supply  the  place  of  that  which  has  already  expended  its 
oxygen  on  the  blood.  Hence  this  fluid  must  circulate,  in  the  first 
few  minutes  after  submersion,  in  a  state  unfitted  for  the  support  of 
life  (unae'rated) ;  but  the  person  lives,  and  is  susceptible  of  recovery 
within  a  short  interval.  After  the  entire  suspension  of  respiration, 
the  action  of  the  heart  gradually  slackens,  and  finally  stops.  It  is 
at  this  period  of  the  arrest  of  circulation  that  asphyxia  passes  into 
death.  Asphyxia  is  determined  by  the  period  at  which  respiration 
is  completely  arrested ;  but  the  point  of  time  at  which  death  from 
drowning  occurs,  is  fixed  by  the  moment  at  which  the  action  of  the 
heart  ceases.  This  varies  considerably,  according  to  age,  sex,  state 
of  health,  and  other  circumstances. 

When  a  person  falls  into  water,  and  retains  his  consciousness, 
violent  attempts  are  made  to  breathe :  at  each  time  that  he  rises  to 
the  surface  a  portion  of  air  is  received  into  the  lungs,  but,  owing  to 
the  mouth  being  on  a  level  with  the  liquid,  water  also  enters  and 
passes  into  the  throat.  A  quantity  of  water  thus  usually  enters  the 
mouth,  which    the    drowning    person    is    irresistibly  compelled   to 


320  DROWNING.      CAUSE    OF    DEATH. 

swallow.     In  his  efforts  to  breathe  while  his  head  is  below  water, 
a  portion  of  this  liquid  is  drawn  into  the  air-tnbes  and  cells  of  the 
lungs.     The  struggle  for  life  may  continue  for  a  longer  or  shorter 
period,  according  to  the  age,  sex,  and  strength  of  the  person ;  but 
the  result  is,  that  the  blood  in  the  lungs  is  imperfectly  aerated,  the 
person  becomes  exhausted,  and  insensibility  follows.     The  mouth 
then  sinks  altogether  below  the  level  of  the  water — air  can  no  longer 
enter  into  the  lungs :  a  portion  of  that  which  they  contain  is  expelled, 
and    rises  in  bubbles  to  the  surface ;    an  indescribable  feeling    of 
delirium,  with  a  ringing  sensation  in  the  ears,  supervenes :  the  per- 
son loses  all  consciousness,  and  sinks  asphyxiated.     In  the  state  of 
asphyxia,  while   the  dark-colored   blood    is  circulated,  convulsive 
movements  of  the  body  take  place,  and  the  contents  of  the  stomach 
are  sometimes  ejected  by  vomiting.     There  does  not  appear  to  be 
any  sensation  of  pain,  and,  as  in  other  cases  of  asphyxia,  if  the 
person  recover,  there  is  a  total  unconsciousness  of  suffering  during 
the  period  when  the  access  of  air  was  cut  off  from  the  lungs.     Some 
persons  who  fall  into  water  are  observed  to  sink  at  once,  without 
making  any  attempt  to  extricate  themselves.     This  may  arise  either 
from  sudden  syncope  or  from  the  stunning  produced  by  the  fall. 
Should  the  person  be  intoxicated  or  otherwise  incapacitated,  as  by 
striking  his  head  in  falling,  he  may  not  again  rise.     These  different 
conditions    under    which    death    may    take    place    will    sufficiently 
account  for  the  difference  in  the  appearances  met  with  in  the  bodies 
of  those  who  have  died  in  water.     A  fatal  result  may  be  accelerated 
by  the  impression  suddenly  produced  upon  the  skin,  from  the  diffe- 
rence of  temperature  between  the  body  and  the  water.     To  those 
who  are  not  accustomed  to  water,  a  sudden  immersion  produces  a 
great  and  rapid  cooling  of  the  surface,  and  forces  the  blood  into  the 
internal  organs.     There  is  difficulty  of  breathing,  or  severe  spasmo- 
dic respiration,   with    giddiness  and    other  symptoms,   which    may 
render  a  person  powerless  to  extricate  himself.     The  effect  of  cold 
on  the  skin  is  seen  in  the  contracted  state  of  the  cutis  in  the  bodies 
of  those  who  have  been  drowned  during  the  winter.     It  is  calculated 
that  in  25  per  cent,  of  all  who  are  drowned  the  cause  of  death  is 
pure  asphyxia,  and  that  in  the  remainder,  syncope  and  cerebral  con- 
gestion amounting  to  apoplexy  may  have  a  share  in  causing  death. 

In  regard  to  the  time  required  for  death  to  take  place  by  drown- 
ing, it  may  be  observed  that  when  the  mouth  is  so  covered  by  water 
that  air  cannot  enter,  asphyxia  comes  on  in  the  course  of  one  or  two 
minutes  at  the  farthest,  and  the  time  at  which  this  occurs  does  not 
appear  to  vary  materially.  Perfect  insensibility  has  supervened  after 
one  minute's  submersion,  and  it  is  probable  that  in  most  cases  a  few 
seconds  would  suffice  for  the  commencement  of  asphyxia.  In  this 
state  the  person  can  make  no  efforts  to  save  himself,  and  death  com- 
monly ensues  in  from  two  to  five  minutes.  The  power  of  restoring 
life  depends  not  merely  on  the  time  that  the  body  may  have  been 
submerged,  but  on  the  condition  of  the  lungs  at  the  time  of  its  re- 
moval from  the  water.  Experiments  lately  conducted  by  a  Com- 
mittee of  the  Medico-.Chirurgieal  Society  have  clearly  proved  that, 


DROWNING.      EFFECT    OF    WATER    ON    THE    LUNGS.        321 

as  a  form  of  asphyxia,  drowning  is  not  only  more  speedily  fatal  to 
life  than  ordinary  suffocation,  but  from  the  effects  produced  on  the 
lungs  by  water,  the  chance  of  recovery  is  lessened. 

The  Committee  found  that  the  difference  in  the  results  was  not 
owing  to  exhaustion  from  struggling,  from  the  violent  efforts  made 
to  breathe,  or  from  the  effect  of  cold  in  immersing  the  whole  of  the 
body,  but  to  the  introduction  of  water  by  aspiration  into  the  minute 
air-tubes  and  cells  of  the  lungs.  This  conclusion  was  derived  from 
the  following  experiments.  Two  dogs  of  the  same  size  were  sub- 
merged at  the  same  moment,  but  one  had  his  windpipe  plugged,  so 
that  no  air  or  water  could  enter,  while  the  other  had  not.  After  two 
minutes  they  were  taken  out  together :  the  one  with  the  windpipe 
plugged  recovered  at  once,  the  other  died.  In  three  experiments 
dogs  with  their  windpipes  plugged  were  kept  below  water  for  four 
minutes:  the  animals  recovered  perfectly  when  removed  from  the 
water.  (Eeport  on  Suspended  Animation,  Med.-Chir.  Trans.,  1862, 
p.  449.)  An  inspection  of  the  bodies  at  once  revealed  the  difference. 
In  animals  simply  deprived  of  air  by  plugging  the  windpipe,  the 
lungs  were  merely  congested ;  but  in  those  which  were  submerged 
in  their  ordinary  condition,  the  lungs  besides  being  more  congested 
and  showing  ecchymosed  points  on  the  surface  and  in  the  substance, 
contained  in  their  bronchial  tubes  a  bloody  mucous  froth,  formed  of 
water,  blood,  and  mucus,  which  completely  filled  the  small  air-tubes. 
The  respiratory  efforts  made  by  the  animal  before  death  had  caused 
the  production  of  this  froth,  which  formed  a  mechanical  impediment 
to  the  entrance  of  air  by  the  movements  of  the  chest,  as  in  respira- 
tion. This  mucous  froth  or  foam  issued  from  the  lungs  on  section, 
and  appeared  to  penetrate  their  entire  substance,  which  was  saturated 
with  water  tinged  with  blood.  The  lungs  were  sodden  with  water, 
heavy,  soft,  doughy,  retained  an  impression  produced  by  the  finger, 
and  were  incapable  of  collapsing.  In  the  lungs  of  animals  which 
recovered  after  a  short  submersion,  little  or  none  of  this  mucous 
froth  was  found  in  the  air-cells.  In  the  fatal  cases  the  quantity  was 
great  in  proportion  to  the  time  of  submersion.  There  is  no  doubt 
that  it  is  produced  by  the  violent  efforts  to  breathe,  which  are  made 
within  a  minute  after  submersion. 

It  may  be  inferred  from  these  results  that  the  power  of  recovery 
in  human  beings  has  a  direct  relation  to  the  presence  of  mucous 
froth  in  the  air-tubes,  and  to  the  penetration  of  the  substance  of  the 
lungs  with  water.  The  larger  the  amount  of  froth  produced  and 
the  greater  the  penetration,  the  less  the  hope  of  recovery ;  for  when 
the  lungs  have  undergone  these  changes  they  are  physically  unfitted 
either  to  receive  or  expel  air  by  respiration — they  are  incapable  of 
collapsing.  These  circumstances  will  account  for  the  fact  that  per- 
sons have  been  resuscitated  in  drowning  under  various  and  even  op- 
posite modes  of  treatment,  and  even  under  no  treatment  at  all.  It 
is  right  that  every  reasonable  effort  should  be  made  to  restore  life,, 
but  if  the  lungs  are  sodden  with  water,  their  functions  cannot  be 
restored  by  any  mode  of  treatment.  The  Committee  found  that  four 
minutes'  complete  submersion  effectually  killed  dogs,  although  after 
21 


322  DEATH    FROM    SECONDARY    CAUSES. 

removal  from  water,  the  heart  continued  to  heat  from  four  to  five 
minutes.  The  continuance  of  the  heart's  action  furnishes,  therefore, 
no  criterion  of  the  power  of  recovery.  A  human  being,  as  a  rule, 
dies  if  submersed  for  a  period  of  from  four  to  five  minutes.  In  a 
few  exceptional  cases,  persons  have  been  resuscitated  after  this 
period,  but  it  is  most  probable  that  in  these  the  lungs  had  sustained 
no  damage. 

Death  from  Secondary  Causes. — Drowning  may  operate  indirectly  as 
the  cause  of  death.  Thus  it  has  been  repeatedly  remarked  that  per- 
sons who  have  been  rescued  from  the  water  in  a  living  state,  and 
who  have  apparently  recovered  from  the  effects  of  submersion,  have 
died,  in  spite  of  treatment,  after  the  lapse  of  some  minutes  or  hours; 
others  have  lingered  for  one  or  two  days,  and  then  have  sunk  appa- 
rently from  exhaustion.  In  those  who  perish  soon  after  removal 
from  water,  death  may  arise  either  from  exhaustion  or  from  the 
obstruction  of  respiration  by  the  penetration  of  water  into  the  air- 
cells  of  the  lungs.  Dr.  Marcet  states  .that  spasm  of  the  glottis  has 
been  among  the  severe  secondary  symptoms  in  persons  who  have 
been  removed  from  water  apparently  drowned.  A  severe  spasm  of 
this  kind  manifested  itself  in  one  case  while  placing  the  patient  in 
a  warm  bath.  ("Med.  Times  and  Gazette,"  February,  1857,  p.  148.) 
When  death  takes  place  at  a  remote  period,  it  may  be  caused  by 
disease ;  and  a  question  may  thence  arise,  whether  the  disease  was 
produced  by  the  immersion  in  water  or  not.  Such  cases  occasion- 
ally present  themselves  before  our  Courts  of  Assize. 

Post-mortem,  Appearances. — The  external  and  internal  appearances 
produced  by  drowning  vary  according  to  the  length  of  time  during 
which  the  body  may  have  remained  in  water,  and  the  period  that 
may  have  elapsed  after  its  removal  and  before  it  is  examined.  Thus, 
in  reference  to  the  bodies  of  two  persons  drowned  by  a  common 
accident,  if  one  is  removed  and  examined  immediately  and  the  other 
is  not  removed  from  the  water  until  after  the  lapse  of  several  days, 
and  is  then  inspected,  the  appearances  will  be  different.  So,  if  the 
two  bodies  are  removed  at  the  same  time,  and  one  is  immediately 
examined,  while  the  other  is  not  inspected  until  a  month  after  re- 
moval, the  proofs  of  drowning  which  may  be  discoverable  in  the 
former,  will  probably  have  disappeared  in  the  latter.  A  protracted 
exposure  of  the  drowned  body  either  to  water  or  air,  especially  if 
the  temperature  is  high,  renders  an  inspection  useless  for  the  purpose 
of  evidence. 

External  Appearances. — Supposing  that  the  body  has  remained  in 
the  water  only  a  few  hours  after  death,  and  the  inspection  has  taken 
place  immediately  on  its  removal,  the  skin  will  be  found  cold  and 
pallid — sometimes  contracted  under  the  form  of  "cutis  anserina." 
This  contracted  state  of  the  skin  when  found  furnishes  strong  evi- 
dence of  the  body  having  gone  into  the  water  living.  The  skin  is 
often  covered  to  a  greater  or  less  extent  by  livid  discolorations ; 
the  face  is  pale  and  calm,  with  a  placid  expression ;  the  eyes  are 
half-open,  the  eyelids  livid,  and  the  pupils  dilated ;  the  mouth  closed. 
or  half-opeu,  the  tongue  swollen  and  congested — frequently  pushed 


INTERNAL    APPEARANCES.  323 

forwards  to  the  inner  surface  of  the  lips,  sometimes  indented  or  even 
lacerated  by  the  teeth ;  and  the  lips,  together  with  the  nostrils,  are 
covered  with  a  mucous  froth  which  issues  from  them.  Kanzler  has 
noticed  in  the  male  subject  a  remarkable  retraction  of  the  penis. 
In  men  who  have  gone  living  into  the  water  and  been  drowned,  this 
appearance  has  been  repeatedly  observed  by  Casper  and  Kanzler ; 
and  the  former  states  that  he  has  not  met  with  this  condition  of  the 
male  organ  after  any  other  form  of  death.  In  strong  and  robust 
men  it  has  been  found  short,  and  strongly  retracted  into  the  skin. 
("Ger.  Leich.-Oeffn."  ii.  109.) 

The  body  and  limbs  of  a  person  recently  drowned  are  usually 
found  relaxed ;  but  cadaveric  rigidity  appears  to  come  on  quickly 
in  cases  of  drowning,  and  the  body  is  often  stiffened  in  the  convulsed 
or  distorted  attitude  which  it  may  have  had  at  the  time  of  death. 
In  a  case  observed  by  Mr.  Beardsley,  the  body  of  a  man  who  was 
drowned  under  ice,  was  found  with  the  arms  stiffened  in  the  attitude 
in  which  he  was  endeavoring  to  support  himself  on  the  ice. 

Among  the  casual  external  appearances,  it  has  been  noticed  that 
the  fingers  and  surface  of  the  body  occasionally  present  abrasions. 
Gravel,  sand,  mud,  weeds,  or  other  substances  may  be  found  locked 
within  the  hands  or  nails  of  drowned  persons ;  for  in  the  act  of 
drowning,  as  common  experience  testifies,  a  person  will  grasp  at  any 
object  within  his  reach,  and  in  his  efforts  to  extricate  himself  he  may 
excoriate  or  wound  his  fingers.  Substances  floating  in  the  water 
are  also  sometimes  found  in  the  nose,  niouth,  and  ears.  There  are, 
however,  many  cases  of  drowning  in  which  such  appearances  do  not 
exist.  There  may  be  no  substance  for  the  drowning  person  to  grasp : 
this  will  depend  in  a  great  degree  upon  the  fact  of  the  water  being 
deep  or  shallow,  of  its  being  confined  within  a  narrow  channel  or 
not,  and  many  other  contingencies.  In  all  cases,  when  the  person 
is  senseless  before  he  falls  into  the  water,  or  when  his  death  is  occa- 
sioned by  syncope,  he  will,  of  course,  be  incapable  of  making  those 
exertions  which  are  necessary  to  the  production  of  this  appearance, 
and  it  is  probable  that  this  frequently  occurs  among  women  who  are 
accidentally  drowned.  When  the  body  has  remained  several  days 
in  water,  the  skin  of  the  palms  of  the  hands  and  soles  of  the  feet  is 
found  thickened,  white,  and  sodden,  as  a  result  of  imbibition. 

Internal  Appearances. — In  a  recently  drowned  body,  the  lungs  and 
heart  present  the  appearances  usually  indicative  of  asphyxia  (p.  bb). 
The  venous  system  is  generally  gorged  with  dark-colored  liquid 
blood.  If  death  has  not  taken  place  from  asphyxia,  or  if  the  body 
has  remained  a  long  time  in  water  before  an  inspection  is  made,  the 
lungs  and  heart  will  not  present  the  characters  about  to  be  described. 
Some  physiologists  have  asserted  that  the  blood  remains  fluid  in  the 
bodies  of  the  drowned  ;  but  more  importance  has  been  attached  to 
this  appearance  than  it  really  merits.  Some  observers  have  found 
the  blood  coagulated  in  the  drowned,  and  I  have  seen  coagula,  like 
those  usually  met  with  alter  death,  in  the  bodies  of  animals  which 
were  drowned  for  the  sake  of  experiment.  If  the  blood  is  found 
generally  liquid,  this  may  be  due  to  the  imbibition  of  water,  or  to 


324  DROWNING.      POST-MORTEM    APPEARANCES. 

putrefactive  changes.  Eiedell  found  the  blood  in  the  heart  and  large 
vessels  to  contain  coagula,  in  inspections  made  from  two  hours  to 
five  days  after  death.  ("  Med.  Gaz.,"  vol.  46,  p.  478.)  Hence  it  fol- 
lows that  the  blood  may  be  found  either  coagulated  or  uncoagulated 
in  those  who  go  into  the  water  living,  and  die  by  drowning. 

The  lungs  are  sometimes  congested,  and  more  generally  distended 
than  collapsed.  Casper  and  Kanzler,  as  a  rule,  found  them  much 
increased  in  volume,  and  completely  filling  the  cavity  of  the  chest, 
so  that  when  the  chest  was  opened  they  protruded  out  of  it;  but  this 
did  not  depend  on  mere  fulness  of  blood.  The  most  accurate  ob- 
servations show  in  recent  cases  of  drowning  that  the  lungs  are 
generally  distended  and  in  a  flabby  condition.  Owing  to  the  pene- 
tration of  their  substance  by  water,  they  have  lost  their  usual  elas- 
ticity, so  that  an  impression  made  upon  them  by  a  finger  is  preserved, 
as  in  an  oedematous  limb.  Eiedell  has  pointed  out  this  flabby  and 
dilated  condition  of  the  lungs  as  a  special  characteristic  of  drowning ; 
although  they  floated,  he  found  that  they  were  three  or  four  times 
as  heavy  as  in  their  natural  state,  owing  to  the  water  in  their  sub- 
stance. ("  Med.  Gaz.,"  vol.  46,  p.  478.)  On  making  a  section  of  any 
part  of  the  lungs,  a  bloody  frothy  liquid  escapes — air  and  water 
being  mixed  together  in  the  air-cells.  These  appearances  are  only 
likely  to  be  observed,  in  a  well-marked  form,  when  the  body  is  exa- 
mined soon  after  death.  The  windpipe,  bronchi,  and  minute  air-tubes 
of  the  lungs,  in  a  recently  drowned  body,  are  filled  more  or  less 
with  a  mucous  froth,  tinged  with  blood,  as  a  result  of  the  last  violent 
efforts  at  respiration,  when  the  mouth  has  sunk  below  the  level  of 
water.  This  appearance  is  not  always  met  with.  Thus  it  has  not 
been  found  in  the  bodies  of  those  who  have  sunk  at  once  below  the 
surface  and  have  not  again  risen  to  breathe.  But  from  recent  expe- 
riments on  animals,  made  by  the  Committee  of  the  Medico-Chirur- 
gical  Society,  its  presence  in  the  air-passages  does  not  depend  on  the 
fact  of  a  person  rising  to  the  surface — although  this  may  increase 
the  quantity — but  rather  upon  the  violent  spasmodic  efforts  made  to 
breathe,  under  circumstances  in  which  water  alone  can  enter  the 
lungs.  These  facts  show  that  a  mucous  froth  is  produced  in  the  air- 
passages  even  in  two  minutes,  when  there  is  entire  submersion  of 
the  head ;  and  its  quantity  appears  to  be  in  proportion  to  the  length 
of  submersion,  and  the  violence  of  the  efforts  made  to  breathe. 

The  presence  in  the  air-passages  of  a  mucous  froth,  frequently 
tinged  with  blood,  may  be  regarded  as  a  characteristic  of  asphyxia 
by  drowning.  When  discovered  in  the  lungs,  associated  with  a 
watery  condition  of  these  organs,  it  furnishes  a  satisfactory  proof  of 
this  mode  of  death.  As  its  presence  depends  on  the  retention  of  air 
in  thin  vesicles  diffused  through  the  air  tubes,  it  is  obvious  that,  ex- 
cept in  recent  inspections,  i.  e.,  within  a  few  hours  of  death,  it  may 
have  wholly  or  partly  disappeared.  Water  passing  in  and  out  by 
the  windpipe  may  destroy  it — also  the  exposure  of  the  body  to  a 
high  temperature.  This  may  account  for  the  fact  that  it  is  not  always 
observed  in  the  inspection  of  the  bodies  of  the  drowned,  when  removed 
from  water.     Violent  efforts  at  respiration  may,  however,  produce 


POST-MORTEM    APPEARANCES.  325 

it — especially  if,  owing  to  the  loss  of  power  of  swallowing,  any- 
liquid  should  find  its  way  into  the  windpipe.  Independently  of  the 
presence  of  water  (sometimes  mixed  with  mud,  sand,  or  weeds)  in 
the  larger  air-tubes,  a  portion  of  this  liquid  is  generally  drawn  into 
the  lungs  by  convulsive  efforts  at  respiration.  It  fills  the  cells,  and 
penetrates  the  substance  of  the  organs,  giving  to  them  the  flabby  or 
doughy  consistency  already  described.  In  some  cases  the  contents 
of  the  stomach  may  be  found  in  the  windpipe  and  lungs :  this  occurs 
when  a  person  has  been  drowned  with  a  full  stomach.  Vomiting 
takes  place,  and  the  vomited  matters  are  drawn  into  the  lungs  by  the 
attempt  to  breathe. 

The  state  of  the  heart  in  the  drowned  has  given  rise  to  some  dis- 
cussion. In  death  from  asphyxia  the  right  cavities  generally  con- 
tain blood,  while  the  left  cavities  are  either  empty,  or  they  contain 
much  less  than  the  right.  Out  of  fifty-three  inspections  made  by  Dr. 
Ogston,  the  right  cavities  were  found  empty  only  in  two  cases,  and 
the  left  cavities  empty  in  fourteen.  ("Med.  Gaz.,"  vol.  48,  p.  291.) 
In  a  case  of  drowning  which  was  examined  by  Mr.  Bishop,  the  right 
side  of  the  heart  contained  scarcely  any  blood ;  and  in  another  case, 
communicated  to  me  December,  1857,  the  only  medical  difficulty 
regarding  death  by  drowning,  presented  itself  in  an  emptiness  or 
non-distension  of  the  right  cavities  of  this  organ.  The  facts  and 
observations  accumulated  by  my  friend  Dr.  Norman  Chevers,  of  the 
Calcutta  Medical  Board,  show  that  a  full  condition  of  the  heart, 
although  a  common,  is  not  an  invariable  concomitant  of  asphyxia, 
either  from  drowning  or  any  other  cause.  ("Medical  Jurisprudence 
for  India,"  1856,  p.  441.)  It  has  been  elsewhere  remarked,  that  the 
action  of  the  heart  continues  after  the  stoppage  of  respiration,  and 
that  the  period  at  which  this  organ  ceases  to  contract  is  variable. 
Hence,  in  some  cases  there  may  be  sufficient  power  in  the  right 
cavities  to  contract  upon  their  contents,  and  to  expel,  more  or  less 
completely,  the  last  traces  of  blood  received  by  them  from  the  body. 
Emptiness  of  the  right  cavities  of  the  heart  must  not,  therefore,  be 
regarded  as  inconsistent  with  death  from  drowning;  at  the  same  time, 
it  cannot  be  taken  as  a  proof  that  the  person  has  died  from  asphyxia. 
Dr.  Biedell  states  that  in  half  the  number  of  instances  which  had 
fallen  under  his  observation,  the  two  sides  of  the  heart  contained 
equal  quantities  of  blood ;  in  the  other  half,  the  right  side  contained 
the  larger  proportion.  In  one  case  only  the  emptiness  of  the  left 
side  contrasted  strongly  with  the  fulness  of  the  right. 

A  greater  or  less  fulness  of  the  vessels  of  the  brain  is  described 
as  one  of  the  appearances  met  with  in  drowning;  but  this,  when  it 
exists,  is  probably  a  consequence  of  a  congested  state  of  the  lungs. 
Some  remarks  have  been  already  made  on  this  subject,  and  from 
these  it  is  evident  that  the  state  of  the  cerebral  vessels  can  afford  no 
presumption  that  death  has  taken  place  by  drowning.  In  regard  to 
the  cases  which  I  have  had  an  opportunity  of  examining,  the  quan- 
tity of  blood  contained  within  the  cerebral  vessels  has  rarely  been 
so  great  as  to  call  for  particular  notice. 

In  examining  the  abdomen,  it  will  commonly  be  found  that  the 


326  WAS    DEATH    CAUSED    BY    DEOWXIXG? 

stomach  contains  water,  which  appears  to  enter  into  this  organ  by  the 
act  of  swallowing  during  the  struggle  for  life.  This  may  be  salt  or 
fresh,  according  to  the  medium  in  which  the  drowning  has  taken 
place.  The  quantity  is  subject  to  great  variation ;  sometimes  it  is 
large,  at  other  times  small,  and  in  some  instances  no  water  whatever 
is  to  be  met  with.  The  absence  of  water  may  probably  indicate  a 
rapid  death,  as  there  could  have  been  no  power  to  swallow.  Orfila 
has  remarked,  that  the  mucous  membrane  of  the  stomach  and  bowels 
is  occasionally  much  discolored  in  drowned  subjects.  He  observed 
also,  that  when  drowning  took  place  while  the  process  of  digestion 
was  going  on,  the  mucous  membrane  of  the  stomach  often  had  a 
pinkish-red,  or  violet-tint.  When  the  dead  body  had  remained  a 
long  time  in  water,  this  membrane  was  observed  to  acquire  a  deep 
violet  or  brown  color.  A  knowledge  of  this  fact  may  be  of  some 
importance  in  those  cases  in  which  a  person  is  suspected  to  have  been 
poisoned  previously  to  submersion.  It  has  been  said  that  the  dia- 
phragm is  generally  much  raised  towards  the  chest;  but  this  may 
depend  on  gaseous  putrefaction,  and  the  increase  in  the  size  of  the 
abdomen  by  the  formation  of  gas  in  the  intestines.  The  urinary 
bladder  in  some  cases  contains  urine;  in  others  it  is  perfectly  empty. 
Casper  found  it  empty  in  one  half  of  the  cases  which  he  examined. 
It  is  obvious  that  the  state  in  which  the  bladder  is  found  must  de- 
pend on  its  condition  at  the  time  at  which  the  drowning  occurred. 
(See,  in  reference  to  the  appearances  in  the  drowned,  a  paper  by  Dr. 
Ogston,  "Med.  Gaz."  vol.  47,  pp.  763,  854,  et  seq. ;  also  another  by 
Dr.  Eiedell,  "Med.  Gaz."  vol.  46,  p.  478;  and  Casper,  "Ger.  Leich- 
Oeff.,"  vol.  1,  p.  87 ;  2,  p.  105 ;  and  "  Klinische  Novellen,"  1863,  p. 
523.) 

Was  Death  caused  by  Drowning  ? — For  a  correct  solution  of  this 
question,  it  will  be  necessary  to  consider  the  appearances  met  with 
in  the  drowned,  and  to  determine  how  far  they  are  characteristic  of 
this  form  of  death.  Among  the  external  signs  of  drowning,  when 
the  body  is  seen  soon  after  death,  are  paleness  of  the  surface,  a  con- 
tracted state  of  the  skin  (cutis  anserina),  and  the  presence  of  a  mu- 
cous froth  about  the  nostrils  and  lips.  The  absence  of  these  appear- 
ances, however,  would  not  prove  that  the  person  had  not  been 
drowned;  for  if  the  body  had  remained  some  time  in  water,  or  if  it 
had  been  long  exposed  to  air  before  it  was  seen  by  a  medical  man. 
the  skin  would  undergo  various  changes  in  its  condition  and  color, 
and  mucous  froth  would  no  longer  be  found  adhering  to  the  nostrils 
and  lips. 

State  of  the  Skin. — The  goose-skin  or  cutis  anserina  which  is  fre- 
quently observed  in  the  drowned,  shows  that  the  skin  possessed  the 
living  power  of  contractility  at  the  time  of  immersion.  Wagner 
suggests  that  the  appearance  might  be  produced  in  a  dead  body  if 
thrown  into  cold  water  immediately  after  death,  i.  e.  while  the  skin 
is  warm.  As  none  but  assassins  would  be  likely  to  resort  to  this 
proceeding,  the  objection  would,  if  admitted,  leave  the  fact  of  drown- 
ing still  to  be  made  out  by  an  internal  inspection.  This  contracted 
state  of  the  skin  could  hardly  be  mistaken  for  a  naturally  rough  or 


MEDICAL    PROOFS.  327 

horny  skin,  as  suggested  by  Caspar.  ("  Ger.  Leich.-Oeffn."  vol.  1,  p. 
89.)  As  this  condition  of  the  skin  is  not  invariably  present,  even 
in  the  recently  drowned,  and  as  it  is  observed  chiefly  in  drowning 
during  cold  weather,  its  absence  must  not  be  taken  to  negative  the 
hypothesis  of  drowning. 

Substances  grasped  in  the  Hands. — Foreign  substances,  such  as 
gravel,  dirt,  weeds,  or  grass,  are  sometimes  found  locked  within  the 
hands  or  lodged  under  the  nails  of  drowned  subjects.  This  fact  may 
occasionally  afford  strong  circumstantial  evidence  of  the  manner  in 
which  a  person  has  died.  If  materials  are  found  grasped  within  the 
hands  of  the  deceased  which  have  evidently  been  torn  from  the 
banks  of  a  canal  or  river,  or  from  the  bottom  of  the  water  in  which 
the  body  is  found,  we  have  strong  presumptive  evidence  that  the 
person  died  within  the  water.  For  although  it  is  possible  to  imagine 
that  the  deceased  may  have  struggled  on  the  bank,  and  have  been 
killed  prior  to  submersion,  yet  in  the  value  attached  to  this  sign  we 
are  assuming  that  there  are  no  marks  of  violence  on  the  person,  nor 
any  other  appearances  about  the  body  sufficiently  striking  to  lead 
the  examiner  to  suspect  that  death  had  occurred  in  any  other  way 
than  by  drowning.  If  the  substance  locked  within  the  fingers  or 
finger-nails  is  sand  of  the  same  character  as  that  existing  at  the  bot- 
tom of  the  river  or  pond,  it  is  difficult  to  conceive  any  stronger  fact 
to  establish  death  from  submersion.  The  abrasion  of  the  fingers  is  a 
circumstance  of  minor  importance ;  no  value  could  be  attached  to 
this  state  of  the  fingers  as  an  indication  of  a  person  having  perished 
by  drowning,  unless  it  were  in  conjunction  with  the  appearances 
above  described.  A  witness  would  be  constrained  to  admit,  in  many 
cases,  that  the  fingers  might  become  abraded  or  excoriated  after 
death,  or  even  before  submersion  ;  while  in  no  case  could  he  be  called 
upon  to  make,  in  regard  to  substances  found  grasped  within  the 
hands,  an  admission  which  would  invalidate  the  evidence  deducible 
from  this  condition.  This  must  then  be  regarded  as  a  satisfactory 
proof  of  a  person  having  been  alive  after  his  body  was  in  the  water. 
It  is  well  known  that  when  two  or  three  are  drowned  by  the  same 
accident,  they  are  not  unfrequently  found  clasped  within  each  other's 
arms ;  a  fact  which  at  once  proves  that  they  must  have  been  living 
when  submerged ;  so  if  a  dead  body  is  discovered  still  holding  to  a 
rope,  cable,  or  oar,  no  further  evidence  is  required  to  show  that  the 
deceased  must  have  died  from  drowning. 

The  internal  appearances  upon  which  medical  jurists  chiefly  rely 
as  proofs  of  this  kind  of  death  are — first,  water  in  the  stomach  ;  and 
secondly,  water  with  a  mucous  froth  in  the  air-passages  and  lungs. 

1.  Water  in  the  Stomach. — Dr.  Riedell  found  that  in  the  majority 
of  cases  of  drowning,  water  passed  into  the  stomach.  In  animals 
previously  killed,  and  placed  for  twenty-four  hours  in  water  with 
the  mouth  wide  open,  no  fluid  penetrated  to  the  stomach.  ("  Med. 
Gaz.,"  vol.  46,  p.  478.)  Water  commonly  passes  into  the  stomach 
of  a  living  animal  while  drowning  by  the  act  of  swallowing.  It  has 
been  observed,  that  when  an  animal  is  stunned  prior  to  submersion, 
water  does  not  pass  into  the  gullet,  and  when  syncope  occurs  none 


328  WAS    DEATH    CAUSED    BY    DROWNING? 

will  be  found.  As  a  proof  that  its  entrance  into  this  organ  depends 
on  the  act  of  swallowing,  it  may  be  stated  that  the  quantity  in  the 
stomach  is  greater  when  an  animal  is  allowed  to  come  frequently  to 
the  surface  and  respire,  than  when  it  is  maintained  altogether  below 
the  surface.  The  power  of  swallowing  is  immediately  suspended  on 
the  occurrence  of  asphyxia,  and  in  this  way  we  may  satisfactorily 
account  for  the  difference  observed  in  the  two  cases.  The  water 
thus  found  is  in  variable  quantity :  and  there  are  some  cases  of 
drowning  in  which  water  is  not  present  in  the  stomach.  It  was 
found  by  Dr.  Ogston,  of  Dundee,  in  five  cases  out  of  seven.  (Ed. 
"  Med.  and  Surg.  Jour.,"  Jan.  1837.)  "Water  does  not  readily  pene- 
trate into  the  stomach  of  a  body  which  has  been  thrown  in  after 
death ;  the  sides  of  the  gullet  applying  themselves  too  closely  to 
each  other  to  allow  of  the  passage  of  fluid.  If  putrefaction  has  ad- 
vanced to  any  extent,  some  water  may  enter ;  but  a  medical  man 
will  easily  judge,  from  the  general  state  of  the  body,  how  far  this 
process  may  have  been  concerned  in  the  admission  of  fluid  into  the 
stomach  and  intestines.  Orfila  has  suggested  that  water  may  be 
found  in  the  stomach  of  a  person  apparently  drowned,  in  conse- 
quence of  this  liquid  having  been  drunk  by  the  deceased,  or  artifi- 
cially injected  by  another  into  the  stomach  after  death.  It  is  diffi- 
cult to  conceive  under  what  circumstances  the  latter  objection  could 
be  made,  or  what  purpose  it  would  answer ;  but  in  relying  upon  the 
presence  of  water  in  the  stomach,  it  may  be  admitted  that  the  de- 
ceased may  have  drunk  water  before  his  body  was  submerged.  The 
mere  discovery  of  water  in  the  stomach,  except  under  circumstances 
to  be  presently  mentioned,  is  not,  therefore,  a  necessary  proof  that 
it  has  been  swallowed  during  the  act  of  drowning. 

It  is  of  course  presumed  that  the  liquid  contained  within  the 
stomach  is  of  the  same  nature  as  that  in  which  the  bod}'-  is  immersed ; 
for  it  is  possible  that  fresh  water  may  be  found  in  the  stomach  of  a 
person  drowned  in  salt  water,  and  in  such  a  case  it  would  be  obvi- 
ously improper  for  a  medical  witness  to  affirm  from  the  mere  presence 
of  water,  that  the  person  had  died  where  his  body  was  dicovered.  If 
the  water  contain  mud,  straw,  duckweed,  moss,  or  any  substances 
like  those  existing  in  the  pond  or  river  where  the  drowning  occurred, 
is  a  proof,  when  the  inspection  is  recent,  of  its  having  been  swallowed 
by  a  living  person.  The  absence  of  water  from  the  stomach  cannot, 
however,  lead  to  the  inference  that  the  person  has  not  died  from 
drowning,  because  in  some  instances  it  is  not  swallowed,  and  in 
others  it  may  drain  away  and  be  lost  after  death  before  an  inspection 
is  made. 

2.  Water  with  Mucous  Froth  in  the  Air-Passages  and  Lungs. — If  the 
body  is  carefully  removed  from  the  water,  and  is  examined  soon 
after  removal,  these  appearances,  which  furnish  satisfactory  evidence 
of  death  from  drowning,  will  be  found.  Dr.  Keidell  regards  the 
presence  of  a  mucous  froth  as  a  constant  sign  of  this  kind  of  death. 
In  all  his  experiments  and  observations  he  states  that  he  found  a 
frothy  fluid  in  the  windpipe,  bronchi,  and  lungs:  after  death  it  gra- 
dually disappears  from  the  air-tubes  by  exosmosis,  but  not  from  the 


MEDICAL    PROOFS.  329 

lungs.  The  fluidity  of  this  froth  is,  he  contends,  a  distinctive  cha- 
racter of  death  from  drowning,  and  is  not  met  with  in  any  other  case 
("  Med.  Gaz.,"  vol.  46,  p.  478.)  The  presence  of  a  frothy  fluid  would 
undoubtedly  show  that  liquid,  from  some  cause,  had  penetrated  into 
the  air-passages;  and  when  taken  in  conjunction  with  the  presence 
of  water  in  the  substance  of  the  lungs,  it  may  be  considered  to  fur- 
nish conclusive  evidence  of  death  from  drowning.  On  the  other 
hand,  its  absence  does  not  necessarily  prove  that  a  person  has  not 
died  from  this  cause.  If  none  is  found  in  a  body  recently  after  death, 
this  may  have  been  the  result  of  syncope  or  apoplexy,  and  there  may 
have  been  no  convulsive  efforts  at  breathing  prior  to  death.  A  mu- 
cous froth  may  not  be  found  when  the  body  has  remained  for  a  long 
period  in  the  water  after  death,  since  by  the  free  passage  of  this  fluid 
into  and  out  of  the  air-tubes,  the  froth,  although  formed  in  the  first 
instance,  may  have  disappeared.  If,  after  removal  from  the  water, 
the  body  is  exposed  to  the  air  for  several  days  before  it  is  examined, 
it  is  rare  that  this  appearance  is  seen.  The  mucous  froth  may  have 
been  formed  in  the  windpipe,  but  it  may  have  entirely  disappeared. 

3.  Water  and  Foreign  Substances  in  the  Lungs. — It  has  been  else- 
where stated  that  in  the  act  of  drowning,  water  is  drawn  with  con- 
siderable force  into  the  lungs,  by  violent  attempts  at  inspiration. 
The  aspiratory  force  thus  exerted  by  the  lungs  is  considerable.  It 
has  been  found  that  when  the  heads  of  animals  are  plunged  below 
mercury,  some  of  this  fluid  metal,  in  spite  of  its  density,  is  actually 
drawn  into  the  lungs,  and  globules  of  it  have  been  found  in  the  air- 
cells.  A  fortiori,  this  takes  place  in  a  greater  degree  with  water  which 
is  forcibly  drawn  into,  and  permeates  the  spongy  texture  of  the 
lungs,  rendering  death  more  rapid  and  recovery  more  difficult  than 
in  other  forms  of  asphyxia.  This  aspiratory  force  of  the  lungs  has 
been  measured,  and  is  found,  in  small  animals,  to  be  equal  to  raising 
a  column  of  mercury  four  inches  in  height.  Not  only  is  water  thus 
drawn  in,  but  sand,  mud,  weeds,  or  other  substances  floating  in  it, 
are  also  carried  into  the  air-tubes  and  cells  of  the  lungs.  When  the 
water  is  mixed  with  weeds  or  mud,  and  water  presenting  the  same 
admixture  is  found  in  the  throat  and  stomach,  this  is  strong  evidence 
that  the  body  has  been  plunged  into  the  medium  when  the  power  of 
breathing  and  swallowing  still  existed,  and  hence  that  the  deceased 
has  been  drowned.  All  attention  to  the  condition  of  the  stomach 
and  lungs  together,  will  therefore  be  of  importance  in  cases  of 
alleged  child-murder  by  drowning,  since  it  may  aid  in  proving  or 
disproving  the  charge. 

When  a  dead  body  is  thrown  into  water,  and  has  remained  there 
some  time,  water,  with  fine  particles  of  sand,  mud,  or  weeds,  may 
pass  through  the  windpipe  into  the  lungs,  and  there  be  deposited. 
[In  the  previous  edition  of  this  work,  the  following  case  is  men- 
tioned :  "  Dr.  Chevers,  of  Calcutta,  was  required  to  examine  the 
body  of  a  child  found  in  a  tank  at  a  distance  from  the  house  of  the 
parents.  The  internal  appearances  showed  that  the  child  had  died 
by  drowning.  The  air-passages  contained  green  vegetable  matter, 
and  the  right  air-tube  was  almost  completely  filled  with  so  large  a 


330  DROWNING.      GENERAL    CONCLUSIONS. 

portion  of  an  aquatic  weed  doubled  together,  that  it  appeared  aston- 
ishing how  such  a  body  could  have  passed  into  the  windpipe.  It 
was  proved  that  no  weed  of  this  kind  grew  in  the  tank  where  the 
body  was  found.  Further  inquiry  led  to  the  discovery  that  the  bodv 
of  the  boy  had  been  found  by  a  woman  in  a  tank  near  his  house,  in 
which  the  weed  found  in  the  air-passages  grew  abundantly.  This 
female  carried  the  corpse  to  the  more  distant  tank  which  belonged  to 
a  person  against  whom  she  bore  a  grudge !" — P.]  Water  under  these 
circumstances,  however,  does  not  penetrate  into  the  substance  of  the 
lungs  as  by  aspirations  during  life,  and  the  amount  which  passes 
through  the  chink  of  the  glottis  is  small.  If  simply  an  after-death 
effect,  the  water  is  found  in  the  larger  air-tubes  unaccompanied  by 
mucous  froth.  In  most  cases,  however,  the  effect  of  aspiration,  as  a 
result  of  living  power,  is  so  manifest,  that  the  examiner  can  have  no 
difficulty  in  forming  an  opinion. 

A  medical  man  may  be  occasionally  required  to  express  an  opinion 
on  the  length  of  time  that  may  have  elapsed  since  the  act  of  drown- 
ing, when  the  dead  body  of  a  person  has  been  discovered  in  water. 
The  rules  which  have  been  suggested  for  the  guidance  of  a  medical 
witness  on  these  occasions  are  open  to  so  many  exceptions,  owing  to 
the  different  degrees  in  which  putrefaction  takes  place  in  bodies 
exposed  under  similar  circumstances,  that  they  are  but  of  little  ser- 
vice as  a  basis  for  medical  evidence. 

From  these  observations  it  will  be  perceived  that  the  only  char- 
acters on  which  reliance  can  be  placed,  as  medical  proofs  of  death 
from  drowning,  are — first,  the  presence  of  a  mucous  froth  in  the 
windpipe  and  air-tubes ;  secondly,  of  water  in  the  air-tubes  and  air- 
cells  of  the  lungs  ;  and  thirdly,  of  water  in  the  stomach.  An  earlv 
inspection  of  the  body  may  thus  enable  a  medical  man  to  come  to 
a  satisfactory  conclusion  that  death  was  or  was  not  caused  by 
drowning.  The  longer  this  inspection  is  delayed,  the  more  ambigu- 
ous the  evidence  becomes,  since  the  froth  slowly  disappears  from 
the  air-tubes,  while  water  may  penetrate  into  the  lungs  and  stomach. 
The  great  cause  of  failure  in  obtaining  medical  proofs  of  drowuing 
is  generally  the  unavoidable  delay  before  an  inspection  is  made. 

If,  in  examining  a  body  taken  from  water,  we  find  upon  it  marks 
of  violence,  or  severe  internal  injuries  sufficient  to  destroy  life,  there 
is  strong  ground  for  suspicion.  Why  the  body  of  a  person  who  has 
really  died  from  natural  causes  should  be  afterwards  thrown  into 
water  it  would  not  be  easy  to  explain  upon  any  hypothesis  of  inno- 
cence, but  we  can  readily  appreciate  the  motive  when  murderous 
violence  has  been  used.  After  the  lapse  of  five  or  six  weeks, 
especially  if  the  body  has  been  removed  from  the  water  for  the 
greater  part  of  that  period,  none  of  the  usual  appearances  of  drown- 
ing will  be  met  with :  in  the  present  day  no  practitioner  would  think 
of  seeking  for  evidence  under  such  circumstances. 

In  consequence  of  the  uncertainty  attendant  on  the  appearances  of 
drowning,  barristers  have  considerable  advantage  in  cross-examining 
those  medical  witnesses  who  appear  to  support  the  theory  of  the 
prosecution  that  death  took  place  from  this  cause.     Legal  ingenuity 


SPECIFIC    GRAVITY    OF    THE    BODY.  331 

is  here  often  strained  to  the  utmost,  to  show  that  there  is  no  certain 
sign  of  drowning,  and  therefore  that  the  deceased  must  have  died 
from  some  other  cause.  The  general  impression  among  non-medi- 
cal persons  appears  to  be  that,  whether  in  drowning  or  suffocation, 
there  ought  to  be  some  particular  visible  change  in  some  part  of  the 
body  to  indicate  at  once  the  cause  of  death ;  but  it  need  hardly  be 
said  that  this  notion  is  founded  on  false  views,  and  if  the  reception 
of  medical  evidence  on  the  cause  of  death  be  made  to  depend  on  the 
production  of  some  such  positive  and  visible  change  of  structure, 
then  it  would  be  better  at  once  not  to  place  the  parties  charged  with  the 
crime  upon  their  trial,  because  it  could  never  be  proved  against  them. 
A  medical  inference  of  drowning  is  founded  upon  a  certain  series  of 
facts,  to  each  of  which,  individually,  it  may  be  easy  to  oppose  plau- 
sible objections ;  but  taken  together  they  furnish  evidence  as  strong 
as  is  commonly  required  for  proof  of  any  other  kind  of  death. 

In  death  from  drowning  a  question  respecting  the  specific  gravity 
of  the  human  body  may  incidentally  arise.  In  the  healthy  living- 
body  this  is  made  up  of  the  combined  specific  gravity  of  its  differ- 
ent parts ;  so  that,  as  in  all  heterogeneous  solids,  it  is  a  complex 
quantity.  In  the  first  place,  about  72  per  cent,  of  the  weight  of  the 
body  consist  of  water — hence  the  question  of  specific  gravity  can 
refer  only  to  the  remaining  28  per  cent,  of  dry  solids.  The  only 
part  of  the  body  which  is  lighter  than  water  is  fat.  The  specific 
gravity  of  this  is  0.92,  and  it  is  calculated  that  the  proportion  of  fat  in 
an  adult  is  about  five  per  cent,  of  the  weight  of  the  body,  or  one- 
twentieth  part.  The  specific  gravity  of  muscle  is  1.085,  of  brain 
1.04,  of  the  soft  organs  generally  1.05,  of  the  lungs  containing  air 
0.94,  and  of  bone,  the  heaviest  part  of  the  body,  2.01.  The  light- 
ness of  the  fatty  portions  is  more  than  counterbalanced  by  the  weight 
of  the  skeleton  (about  ten-and-half  pounds  in  the  male,  and  nine 
pounds  in  the  female),  so  that  the  naked  human  body,  placed  on 
water,  has  a  slight  tendency  to  sink.  This  tendency  diminishes  just 
in  proportion  to  the  quantity  of  the  body  immersed ;  because  all 
those  parts  which  are  out  of  water,  not  being  supported  by  water, 
become  so  much  additional  absolute  weight  to  the  portion  immersed. 
Hence  the  frequent  cause  of  death  by  drowning.  An  inexperienced 
person  exhausts  himself  by  exertion,  raises  his  arms  continually  out 
of  the  water,  and  as  often  sinks,  owing  to  their  weight  having  just 
so  much  effect  on  his  body  as  if  a  leaden  weight  had  been  suddenly 
applied  to  his  feet  to  sink  him.  When  the  whole  of  the  living  body 
is  immersed,  the  specific  gravity,  owing  to  the  expansion  of  the 
chest,  differs  so  little  from  that  of  water,  that  a  very  slight  motion 
of  the  hands  or  feet  will  suffice  to  keep  a  person  on  the  surface. 
The  head,  owing  to  the  weight  of  the  bones  of  the  skull,  has  always 
a  tendency  to  sink  below  the  level  of  water,  and  muscular  force  is 
required  to  keep  it  above  the  surface.  There  are  two  circumstances 
which  cause  the  specific  gravity  of  the  body  to  vary.  If  the  quan- 
tity of  fat  is  proportionally  large,  it  will  be  diminished ;  and  such  a 
person  will  float  more  readily  than  another  in  an  opposite  condition. 
On  the  other  hand,  a  large  proportion  of  bone  renders  a  person 


332  SINKING    AND    FLOATING    OF    BODIES. 

heavier  than  his  bulk  of  water ;  and  his  body  will  sink  more  rapidly 
than  that  of  another.  These  two  modifying  causes  of  buoyancy  are 
liable  to  constant  variation :  hence  the  different  accounts  given  by 
experimentalists  relative  to  the  specific  gravity  of  the  human  body. 
The  bodies  of  women  are,  caeteris  paribus,  of  less  specific  gravity 
than  those  of  men :  the  skeleton  is  smaller,  and  there  is  a  greater 
proportion  of  fat — hence  they  more  readily  float.  Infants  and  young 
children  float  with  the  greatest  ease :  the  quantity  of  fat  is  usually 
in  large  proportion,  and  the  bones  are  light — the  earthy  matter  being 
not  yet  fully  deposited.  Thus,  in  infanticide  by  drowning,  the  body 
of  the  child  rises  very  speedily  to  the  surface — if,  indeed,  it  does 
not  remain  altogether  upon  it. 

There  are  some  other  points  to  be  considered  in  relation  to  the 
buoyancy  of  the  living  human  body.  1.  Respiration. — It  is  the  fact 
of  the  lungs  being  filled  with  air  that  gives  the  general  lightness  to 
it.  If  these  organs  are  emptied  while  the  face  is  under  water  and 
the  person  cannot  inhale  again,  the  body  remains  specifically  heavier 
than  water  and  will  sink.  Hence  it  follows  that,  casteris  paribus,  a 
person  with  a  large  and  capacious  chest  floats  more  easily  than  one 
whose  chest  is  small  and  contracted.  Hence,  also,  in  a  living  person 
the  body  has  a  tendency  to  rise  out  of  water  during  inspiration,  and 
to  sink  during  expiration — the  quantity  of  water  displaced  under 
these  two  opposite  conditions  of  the  respiratory  organs  being  very 
different.  The  entrance  into  water  with  the  chest  nearly  emptied  as 
the  result  of  a  loud  scream  or  shriek,  is  very  unfavorable  to  the 
buoyancy  of  the  body.  The  fact  of  clothes  being  on  the  person  may 
also  make  a  difference — either,  from  their  nature,  in  serving  to  buoy 
up  the  body,  or  from  their  weight  to  sink  it  more  deeply.  Women 
are  sometimes  saved  from  drowning  by  reason  of  their  clothes  float- 
ing, and  thus  presenting  a  large  surface  to  the  water;  it  is  partly 
owing  to  this  circumstance  that  the  bodies  of  drowned  women  often 
remain  floating  on  the  water  immediately  after  death. 

It  may  be  laid  down  as  a  general  rule,  that  the  recently  dead  body 
unclothed  is,  when  left  to  itself,  heavier  than  water,  and  sinks  when 
immersed.  The  expulsion  of  air  from  the  lungs  and  their  penetra- 
tion by  water,  combined  with  the  fact  that  the  bones  and  all  the  soft 
parts,  excepting  the  fat,  are  of  greater  specific  gravity  than  water, 
offer  a  sufficient  explanation  of  the  sinking.  After  a  variable  period, 
generally  not  more  than  a  few  da}rs,  the  body  will  rise  again  to  the 
surface,  and  float.  The  period  of  its  rising  will  depend — 1st.  on  the 
specific  gravity  of  the  body;  2dly,  on  the  nature  of  the  water, 
whether  salt  or  fresh;  3dly,  on  the  access  of  heat  and  air  in  facili- 
tating putrefaction.  If  the  gases  generated  find  an  escape,  the  body 
will  sink ;  more  gases  may  form,  and  then  it  will  again  rise,  so  that 
the  sinking  and  rising  may  become  alternate  phenomena.  A  small 
quantity  of  air  collected  in  the  abdomen,  as  a  result  of  putrefaction, 
will  suffice  for  the  floating  of  the  body.  Thus,  taking  the  specific 
gravity  of  the  dead  body  at  1.08  to  1.1,  it  would  require  but  little 
air  to  keep  it  at  or  near  the  surface  of  the  water.  But  a  dead  body, 
whether  death  has  been  caused  by  drowning  or  not,  may  not  sink  at 


MARKS    OF    VIOLENCE    OX    THE    DROWNED.  333 

all,  owing  to  some  one  of  the  counteracting  causes  above  mentioned. 
Several  cases  are  reported  in  which  the  bodies  of  persons  recently 
drowned  have  floated. 

Marks  of  \  'iolence  on  the  Drowned. — The  chief  inquiry  with  regard 
to  marks  of  violence  on  the  bodies  of  the  drowned  is  whether  they 
have  resulted  from  accident  or  design.  In  forming  an  opinion,  a 
witness  must  give  due  value  to  the  accidents  to  which  a  body  float- 
ing loosely  in  water  may  be  exposed.  Bruises  or  ecchymoses  of 
considerable  extent  are  sometimes  seen  on  the  drowned,  when  the 
bodies  have  been  carried  by  a  current  against  mechanical  obstacles 
in  a  navigable  river  or  canal.  If  the  deceased  fell  from  a  consider- 
able height  into  water,  his  body  in  falling  may  have  struck  against 
a  rock  or  projection,  and  have  produced  extensive  marks  of  violence. 
Dead  bodies  taken  out  of  wells  often  present  considerable  marks  of 
violence  of  a  vital  character  when  the  deceased  persons  have  fallen 
in  accidentally,  or  have  thrown  themselves  in  intentionally.  The 
presence  of  these  marks  must  not  create  a  hasty  suspicion  of  murder. 
It  is  manifestly  impossible  to  lay  down  any  specific  rules  for  forming 
a  decision  in  cases  of  this  kind,  since,  probably,  no  two  instances 
will  be  met  with  which  will  be  perfectly  similar  in  the  details.  In 
clearing  up  these  doubtful  points,  everything  must  depend  on  the 
tact  and  experience  of  the  practitioner  who  is  called  upon  to  conduct 
an  investigation.  The  first  question  which  he  has  to  determine  is, 
whether  the  injuries  on  the  body  were  produced  before  or  after  death. 
(See  Wounds,  ante,  p.  212.)  If  after  death  then  they  ought  to  be 
obviously  of  accidental  origin.  Accidental  violence  may  sometimes 
be  of  a  serious  nature,  so  serious  that  a  practitioner  might  well  doubt 
whether  it  did  not  indicate  that  the  deceased  had  been  violently 
treated  prior  to  submersion.  If  a  dead  body  were  taken  out  of  water, 
with  one  or  both  limbs  dislocated,  or  the  vertebras  of  the  neck  frac- 
tured, and  a  surgeon  was  asked  whether  such  injuries  could  be  acci- 
dental and  coincident  with  or  consequent  on  drowning,  the  answer 
would  probably  be  in  the  negative.  But  an  instance  has  occurred 
in  which  both  arms  were  accidentally  dislocated  at  the  shoulders  in 
the  act  of  drowning  as  the  result  of  a  fall  into  the  water  from  a 
great  height. 

The  great  point  with  regard  to  all  marks  of  violence  on  the 
drowned,  is  to  throw  light  upon  the  questions — 1st,  whether  drown- 
ing was  really  the  cause  of  death ;  and  2dly,  whether,  if  so,  the  act 
was  the  result  of  accident,  suicide,  or  homicide.  This  last  question 
does  not  concern  a  medical  witness  so  much  as  a  jury,  who  will 
determine  it  from  the  facts,  medical  and  general,  proved  before  them. 

There  is  one  case,  of  rare  occurrence,  in  which  a  practitioner 
would  be  apt  to  be  misled  by  trusting  to  appearances  found  on  the 
drowned.  If  a  dead  body  were  removed  from  water  with  a  deep 
ecchymosed  circle  round  the  neck,  evidently  produced  by  a  cord  or 
ligature,  but  no  traces  of  which  could  be  found,  it  is  not  improbable 
that  a  suspicion  would  be  at  once  raised  that  deceased  had  been 
murdered  by  strangulation,  and  the  body  afterwards  thrown  into 
water.     A  case  occurred  some  years  since  in  which  a  mark  was  pro- 


334:  FRACTURES    IX    THE    DROWNED. 

duced  on  the  neck  of  a  woman  who  was  accidentally  drowned,  as  a 
result  of  the  compression  produced  by  the  string  of  her  cloak. 
Marks,  resembling  those  of  strangulation,  have  been  produced  on 
the  necks  of  dead  bodies  floating  in  water,  where  they  have  been 
driven  by  a  strong  current  against  the  stumps  of  trees  or  other 
obstacles  in  the  stream. 

It  might  be  said,  that  in  cases  of  this  description  circumstantial 
evidence  would  commonly  show  how  the  mark  had  originated.  In 
admitting  the  truth  of  this  observation  we  must  remember  that  cir- 
cumstances, as  matters  of  proof,  do  not  always  present  themselves 
to  our  notice,  or  occur  to  our  judgment,  at  the  precise  time  that  the 
law  stands  most  in  need  of  them.  While,  then,  we  use  great  caution 
in  drawing  an  inference  when  there  are  such  strong  grounds  for 
suspicion,  we  should  not  neglect  to  examine  carefully  the  most 
trivial  appearances. 

Fractures  are  not  often  met  with  in  the  drowned  as  the  result  of 
accident.  Certain  fractures  likely  to  be  followed  by  immediate 
death  may  forbid  the  supposition  of  their  having  occurred  after 
drowning,  and  a  careful  examination  of  the  body  may  show  that 
they  were  not  likely  to  have  arisen  from  accident  at  or  about  the 
time  of  submersion. 

The  medico-legal  question  has  arisen  whether  fractures  of  the 
vertebrae  of  the  neck  can  occur  from  accident  alone,  at  or  about  the 
time  of  drowning.  In  August,  1858,  a  gentleman,  in  jumping  from 
a  bathing-machine  head-foremost  into  water  more  shallow  than  he 
had  expected,  caused  a  fracture  and  displacement  of  the  cervical 
vertebrse,  which  led  to  death.  Mr.  South  quotes  the  case  of  a  man 
who  threw  himself  into  a  river  to  bathe  from  a  height  of  seven  or 
eight  feet,  the  water  being  only  three  feet  deep.  He  rose  to  the 
surface,  but  fell  back  senseless.  When  he  recovered  his  conscious- 
ness, the  account  he  gave  of  the  accident  was,  that  he  felt  his  hands 
touch  the  bottom  of  the  river,  but  to  save  his  head  drew  it  violently 
back,  upon  which  he  lost  all  consciousness.  He  died  in  about  ten 
hours,  and  on  examination  the  skin  of  the  back  of  the  neck  was 
much  ecchymosed,  the  interspaces  of  the  muscles  were  gorged,  and 
the  spinal  canal  was  filled  with  blood.  The  body  of  the  fifth  ver- 
tebra of  the  neck  was  broken  across  about  the  middle  of  its  depth, 
and  the  two  pieces  were  completely  separated  from  the  lateral  parts. 
As  there  was  no  mark  of  contusion  or  dirt  on  the  head,  Eeveillon, 
who  reports  the  case,  believes  that  the  fracture  arose  from  muscular 
action,  and  not  from  a  blow  received  by  striking  the  bottom :  but 
this  is  doubtful.  In  another  instance  related  by  Mr.  South,  a  sailor 
jumped  headlong  into  the  sea  to  bathe,  a  sail  being  spread  three  feet 
below  the  surface.  He  immediately  became  motionless,  and  died  in 
forty-eight  hours.  The  fourth  and  fifth  vertebras  of  the  neck  were 
found  extensively  fractured,  and  the  spinal  marrow  was  crushed  and 
lacerated.  ("  Chelius's  Surgery,"  part  6,  Fractures.)  In  this  ease 
the  fracture  must  have  resulted  from  contact  with  the  water  or  the 
sail ;  but  as  the  latter  was  freely  floating,  this  would  be  a  yielding 


HOMICIDAL    AND    SUICIDAL    DROWNING.  335 

medium :  hence  this  serious  injury  may  occur  accidentally  in  cases 
in  which  we  might  not  be  prepared  to  look  for  it. 

Was  Drowning  the  Result  of  Homicide,  Suicide,  or  Accident  ? — Al- 
though the  question  whether  the  act  of  drowning  was  the  result  of 
suicide  or  murder  properly  falls  within  the  province  of  a  jury,  there 
are  certain  points  in  relation  to  it  which  require  to  be  noticed  by  a 
medical  witness.  In  the  first  place,  it  is  not  to  be  imagined  that  an 
examination  of  the  body  will  develop  any  differences  in  either  of  the 
three  supposed  kinds  of  death.  So  far  as  the  phenomena  of  drown- 
ing are  concerned,  they  are  the  same,  and  they  are  accompanied  by 
the  same  appearances  after  death  in  each  case.  In  drowning  which 
is  accidental  or  suicidal  it  is  not  usual,  as  it  has  already  been  ob- 
served, to  meet  with  marks  of  violence  on  the  person,  except  such 
as  are  purely  of  accidental  origin,  and  have  commonly  been  pro- 
duced after  death.  In  accidental  drowning  this  is  almost  a  constant 
rule;  but  if  the  person  has  fallen  from  any  height,  his  body  may  be 
injured  in  the  fall,  either  by  projections  on  the  banks  of  a  river  or 
canal,  or  by  mere  concussion  on  the  water  ;  allowance  for  either  of 
which  we  must  be  prepared  to  make,  according  to  the  situation  of  the 
spot  from  which  the  person  is  supposed  to  have  fallen. 

It  is  calculated  that  in  England  drowning  is  the  cause  of  death  in 
nearly  one-half  of  all  suicides ;  but  this  of  course  will  vary  accord- 
ing to  localities.  In  suicidal  drowning  we  have  a  difficulty  to  en- 
counter which  we  do  not  meet  with  in  that  which  is  accidental.  A 
man  may  have  attempted  suicide  by  some  other  means  previously  to 
throwing  himself  into  the  water ;  thus  then,  besides  the  accidental 
violence  of  accidental  drowning,  we  may  meet  with  violence  on  the 
person  evidently  indicating  wilful  perpetration.  What  is  the  nature 
of  this  violence  ?  Is  it  to  be  defined  ?  Can  it  always  be  distinguished 
from  that  which  is  positively  homicidal?  The  answers  to  these  ques- 
tions must  depend  on  the  circumstances  proved  in  each  case. 

Drowning  in  Shallow  Water. — Homicide  has  been  sometimes  pre- 
sumed  from  the  peculiar  circumstances  under  which  a  body  has  been 
discovered.  Thus,  for  instance,  it  has  been  a  debated  question, 
whether  a  person  intent  on  suicide  can  voluntarily  drown  himself  in 
shallow  water,  as  in  a  bath,  by  turning  upon  his  face  and  retaining 
this  position  with  his  mouth  below  the  level  of  the  water.  This 
question  has  been  long  since  settled  in  the  affirmative  by  the  occur- 
rence of  well-authenticated  cases.  It  appears  to  have  been  raised 
originally  on  the  theoretical  view,  .that  the  resolution  of  a  suicide 
would  fail  him  in  such  a  situation,  and  that,  having  the  means  of 
escape,  he  would  lose  no  time  in  extricating  himself.  It  need  hardly 
be  stated  that  the  mere  immersion  of  the  mouth  in  water  not  more 
than  a  few  inches  deep,  will  produce  all  the  phenomena  of  death  by 
drowning,  with  the  exception  that  little  or  no  water  would  probably 
be  found  in  the  stomach.  A  man  may  thus  die  in  two  or  three 
minutes.  Devergie  mentions  an  instance  which  occurred  in  May, 
1833,  where  a  man  was  found  drowned  in  a  small  stream,  his  face 
towards  the  ground,  and  his  head  just  covered  by  the  water,  which 
was  not  more  than  a  foot  in  depth.     On  dissection  there  were  all  the 


6ob  ACCIDENTAL    DROWNING. 

appearances  of  drowning  present,  and  a  large  quantity  of  sand  and 
gravel  was  found  occupying  the  windpipe  and  smaller  air-tubes.  (Op. 
cit.  vol.  2,  p.  332.)  A  case  is  mentioned  by  Dr.  Smith,  in  which  a 
woman  committed  suicide  by  breaking  a  hole  in  the  ice  of  a  pond, 
during  the  winter,  and  thrusting  her  head  into  the  water,  the  rest  of 
her  body  being  out.  A  man  was  found  dead  with  his  face  down- 
wards in  a  small  stream  of  water  only  six  inches  deep.  The  water 
was  so  shallow  that  it  did  not  cover  the  deceased's  body  or  his  head. 
There  was  clear  evidence  that  this  was  a  case  of  suicidal  drowning. 
Although  a  person  has  for  a  short  time  the  power  of  removing  from 
a  position  in  which  he  must  speedily  die,  that  power  is  soon  lost.  If 
the  mouth  is  kept  below  water  by  a  strong  voluntary  effort  for  half 
a  minute  or  longer,  the  unaerated  blood  is  circulated  through  the 
brain,  and  the  person  becomes  powerless,  so  that  his  fate  is  not  now 
in  his  own  hands.  Lunatics  and  other  persons  have  thus  destroyed 
themselves  in  shallow  baths,  although  left  unwatched  by  the  at- 
tendant for  only  four  or  five  minutes.  The  discovery  of  dead  bodies 
under  these  circumstances  is,  therefore,  quite  consistent  with  suicide, 
but  it  does  not  necessarily  prove  that  the  act  was  suicidal.  It  can- 
not be  denied  that  a  person  if  young  or  enfeebled  by  disease  or  age 
may  be  held  by  others  in  such  a  position  sufficiently  long  to  pro- 
duce death  from  drowning,  but  if  he  is  capable  of  making  resistance, 
we  ought  to  find  some  marks  of  violence  on  the  limbs  or  body.  So, 
again,  such  a  position  is  by  no  means  incompatible  with  accidental 
drowning ;  and  on  this  it  may  happen  that  a  medical  practitioner 
will  be  called  to  express  an  opinion.  A  man  in  a  state  of  deep  in- 
toxication, or  when  suddenly  attacked  by  syncope,  epilepsy,  or  apo- 
plexy, may  fall  with  his  face  in  a  gutter,  ditch,  or  small  pool  of 
water ;  he  may  die  in  this  position,  not  having  the  power  to  extri- 
cate himself.  Even  marks  of  violence  on  the  body  must  not  be  too 
hastily  construed  into  proofs  of  murder.  Not  long  since  a  case  of 
this  description  gave  rise  to  a  trial  for  murder  in  one  of  our  midland 
counties.  A  man  was  found  dead  with  his  face  in  some  melted  snow, 
and  there  were  several  severe  contusions  on  his  body.  The  evidence 
showed  that,  after  a  quarrel  he  had  left  a  neighboring  inn  much  in- 
toxicated ;  and  it  was  rendered  extremely  probable  that  he  had  per- 
ished accidentally  on  his  way  home.  There  was  no  reason  to  suppose 
that  he  had  been  murdered.  Infants,  from  mere  helplessness,  may 
be  drowned  under  similar  circumstances ;  but  at  the  same  time  an 
assassin  may  select  this  mode  of  destroying  life  in  order  to  give  the 
appearance  of  accident. 

Ligatures  on  the  Hands  and  Feet. — When  a  drowned  body  is  re- 
moved from  water  with  the  hands  or  the  hands  and  feet  bound  with 
cords,  it  is  usually  considered  that  Ave  have  therein  presumptive 
evidence  of  homicide ;  but  numerous  cases  are  recorded  in  which 
suicides  have  actually  bound  themselves  in  this  manner  or  have  at- 
tached heavy  weights  to  their  bodies,  before  throwing  themselves 
into  water,  for  the  express  purpose  of  preventing  any  chance  of  their 
escaping  death. 


HANGING.      CAUSE    OF    DEATH.  337 


HANGING. 


CHAPTEE   XXXVI. 

Causes  of  death. — death  from  the  secondary  effects. — post- 
mortem APPEARANCES. — MARK   OF  THE  CORD  OR  LIGATURE. — WAS 

DEATH  CAUSED  BY  HANGING? HANGING  AFTER  DEATH. — SUMMARY 

OF  MEDICAL  EVIDENCE. — MARKS  OF  VIOLENCE  ON  THE  HANGED. — 
WAS  THE  HANGING  THE  RESULT  OF  ACCIDENT,  SUICIDE,  OR  HOMI- 
CIDE?— THE  POSITION  OF  THE  BODY. 

Cause  of  Death.  Asphyxia. — By  hanging  we  are  to  understand 
that  kind  of  death  in  which  the  body  is  wholly  or  partially  sus- 
pended by  the  neck,  and  the  constricting  force  is  the  weight  of  the 
body  itself,  while  in  strangulation  the  constricting  force  is  due  to 
some  other  cause.  In  both  cases  death  commonly  results  from  as- 
phyxia (p.  55),  although  this  must  depend  in  a  great  measure  upon 
the  position  of  the  ligature  on  the  neck,  as  well  as  on  the  degree  of 
pressure  produced.  If  the  cord  is  loose,  or  applied  to  the  upper 
part  of  the  neck,  a  small  quantity  of  the  air  may  still  reach  the 
lungs,  and  then  the  cerebral  circulation  may  become  interrupted  by 
the  compression  of  the  great  vessels  of  the  neck.  In  this  case  apo- 
plexy of  the  congestive  kind  is  induced,  and  operates  as  the  imme- 
diate cause  of  death.  It  is  easy  to  conceive  that  there  may  be  a 
mixed  condition  of  asphyxia  and  apoplexy,  and  according  to  the  ob- 
servations of  Professors  Casper  and  Eemer  this  is  actually  met  with 
in  a  great  number  of  cases  of  death  from  hanging. 

It  has  been  observed  in  the  execution  of  criminals,  that  death 
takes  place  at  different  intervals  of  time  after  suspension.  This  dif- 
ference is  probably  dependent  on  the  greater  or  less  degree  of  con- 
striction produced  by  the  ligature.  If  the  rope  should  press  upon 
the  larynx  or  above  this  organ,  the  closure  of  the  air-passages  will 
not  be  so  complete  as  if  pressed  upon  the  windpipe  immediately 
below  the  cricoid  cartilage.  A  slight  degree  of  respiration  might  in 
the  former  case  continue  for  a  short  interval,  by  which  the  life  of  a 
person  would  be  prolonged,  while  in  the  latter,  death  would  be  im- 
mediate. If  the  windpipe  is  in  part  ossified,  the  pressure  of  the 
ligature  is  less  perfect,  and  death  will  then  take  place  more  slowly. 
Louis  found  that  an  occasional  cause  of  death  in  hanging  was  a  dis- 
placement of  the  second  vertebra  of  the  neck  whereby  the  spinal 
marrow  was  suddenly  compressed.  As  a  general  rule  this  cause  of 
death  is  only  likely  to  be  observed  in  corpulent  or  heavy  bodies, 
22 


838  HANGING.      LOSS    OF    CONSCIOUSNESS. 

when  a  long  fall  is  given  to  the  cord,  and  when  much  violence  has  been 
at  the  same  time  employed  by  the  executioner.  Fractures  of  the  ver- 
tebrae may  occur  and  prove  fatal  by  compressing  the  spinal  marrow. 
Death  may  also  be  caused  by  the  effusion  of  blood  on  the  spinal  mem- 
branes (sheath),  thereby  giving  rise  to  fatal  compression.  This  is 
likely  to  happen  when  the  head  falls  or  is  bent  suddenly  backwards, 
so  that  the  weight  of  the  body  is  supported  on  the  back  of  the  neck. 

Death  from  hanging  appears  to  take  place  very  rapidly,  and  with- 
out causing  any  suffering  to  the  person.  It  is  observed,  that  in  those 
who  are  criminally  executed  there  are  often  violent  convulsions  of 
the  limbs  and  trunk.  There  is  no  reason,  however,  to  believe  that 
the  individual  suffers  pain,  any  more  than  in  the  convulsions  of  an 
epileptic  fit.  On  recovery  there  is  an  entire  loss  of  consciousness  of 
pain  in  both  cases.  The  circulation  of  dark-colored  blood  through 
the  brain  and  spinal  cord  may  account  for  these  effects.  Efforts  to 
inspire  are  made  for  one  or  two  minutes  after  the  closure  or  com- 
pression of  the  windpipe.  The  diaphragm"  and  intercostal  muscles 
act  spasmodically,  but  no  air  enters  the  lungs ;  and  it  is  probable 
that  in  the  act  of  hanging,  part  of  the  air  contained  in  the  organs  is 
convulsively  expelled.  When  the  suspension  of  the  body  has  only 
continued  a  few  minutes,  it  has  often  been  found  impossible  to  re- 
store life ;  and  indeed  the  period  at  which  resuscitation  may  take 
place  varies  according  to  circumstances.  Supposing  the  hanging  to 
be  unattended  with  violence  to  parts  about  the  neck,  soma  persons 
might  be  resuscitated  after  five  minutes'  suspension  or  longer,  but 
then  it  has  been  observed  that  they  have  subsequently  died  from 
secondary  causes  affecting  the  brain  and  nervous  system.  Others, 
again,  may  not  be  recovered  when  they  are  cut  down  immediately 
after  suspension — a  fact  which  depends  probably  on  the  different 
degrees  to  which  asphyxia  or  apoplexy  has  extended.  When  the 
ligature  is  so  placed  as  to  press  on  the  windpipe  below  the  larynx, 
insensibility  and  death  are  almost  instantaneous. 

We  learn  from  those  who  have  been  resuscitated,  as  well  as  from 
experiments  performed  by  persons  upon  themselves,  that  the  insen- 
sibility of  asphyxia  comes  on  in  the  most  insidious  manner  in  death 
from  hanging,  and  that  a  slight  constriction  of  the  windpipe  will 
speedily  produce  loss  of  consciousness  and  muscular  power.  ("  De- 
vergie,"  2,  370.)  The  only  symptoms  of  which  the  hanged  persons 
have  been  conscious,  were  a  ringing  in  the  ears,  a  flash  of  light  be- 
fore the  eyes,  then  darkness  and  oblivion.  The  only  profitable  in- 
ference in  a  medico-legal  view,  which  can  be  drawn  from  observa- 
tions of  this  kind  is,  that  asphyxia  is  not  only  rapidly  induced,  but 
that  it  supervenes  under  circumstances  where  it  would  not  be  gene- 
rally expected  to  occur — i.  e.,  when  the  weight  of  the  body  is  in 
great  part  supported.  M.  Fleischmann  found  that  a  cord  might  be 
placed  round  his  neck  between  the  chin  and  os  hyoides,  and  tight- 
ened either  laterally  or  posteriorly  without  perceptibly  interrupting 
xespiration ;  but  while  the  respiratory  process  was  thus  carried  on, 
his  face  became  red,  his  eyes  prominent,  and  his  head  felt  hot.  These 
.symptoms  were  followed  by  a  sense  of  weight,  a  feeling  of  incipient 


EXTERNAL    APPEARANCES.  339 

stupefaction,  and  a  hissing  noise  in  the  ears.  On  the  occurrence  of 
this  last  symptom,  the  experiment,  he  says,  should  be  discontinued, 
or  the  consequences  may  be  serious !  His  first  experiment  on  him- 
self lasted  two  minutes ;  but  in  the  second,  owing  to  the  cord  by  its 
pressure  more  completely  interrupting  respiration,  the  noise  in  the 
ears  appeared  in  half  a  minute.  When  the  pressure  was  applied  on 
the  windpipe  the  effect  was  instantaneous,  but  when  on  the  cricoid 
cartilage  it  was  not  immediate.  If  it  was  applied  between  the  os 
hyoides  and  the  thyroid  cartilage,  or  on  the  os  hyoides  itself,  the 
period  during  which  a  person  could  breathe  was  extremely  short ; 
and  this  result  was  more  striking  when  the  act  of  expiration  was 
performed  at  the  moment  of  applying  the  pressure.  The  death  of 
tScott,  the  American  diver,  in  January,  1840,  shows  how  readily  as- 
phyxia may  be  induced  by  a  slight  compression  of  the  throat,  even 
when  a  person  might  be  supposed  to  have  both  the  knowledge  and 
the  power  to  save  himself.  This  man  was  in  the  habit  of  making 
public  experiments  on  hanging,  and  had  frequently  before  gone 
through  them  without  danger ;  but  on  the  last  occasion,  it  is  pro- 
bable that  a  slight  shifting  of  the  ligature  from  under  the  jawbone 
caused  so  much  compression  on  the  throat  between  the  chin  and 
larynx,  as  speedily  to  produce  asphyxia.  No  attempt  was  made 
to  save  him  until  it  was  too  late,  and  he  was  not  brought  to  a  hos- 
pital until  thirty-three  minutes  had  elapsed.  He  was  allowed  to 
hang  thirteen  minutes — the  spectators  thinking  that  the  deceased  was 
only  prolonging  the  experiment  for  their  gratification !  The  very 
insidious  and  painless  manner  in  which  a  person  who  is  suspended 
passes  from  life  into  death,  is  also  well  illustrated  in  the  report  of 
the  case  of  Homshaw,  published  by  Dr.  Chowne.  ("  Lancet,"  April 
17,  1817,  p.  404.)  This  man  was  on  three  occasions  resuscitated 
from  hanging — a  feat  which,  like  Scott,  he  had  performed  in  London 
for  public  gratification.  He  stated  that  on  the  last  occasion  he  lost 
his  senses  almost  at  once ;  it  seemed  as  if  he  could  not  get  his  breath, 
and  that  some  great  weight  was  attached  to  his  feet :  he  felt  that  he 
could  not  move  his  hands  or  legs  to  save  himself,  and  that  the  power 
of  thinking  was  gone.  It  is  not  improbable  that  many  persons  have 
thus  lost  their  lives  by  privately  attempting  these  experiments,  and 
their  cases  have  been  wrongly  set  down  to  acts  of  suicide.  There 
is  reason  to  believe  that  boys  have  thus  frequently  but  unintention- 
ally destroyed  themselves,  from  a  strange  principle  of  imitation  or 
curiosity. 

Post-mortem  Appearances. — The  external  appearances  met  with  in 
the  hanged  have  been  generally  taken  by  medico-legal  writers  from 
those  seen  in  the  bodies  of  persons  who  have  been  criminally  exe- 
cuted, or  who  have  been  violently  hanged.  Thus  among  them  are 
the  following:  Lividity  and  swelling  of  the  face,  especially  of  the 
lips,  which  appear  distorted ;  the  eyelids  are  swollen,  and  of  a  bluish 
color;  the  eyes  red,  projecting  forwards,  and  sometimes  partially 
forced  out  of  their  cavities ;  the  tongue  enlarged,  livid,  and  either 
compressed  between  the  teeth  or  sometimes  protruded :  the  lower 
jaw  is  retracted,  and  a  bloody  froth  sometimes  exists  about  the  lips 


340  INTERNAL    APPEARANCES. 

and  nostrils.  There  is  a  deep  and  ecchymosed  impression  around  the 
neck,  indicating  the  course  of  the  cord,  the  skin  being  occasionally 
excoriated ;  laceration  of  the  muscles  and  ligaments  in  the  hyoideal 
region  ;  laceration  or  contusion  of  the  larynx,  or  of  the  upper  part 
of  the  windpipe.  There  are  also,  commonly,  circumscribed  patches 
of  ecchymosis  varying  in  extent,  about  the  upper  part  of  the  body 
and  the  upper  and  lower  limbs,  with  a  deep  livid  discoloration  of 
the  hands ;  the  fingers  are  generally  much  contracted  or  firmly 
clenched,  and  the  hands  and  nails,  as  well  as  the  ears,  are  livid ;  the 
urine  and  feces  are  sometimes  involuntarily  expelled  at  the  moment 
of  death.  Such  appearances  will  rarely  be  found  in  those  cases  of 
suicidal  hanging  which  are  likely  to  come  before  a  medical  practi- 
tioner. In  these  the  face  is  generally  pale,  and  the  mark  on  the 
neck  is  a  simple  depression  in  the  skin,  usually  without  ecchymosis, 
and  acquiring  a  horny  or  parchment  color  only  after  some  time. 
Esquirol  found,  in  one  instance,  that  when  the  body  was  examined 
immediately  after  death,  the  face  was  not  livid ;  but  it  first  began  to 
assume  a  violet  hue  in  eight  or  ten  hours.  He  thought  that  when 
the  cord  was  left  round  the  neck  the  face  would  be  livid,  but  if  re- 
moved immediately  after  suspension,  pale.  This  view  is  not,  how- 
ever, borne  out  by  observation.  The  tongue  is  not  always  protruded. 
Devergie  found  that  there  was  protrusion  of  this  organ  in  eleven 
cases  out  of  twenty-seven.  This  protrusion  was  formerly  supposed 
to  depend  upon  the  position  of  the  ligature  :  thus  it  was  said,  when 
this  was  below  the  cricoid  cartilage,  the  whole  of  the  larynx  was 
drawn  upwards,  and  the  tongue  carried  forwards  with  it,  while  when 
above  the  os  hyoides  the  tongue  was  drawn  backwards.  The  protru- 
sion or  non-protrusion  of  the  tongue  does  not  depend  upon  any 
mechanical  effect  of  this  kind,  but  simply  upon  congestion ;  for  it  is 
occasionally  met  with  thus  protruding  in  cases  of  drowning  and  suffo- 
cation. Besides  the  protrusion  has  not  been  found  to  have  any  direct 
relation  to  the  position  of  the  ligature. 

There  is  another  appearance  on  which  a  remark  may  be  made — 
namely,  the  state  of  the  hands.  As  a  general  rule,  in  violent  hang- 
ing or  strangulation,  the  hands  are  clenched.  This  appearance  may 
not  always  be  found,  as  it  may  exist  and  be  destroyed  before  the 
body  undergoes  medical  inspection.  When  the  constriction  of  the 
neck  is  produced  suddenly,  and  with  great  violence,  we  may  expect 
to  meet  with  it.  Thus  it  is  found  in  the  cases  of  executed  criminals, 
and  in  strangulation  attended  with  great  violence,  whether  the  act 
be  due  to  homicide  or  suicide.  In  cases  in  which  the  constriction  is 
gradually  produced,  the  clenched  state  of  the  hands  may  not  be 
found.  Convulsions  generally  attend  violent  hanging  or  strangu- 
lation. The  influence  of  these  on  the  attitude  or  dress  may  not  be 
apparent  unless  the  body  be  sitting  or  lying. 

Internally,  we  meet  with  the  appearances  of  asphyxia — i.  e.  en- 
gorgement of  the  lungs  and  venous  system  generally  with  dark- 
colored  fluid  blood:  the  lungs  otherwise  present  no  particular 
appearances.  The  right  side  of  the  heart,  and  the  great  vessels 
connected  with  it,  are  commonly  distended  with  blood.     But  when  the 


APPEARANCES    OF    THE    NECK.  341 

inspection  has  been  delayed  for  several  days,  this  distension  may 
not  be  observed.  The  mucous  membrane  of  the  windpipe  is  more 
or  less  congested,  and  is  sometimes  covered  with  a  fine  bloody 
mucous  froth.  This  may  be  owing  to  imperfectly  obstructed  respi- 
ration, and  to  spasmodic  efforts  at  breathing.  The  vessels  of  the 
brain  are  commonly  found  congested ;  and  in  some  rare  instances  it 
is  said  extravasation  of  blood  has  been  met  with  on  the  membranes 
,  or  in  the  substance  of  the  organ!  Effusion  of  blood  is,  however,  so 
rare  that  Eemer  found  this  appearance  described  only  once  among 
one  hundred  and  one  cases ;  and  in  one  hundred  and  six  cases  re- 
corded by  Casper  it  was  not  found  in  a  single  instance.  In  one  case 
of  death  from  hanging,  Sir  B.  Brodie  found  a  large  effusion  of  blood 
in  the  substance  of  the  brain,  and  he  refers  to  another  case  in  which 
there  was  a  considerable  effusion  between  the  membranes.  ("  Lec- 
tures on  Pathology,"  p.  58.)  The  venous  congestion  of  the  cerebral 
vessels  is,  however,  rarely  greater  than  in  other  cases  of  asphyxia, 
and  is  probably  dependent  on  the  degree  in  which  the  lungs  have 
become  engorged.  In  most  instances  there  is  increased  redness  of 
the  substance  of  the  brain,  so  that,  on  making  a  section  of  the  hemi- 
spheres a  greater  number  of  bloody  points  (puncta  cruenta)  than 
usual  will  appear.  The  kidneys  have  been  found  much  congested. 
A  more  important  circumstance  has  been  noticed  by  Dr.  Yelloly — 
namely,  that  in  examining  the  stomachs  of  five  criminals  who  have 
been  hanged,  he  found  great  congestion  in  all,  while  there  was  blood 
coagulated  upon  the  mucous  membrane  in  two.  Such  an  appear- 
ance might,  it  is  obvious,  be  attributed  in  a  suspicious  case  to  the 
action  of  some  irritant  substance.  (See  "  Ann.  d'Hyg."  1830,  p. 
166 ;  1835,  p.  208  ;  1838,  p.  471.)  In  the  case  of  Good,  who  was  exe- 
cuted for  murder  some  years  since,  the  stomach  was  found  on  inspec- 
tion to  present  over  its  whole  surface  a  well-marked  redness,  resem- 
bling the  effect  produced  by  an  irritant  poison.  The  redness  was 
especially  observed  at  the  pyloric  end,  where  it  assumed  a  somewhat 
striated  character.  A  drawing  representing  the  appearance  of  the 
interior  of  the  stomach  is  preserved  in  the  Museum  collection  of 
Guy's  Hospital.  In  a  case  examined  by  Mr.  Stuart,  of  Azimghur, 
in  1854,  the  stomach  and  intestines,  especially  the  inner  coat  of  the 
former,  were  much  congested  and  inflamed,  as  if  the  man  had  died 
from  poisoning.  The  contents  of  the  stomach  were  analyzed,  but 
no  poison  was  found.  Dr.  Chevers,  who  quotes  this  case,  states  that 
he  has  more  than  once  verified  Dr.  Yelloly's  observation,  and  has 
found  the  mucous  membrane  of  the  stomach  much  congested  in 
death  from  hanging.     ("  Medical  Jurisprudence  for  India,"  p.  397.) 

The  most  striking  external  appearance,  however,  is  the  mark  pro- 
duced on  the  neck  by  the  ligature.  The  skin  is  commonly  depressed, 
and  sometimes  ecchymosed,  but  rarely  throughout  its  whole  extent : 
it  is  frequently  free  from  all  traces  of  discoloration  as  the  result  of 
ecchymosis,  the  skin  in  the  depression  being  then  hard,  brown,  or 
of  a  parchment  color  and  consistency ;  or  there  may  be  only  a  thin 
line  of  blue  or  livid  color  in  the  upper  or  lower  border  of  the 
depression,  and  chiefly  in  front.     The  course  of  the  mark  is  gene- 


342  INJURY    TO    THE    MUSCLES. 

rally  oblique,  being  lower  in  the  fore-part  than  behind,  and  it  is 
often  interrupted.  It  is  most  commonly  above  the  larynx.  If  the 
noose  should  happen  to  be  in  front  the  mark  may  be  circular,  the 
jaw  preventing  the  ligature  from  rising  upwards  in  the  same  degree 
before,  as  it  commonly  does  behind.  The  mark  is  generally  single, 
but  we  may  meet  with  it  double,  as  when  the  ligature  has  been 
formed  into  two  circles  or  loops  previously  to  its  application.  Its 
other  characters  will  depend  upon  the  nature  of  the  ligature  em-  < 
ployed.  Thus  a  large  and  wide  ligature  rarely  produces  ecchy- 
mosis — the  mark  is  wide  and  superficial ;  but  a  small  ligature  pro- 
duces a  narrow  and  deep  impression,  sometimes  accompanied  with 
laceration  of  the  cuticle  and  effusion  beneath  the  skin. 

The  ligature  or  cord  should  always  be  examined  for  blood,  hair, 
or  other  suspicious  substances. 

It  was  formerly  believed  that  the  impression  on  the  skin  produced 
by  the  cord  was  invariably  discolored  from  effusion  of  blood,  or 
ecchymosis ;  but  more  correct  observation  has  shown  that  this  con- 
dition is  an  exception  to  the  general  rule.  When  ecchymosis  does 
exist,  it  is  commonly  superficial  and  of  slight  extent.  There  is 
rarely,  if  ever,  effusion  of  blood  in  the  cellular  tissue.  In  the  bodies 
of  persons  who  have  been  criminally  executed,  it  is  not  unusual  to 
find  ecchymosis,  but  even  here  it  is  not  always  present,  or  only  in 
front  of  the  neck.  Dr.  Croker  King,  in  examining  the  neck  of  an  exe- 
cuted criminal,  did  not  discover  the  smallest  effusion  of  blood  in  the 
course  of  the  cord,  although  in  this  case  the  body  had  been  allowed 
to  fall  from  a  height  of  seven  feet  and  a  half,  with  a  fearful  jerk. 
("  Dublin  Quarterly  Journal,"  No.  35,  Aug.  185-4,  p.  86 ;  and  "  Cases 
of  Kuptured  Intestine,"  1855,  p.  12.)  The  theory  of  the  production 
of  ecchymosis  has  been  carried  so  far  that  a  livid  mark  in  the  course 
of  the  cord  was  formerly  said  to  be  the  best  criterion  for  distinguish- 
ing hanging  in  the  living  from  hanging  in  the  dead  body !  This 
statement,  however,  is  not  in  accordance  with  facts.  In  a  large 
number  of  cases  the  skin,  instead  of  being  blue  or  livid,  or  present- 
ing an  effusion  of  blood  in  the  cellular  tissue  beneath,  is  hard,  and 
of  a  yellow  color,  resembling  parchment.  It  has  that  appearance 
which  the  cutis  commonly  assumes  when  the  cuticle  has  been  re- 
moved from  it  two  or  three  days ;  and,  on  dissecting  it  off,  the  cellu- 
lar membrane  beneath  often  appears  condensed  and  of  a  silvery 
whiteness.  Dr.  Chevers  states  that  in  cases  of  death  from  hanging- 
he  has  not  met  with  any  ecchymosis  in  the  skin  along  the  course  of 
the  mark.  (Op.  cit.  p.  106.)  In  some  instances  the  mark  has  pre- 
sented itself  simply  as  a  white  depression ;  this  has  been  chiefly 
observed  in  fat  subjects.  The  observations  of  Casper  on  this  point 
are  as  follows :  out  of  seventy-one  cases  there  was  no  ecchymosis 
produced  by  the  cord  in  fifty,  and  thus  in  two-thirds  of  all  the  cases 
examined,  it  was  entirely  absent.  He  also  found  that  there  was  no 
diiVerence  in  the  appearance  whether  the  ligature  was  removed 
t  sooner  or  later  after  death. 

1  "I    Injuries  to  the  muscles  and  deep-seated  parts  of  the  neck  are,  of 
*  course,  only  likely  to  be  seen  when  considerable  violence  has  been 


INJURY    TO    THE    MUSCLES.  343 

used  in  hanging.  In  one  or  two  instances  the  lining  membrane  of 
the  common  carotid  artery  has  been  found  lacerated.  Congestion 
and  swelling  of  the  genital  organs  in  both  sexes  have  been  set  down 
among  the  common  consequences  of  hanging — but  many  observers 
have  not  met  with  these  conditions ;  and  it  is  doubtful  whether, 
unless  the  body  is  examined  speedily  after  suspension,  any  marked 
difference  would  be  discovered.  A  more  common  sign,  perhaps,  is 
the  discharge  of  the  spermatic  secretion  in  the  male,  by  a  spasmodic 
action,  at  the  moment  at  which  death  takes  place.  It  appears  to  me 
that  no  reliance  can  be  placed  upon  evidence  derivable  from  this 
appearance,  and  yet  it  has  sufficed  to  give  rise  to  a  violent  contro- 
versy among  French  medical  jurists.  ("Ann.  d'Hyg."  1839,  vol.  1, 
pp.  169,  467  ;  vol.  2,  p.  393 ;  1840,  vol.  2,  p.  314.)  Unless  death 
from  hanging  is  strongly  established  by  other  facts,  neither  the  exa- 
mination of  the  linen  of  the  deceased,  nor  the  application  of  the 
microscope  to  the  mucous  fluid  found  in  the  urethra,  would  be  of 
any  practical  value  in  elucidating  the  question — at  least  to  the  satis- 
faction of  an  English  jury. 

The  following  may  be  regarded  as  a  summary  of  the  appearances 
in  hanging,  when  death  has  really  taken  place  from  asphyxia.  The 
countenance  is  either  livid  or  pale,  the  eyes  are  prominent,  the 
tongue  congested  and  occasionally  protruded,  the  lower  jaw  re- 
tracted :  the  skin  is  covered  with  patches  of  cadaveric  lividity,  the 
hands  are  livid  and  clenched — an  oblique  mark  is  found  on  the  neck 
— sometimes  presenting  traces  of  ecchymosis :  commonly,  however, 
the  skin  is  only  brown  in  color  and  hardened.  The  larynx,  wind- 
pipe, and  subjacent  muscles  are  lacerated,  depressed,  or  discolored. 
The  vessels  of  the  brain  are  congested,  as  well  as  those  of  the  lungs 
and  the  right  cavities  of  the  heart.  A  mucous  froth  tinged  with 
blood  is  occasionally  found  in  the  windpipe.  These  appearances 
will  of  course  be  modified,  or  they  may  be  altogether  absent,  when 
death  has  arisen  from  a  disorder  of  the  cerebral  circulation,  or  from 
injury  to  the  spinal  marrow,  either  by  effusion  of  blood,  fracture,  or 
displacement. 

[Dr.  John  Packard,  of  Philadelphia,  has  kindly  furnished  me  with 
the  following  notes  of  the  post-mortem  examination  in  the  case  of 
Anton  Probst,  convicted  of  the  murder  of  the  Dearing  family,  and 
executed  June  8,  1866. 

"  The  examination  was  made  about  twenty-nine  hours  after  the 
hanging. 

"  The  face  was  mottled  purplish,  in  a  very  marked  degree,  by 
post-mortem  change.  The  under  or  posterior  portion  of  the  body 
and  extremities  was  also  mottled  by  hypostatic  congestion,  but  less 
so  than  the  face.  The  eyes  were  not  protruded,  nor  had  the  tongue 
been  bitten. 

"The  mark  of  the  cord  was  very  distinct  on  the  neck,  except  at 
a  point  a  little  below  and  in  front  of  the  left  ear,  where  the  knot  had 
been;  here  the  skin  was  unchanged.    The  mark  was  purplish  brown. 

"  On  the  right  side,  the  sterno-cleido-mastoid  muscle  was  ruptured 
nearly  through,  apparently  just  where  the  cord  had  pressed  it. 


314  WAS    DEATH    CAUSED    BY    HANGING? 

"  Both  the  greater  cornua  of  the  hyoid  bone  were  broken  through 
obliquely,  near  their  origins.  The  laryngeal  cartilages,  as  well  as 
the  great  vessels  of  the  neck,  were  intact. 

"  No  fracture  or  dislocation  of  the  cervical  vertebras  existed,  nor 
was  there  any  discoverable  lesion  of  the  spinal  cord.  (The  thorax 
and  abdomen  having  been  opened  before  the  sawing  of  the  cranium, 
the  state  of  the  brain  is  not  accurately  known.)  - 

"The  heart  and  great  vessels  were  empty;  the  lungs  quite  free  from 
congestion.     All  the  abdominal  viscera  were  healthy. 

"  No  evidences  of  priapism  or  sexual  excitement  existed. 

"  Death  seemed  to  have  been  caused  by  pressure  upon  the  great 
nerves  (the  pneumogastric  and  phrenic)  distributed  to  the  organs  of 
circulation  and  respiration." — P.] 

Was  Death  caused  by  Hanging? — When  a  person  is  found  dead 
and  his  body  is  suspended,  it  may  be  a  question  whether  death  really 
took  place  from  hanging  or  not.  In  investigating  a  case  of  this  kind, 
it  is  necessary  to  draw  a  distinction  between  the  external  and  internal 
appearances  of  the  body.  The  former  alone  can  assist  us  in  return- 
ing an  answer  to  this  question :  the  internal  appearances  of  the  body 
can  furnish  only  the  general  signs  of  asphyxia,  and  enable  us  to  say 
whether  any  latent  cause  of  death  existed  or  not. 

The  Mark  of  the  Cord. — Among  the  external  appearances  it  is 
chiefly  to  the  mark  produced  by  the  cord  on  the  neck  that  medical 
jurists  have  looked  for  the  determination  of  this  question.  As  the 
form,  position,  and  other  characteristics  of  this  mark  have  been 
already  described,  it  will  now  be  necessary  to  allude  to  it  only  as 
furnishing  evidence  of  life  at  the  time  of  its  production.  It  has  been 
stated,  that  so  far  from  being  constantly  livid  or  ecchymosed,  this 
condition  is,  in  reality,  not  seen  in  more  than  one-half  of  the  cases 
which  occur.  But  admitting  that  we  find  ecchymosis  in  the  course 
of  the  ligature,  are  we  always  to  infer  that  it  must  have  been  ap- 
plied while  the  person  was  living?  There  are  cases  which  show 
that  the  presence  of  active  life  is  not  necessary  for  the  production  of 
ecchymosis  in  the  mark  :  and  from  the  experiments  of  Devergie,  it 
would  appear  that  if  a  body  is  hanged  immediately  or  a  short  time 
after  deal/t,  an  ecchymosed  mark  may  be  produced  on  the  neck  by 
the  ligature.  (Op.  cit.  vol.  2,  p.  408.)  If  a  few  hours  were  suffered 
to  elapse,  so  that  the  body  had  become  cold  before  suspension,  no 
ecchymosis  was  produced  by  the  ligature.  Professor  Yrolik  of 
Amsterdam  found,  however,  that  a  slightly  livid  mark  was  produced 
on  the  neck  of  a  dead  body,  which  had  been  suspended  after  the 
lapse  of  an  hour  from  the  time  of  death.  (Casper  "  Woch.1'  Feb. 
1338.)  Hence  this  condition  of  the  mark  in  a  body  found  dead 
merely  indicates,  either  that  the  deceased  must  have  been  hanged 
while  living,  or  very  soon  after  the  breath  had  left  his  body.  It 
would  be  for  a  jury  to  decide  between  these  two  assumptions;  and 
to  consider  why,  when  a  man  had  really  died  from  any  other  cause, 
his  body  should  have  been  hanged  in  secrecy  immediately  after  death. 
(See  "Ann.  d'Hyg."  1842,  vol.  1,  p.  134.)  The  circumstance  that  an 
ecchymosed  mark  may  be  produced  by  suspending  a  recently  dead 


EFFECTS    OF    HANGING    AFTER    DEATH.  345 

body  bears  out  the  statement  of  Merzdorff — that  it  would  be  in  the 
highest  degree  difficult,  if  not  utterly  impossible,  to  determine  medi- 
cally, from  an  inspection,  whether  a  man  had  been  hanged  while 
living,  or  whether  he  had  been  first  suffocated,  and  his  body  sus- 
pended immediately  after  death.  In  making  this  admission  it  is 
proper  to  bear  in  mind,  that  that  which  is  difficult  to  a  conscientious 
medical  jurist  in  confining  himself  to  the  medical  facts,  is  often 
easily  decided  by  a  jury  from  these  as  well  as  the  general  evidence 
afforded  to  them. 

Sometimes,  besides  ecchymosis,  there  are  abrasions  of  the  skin  in 
the  course  of  the  cord,  and  these  are  known  to  have  been  produced 
during  life  by  the  effusion  of  blood  which  accompanies  them.  Devergie 
never  met  with  this  appearance  in  the  hanging  of  a  dead  body  even 
when  the  hanging  took  place  immediately  after  death.  The  disco- 
very of  effused  coagula  in  or  about  the  spinal  column  would  render 
it  probable  that  the  deceased  must  have  been  hanged  while  living. 
Such  marks  of  violence  are,  however,  rare  in  cases  of  hanging :  and 
when  they  are  found,  it  might  be  assumed  that  the  effusion  and 
coagulation  of  blood  had  been  caused  by  violence  offered  to  the 
neck  immediately  after  death ;  but  this  assumption  may  be  met  by 
the  question  already  suggested — namely,  why  death  by  hanging 
should  be  simulated  in  the  body  of  a  person  who  is  alleged  to  have 
died  from  another  cause ! 

With  regard  to  the  other,  or  more  common  kind  of  mark  in  sui- 
cidal hanging,  it  can  scarcely  be  said  to  furnish  any  evidence  in  re- 
lation to  the  question  which  we  are  here  considering.  The  depres- 
sion may  be  hard  and  brown,  although  it  does  not  usually  acquire 
this  color  until  some  hours  have  elapsed  after  death ;  for  it  appears 
to  depend  simply  upon  a  desiccation  or  drying  of  that  portion  of 
the  skin  which  has  been  compressed  by  the  ligature.  Sometimes 
the  upper  and  lower  borders  only  of  the  depression  present  a  faint 
line  of  redness  or  lividity ;  and  it  is  worthy  of  remark,  that  when 
the  ligature  presents  any  knots  or  irregularities,  those  portions  of 
skin  which  sustain  the  greatest  compression  are  white,  while  those 
which  are  uncompressed  are  found  more  or  less  ecchymosed.  It  is 
in  this  manner  that  the  form  of  a  ligature  is  sometimes  accurately 
brought  out.  It  may  be  remarked  of  these  depressions  produced  by 
the  cord,  that  the  characters  which  they  present  are  the  same  whether 
the  hanging  has  taken  place  during  life  or  soon  after  death  :, — the 
appearances  may  be  similar  in  the  two  cases. 

The  experiments  performed  on  dead  bodies  by  Casper  and  other 
observers,  show  that  the  ordinary  or  non-ecchymosed  mark  caused 
by  hanging  during  life  may  be  produced  by  a  ligature  applied  to  the 
neck  of  a  subject  within  two  hours  or  at  a  much  longer  period  after 
death — consequently  the  presence  of  this  mark  on  the  neck  is  no 
criterion  whether  the  hanging  took  place  during  life  or  after  death. 
The  changes  in  the  skin  beneath  the  mark  are  also  destitute  of  any 
distinctive  characters  :  there  is  the  same  condensation  of  the  cellular 
membrane  whether  the  hanging  has  occurred  in  the  living  or  dead. 


3-16  SUMMARY    OF    MEDICAL    EVIDENCE. 

These  changes  are  the  simple  result  of  a  physical  cause — mechanical 
compression. 

Summary  of  Medical  Evidence. — From  the  foregoing  considerations, 
we  draw  the  conclusion  that  there  is  no  distinctive  sign  by  which 
the  hanging  of  a  Uving  person  can  be  determined  from  an  inspection 
of  the  dead  body.  All  the  external  marks  may  be  simulated  in  a 
dead  body,  and  the  internal  appearances  furnish  no  characteristic 
evidence  whatever.  Still,  when  the  greater  number  of  the  signs 
enumerated  are  present,  and  there  is  no  other  satisfactory  cause  to 
account  for  death,  we  have  strong  reason  to  presume  that  the  de- 
ceased has  died  from  hanging.  We  must  not,  however,  abandon 
medical  evidence  on  these  occasions,  merely  because  plausible  objec- 
tions may  be  taken  to  isolated  portions  of  it.  Facts  may  show  that, 
however  valid  such  objections  may  be  in  the  abstract,  they  are 
wholly  inapplicable  in  the  concrete,  i.  e.  to  the  particular  case  under 
investigation.  Perhaps  the  greatest  medical  difficulties  occur  in 
reference  to  cases  of  suicide,  owing  to  the  slight  appearances  which 
attend  this  form  of  death  ;  but  on  these  occasions  moral  and  circum- 
stantial proofs  are  so  generally  forthcoming,  that  a  medical  inspec- 
tion of  the  body  is  scarcely  ever  deemed  necessary  by  a  coroner.  If, 
then,  it  is  admitted  by  a  medical  jurist,  that  it  is  not  in  all  cases  pos- 
sible to  distinguish  hanging  in  the  living  from  hanging  in  the  dead, 
the  admission  must  be  considered  as  having  reference  to  cases  wherein 
persons  destroy  themselves,  and  not  to  cases  in  which  they  are  de- 
stroyed by  others.  Even  if  a  doubt  were  raised  in  any  particular 
instance,  it  is  more  than  probable  that  circumstantial  evidence  would 
furnish  data  for  a  decision,  and  thus  satisfactorily  make  up  for  the 
want  of  strict  medico-legal  proofs.  If  when  we  found  a  deeply 
ecchymosed  or  livid  mark  around  the  neck  of  a  dead  subject,  we 
said,  all  other  circumstances  being  equal,  that  the  person  had  most 
probably  died  from  hanging,  we  should  not  be  departing  from  a 
proper  discharge  of  our  duty ;  since,  although  it  is  medically  possi- 
ble that  such  a  mark  may,  by  a  certain  amount  of  skill,  be  produced 
after  death,  yet  as  it  would  be  only  a  murderer  who  would  think  of 
hanging  up  a  recently  dead  body  to  simulate  suicide,  so  it  is  certain 
that  in  this  case  there  would  be  some  obvious  indications  of  another 
kind  of  violent  death  about  the  person.  The  absence  of  these,  and 
the  presence  of  ecchymosis  in  the  course  of  the  cord,  would,  it  ap- 
pears to  me,  leave  the  question  of  hanging  during  life  decidedly 
settled  in  the  affirmative.  Some  caution  should  be  used  in  express- 
ing an  opinion  that  hanging  took  place  after  death,  in  Cases  in  which 
there  is  no  ecchymosis  in  the  seat  of  the  ligature ;  because,  while 
such  a  opinion  would  be  generally  correct,  it  might  in  some  instances 
lead  to  the  concealment  of  the  real  mode  of  death.  Many  facts 
already  adduced  show  that  numerous  cases  of  hanging  during  life 
would  be  pronounced  to  be  cases  of  hanging  after  death  if  the  ab- 
sence of  ecchymosis  were  taken  as  a  criterion.  The  mere  discovery 
of  marks  of  violence  about  the  person  is  not  of  itself  sufficient  to 
rebut  the  presumption  of  death  from  hanging  on  these  occasions. 
The  violence  should  at  least  be  of  such  a  nature  as  to  account  for 


MARKS    OF    VIOLENCE    ON    THE    HANGED.  347 

the  immediate  destruction  of  life,  or  it  can  throw  no  light  upon  the 
question  whether  the  person  might  not  have  died  from  hanging,  in 
spite  of  the  marks  of  maltreatment  found  upon  the  body. 

If,  in  reference  to  a  body  found  hanging,  a  medical  jurist  should 
assert  that  death  had  not  taken  place  from  this  cause,  this  would  be 
tantamount  to  declaring  that  the  deceased  must  have  been  murdered ; 
because  it  is  difficult  to  suppose  that  any  one  but  a  murderer  would 
have  a  reasonable  motive  for  hanging  up  a  recently  dead  person. 
This  hanging  after  death  has  been  frequently  carried  out  with  the 
view  of  concealing  the  real  mode  of  death,  and  of  making  the  act 
appear  to  be  one  of  suicide. 

Marks  of  Violence  on  the  Hanged. — The  "presence  of  marks  of  vio- 
lence on  the  body  of  a  hanged  person  is  important,  and  it  will  there- 
fore be  proper  for  a  witness  to  notice  accurately  their  situation,  ex- 
tent, and  direction.  Having  satisfied  himself  that  they  must  have  been 
received  during  life,  he  will  have  to  consider  the  probability  of  their 
being  of  accidental  origin  or  not.  These  marks  of  violence  are  not 
always  to  be  regarded  as  furnishing  unequivocal  proofs  of  murder ; 
for  it  is  possible  that  they  may  have  been  produced  by  the  person 
himself  before  hanging,  and  not  succeeding  in  committing  suicide 
by  these  attempts,  he  may  subsequently  have  resolved  to  accomplish 
his  purpose  by  suspending  himself.  Let  the  witness  duly  reflect  on 
these  circumstances  before  he  allows  his  opinion  to  implicate  any 
suspected  individual ;  let  him  consider  that  a  hanged  subject  may 
bear  the  marks  of  a  gunshot  wound,  his  throat  may  be  cut,  his  per- 
son lacerated  or  disfigured,  and  yet,  before  a  suspicion  of  homicide 
is  allowed  to  be  entertained,  it  ought  to  be  clearly  shown  that  such 
injuries  could  not  by  any  probability,  have  been  self-inflicted.  The 
importance  of  observing  caution  in  such  a  case  will  be  still  more 
manifest  when  there  is  no  ecchymosis  produced  by  the  cord,  and  the 
face  does  not  present  the  usual  appearances  of  hanging. 

Marks  of  violence  on  a  hanged  subject  may  in  some  cases  be  fairly 
ascribed  to  accident.  If  the  person  has  precipitated  himself  with  any 
violence  from  a  chair  or  table  in  a  furnished  apartment,  he  may  have 
fallen  against  articles  of  furniture,  and  thus  have  caused  lacerations 
and  bruises,  especially  on  the  limbs  or  body.  The  rope  may  have 
given  way,  and  the  person,  in  falling,  have  injured  himself;  but  he 
may  afterwards  have  had  resolution  enough  to  suspend  himself 
again.  Such  an  occurrence  may  be  rare ;  but  when  the  presence  of 
these  injuries  is  made  to  form  the  chief  ground  of  accusation  against 
another  person,  their  possibly  accidental  origin  ought  not  to  be  lost 
sight  of  by  a  considerate  witness.  If  we  suppose  the  deceased  to 
have  been  hanged  in  a  state  of  intoxication  or  stupefaction,  medical 
evidence  alone  will  rarely  suffice  to  determine  the  question  of  homi- 
cide or  suicide.  The  absence  of  all  marks  of  violence  from  the  body 
might  actually  lull  suspicion.  It  is  proper  on  these  occasions  to  look 
to  the  hands  of  the  deceased,  since  it  is  with  these  that  a  person  de- 
fends himself;  and,  unless  taken  unawares,  it  is  almost  certain  if  the 
hanging  were  homicidal,  that  there  would  be  traces  of  violence  on 
these  parts.     The  clothes  would  be  torn  and  discomposed,  and  the 


348  ACCIDENTAL    AND    HOMICIDAL    HANGING. 

whole  appearance  of  the  deceased  would  be  that  of  one  who  had 
done  his  utmost  to  resist  a  violent  murderous  attack.  There  might 
be  some  injuries  which  could  not  be  attributed  to  accident  under  the 
circumstances.  Among  these  we  may  enumerate  fractures,  disloca- 
tions, deeply  penetrating  incised  and  gunshot  wounds.  Now  the 
question  is — Do  these  serious  injuries  necessarily  establish  homicidal 
hanging  ?  The  answer  must  be  in  the  negative  ;  although  when 
fractures  or  dislocations  exist,  there  are  strong  grounds  for  suspicion. 
("Ann.  d'Hyg."  1842,  vol.  1,  p.  160.) 

Suicides  frequently  make  attempts  on  their  lives  by  various  means, 
as  by  poison,  the  use  of  razors,  knives  or  pistols,  and  still  retain 
power  to  hang  themselves.*  Such  cases  as  these  are  generally  deter- 
mined by  circumstantial  evidence.  A  suicide  may  attempt  to  de- 
stroy himself  with  a  knife  or  pistol ;  he  may  fail  in  the  attempt,  and 
ultimately  hang  himself.  Any  description  of  wound,  provided  it  be 
such  as  to  allow  of  a  person  surviving  a  sufficient  time,  may  thus  be 
found  on  a  hanged  subject,  and  yet  constitute  no  proof  whatever  of 
murder.  If  there  are  circumstances  about  the  wound  or  injury 
which  show  that  it  could  not  have  been  self-inflicted,  this  of  course 
will  affect  the  conclusion ;  but  when  such  circumstances  are  not  met 
with,  a  cautious  medical  jurist  should  say,  in  answer  to  inquiries  re- 
specting the  origin  of  these  wounds,  that  they  may  have  been  inflicted 
either  by  the  deceased  himself  or  by  another.  The  medical  facts  of 
the  case  might  be  consistent  with  either  view.  In  one  instance  of 
suicidal  hanging  there  were  lacerated  wounds  upon  the  head,  and  a 
handkerchief  was  found  blocking  up  the  mouth.  Of  course  if,  in 
any  case,  the  wounds  or  injuries  are  of  a  decidedly  mortal  nature, 
and  have  probably  caused  death,  the  presumption  of  murder  is  very 
strong ;  for  who  but  a  murderer  would  suspend  the  dead  body  of  a 
person  so  wounded,  immediately  after  death  ?  ("  Ann.  d'Hvg.  1835, 
vol.  2,  p.  410.) 

Was  the  Hanging  the  Result  of  Accident,  Homicide,  or  Suicide  ? — Most 
medical  jurists  have  passed  over  the  subject  of  accidental  hanging, 
probably  believing  it  to  be  impossible.  In  the  sense  commonly  im- 
plied by  the  term  it  is  certainly  unusual,  but  although  rare,  it  is  a  pos- 
sible occurrence.  Circumstantial  evidence  will  always  suffice  for  the 
discrimination  of  accidental  hanging ;  and  we  have  therefore  merely 
to  inquire  whether,  when  the  body  of  a  person  is  found  hanging 
under  circumstances  which  do  not  allow  of  the  suspicion  of  accident, 
the  act  has  been  the  result  of  suicide  or  of  homicide.  A  medical  wit- 
ness must  remember  that  this  is  strictly  a  question  for  the  jury.  It 
is  not  for  him  to  say  whether  a  man  has  hanged  himself  or  been 
hanged  by  others,  but  merely  to  state,  when  required,  those  medical 
circumstances  which  support  or  rebut  one  or  the  other  presumption. 
The  jury,  under  the  direction  of  the  judge,  will  arrive  at  a  conclu- 
sion, from  the  whole  of  the  evidence  medical  and  non-medical. 

It  has  been  truly  observed,  that  of  all  the  forms  of  committing 
murder,  hanging  is  one  of  the  most  difficult,  and  it  is  therefore  but 
seldom  resorted  to.  In  most  cases  when  a  person  has  been  hanged 
by  others,  it  has  been  after  death,  in  order  to  avert  a  suspicion  of 


HOMICIDAL    AXD    SUICIDAL    HANGING.  349 

homicide.  Hence  the  discovery  of  a  person  hanging  affords  prima 
facie  evidence  of  suicide,  supposing  it  to  be  rendered  absolutely  cer- 
tain that  death  has  taken  place  from  this  cause.  We  must,  however, 
admit  that  a  man  may  be  murdered  by  hanging,  and  that  the  appear- 
ances about  his  body  will  not  afford  the  smallest  evidence  of  the  fact. 
The  circumstances  which  will  justify  a  medical  jurist  in  making  this 
admission  are  the  following :  First,  when  the  person  hanged  is  fee- 
ble, and  the  assailant  a  strong  healthy  man.  Thus  a  child,  a  youth, 
a  female,  or  a  person  at  any  period  of  life,  worn  out  and  exhausted 
by  disease  or  infirmity,  may  be  destroyed  by  hanging.  Secondly, 
when  the  person  hanged,  although  usually  strong  and  vigorous,  is 
at  the  time  in  a  state  of  intoxication,  stupefied  by  narcotics,  or  ex- 
hausted by  his  attempts  to  defend  himself.  Thirdly,  in  all  cases 
murder  may  be  committed  by  hanging  when  many  are  combined 
against  one  person.  With  these  exceptions,  then,  a  practitioner  will 
be  correct  in  deciding,  in  a  suspected  case,  in  favor  of  the  presump- 
tion of  suicide.  Unless  the  person  labored  under  stupefaction,  in- 
toxication, or  great  bodily  weakness,  we  must  expect  to  find  in 
homicidal  hanging,  marks  of  violence  about  the  body ;  for  there  are 
few  who  would  allow  themselves  to  be  murdered  without  offering 
some  resistance — notwithstanding  the  assertion  of  Mahon,  that  some 
might  submit  to  this  mode  of  death  with  philosophical  resignation 
when  they  saw  that  resistance  was  hopeless ! 

Some  medical  jurists  have  thought  that  the  mark  left  by  the  cord 
on  the  neck  would  serve  as  a  criterion  of  murder  on  which  we  might 
depend.  Thus  it  has  been  said,  if  the  mark  is  circular  and  situated 
at  the  lower  part  of  the  neck  it  is  an  unequivocal  proof  of  murder. 
In  hanging,  the  mark  of  the  cord  is  generally  oblique,  being  higher 
at  the  back  part  of  the  neck,  in  consequence  of  the  loop  formed  by 
it  yielding  more  in  this  direction  than  in  front.  But  it  is  an  error  to 
suppose  that  this  want  of  obliquity  in  the  impression  can  afford  any 
evidence  in  favor  of  the  act  having  been  homicidal.  Its  form  will 
depend  in  a  great  degree  upon  the  fact  of  the  body  being  supported 
or  not,  for  it  is  the  weight  of  the  body  which  causes  its  obliquity ; 
it  will  also  depend  on  the  manner  in  which  the  cord  is  adjusted.  A 
case  of  suicidal  hanging  is  related  by  Orfila,  in  which  the  mark  of 
the  cord  extended  horizontally  round  the  neck  from  behind  forwards. 
(Med.  Leg.  torn.  2,  p.  376.)  The  slip-knot  of  the  cord  was  in  front 
of  the  neck,  and  it  is  obvious  that  when  the  cord  is  thus  adjusted 
by  a  suicide,  there  will  be  scarcely  any  obliquity  in  the  depression 
produced  by  it.  Equally  ill-founded  is  the  assertion,  that  the  exist- 
ence of  two  impressions  on  the  neck  affords  positive  proof  of  homicide. 
One  of  these  impressions  may  be  at  the  lower  part  of  the  neck,  and 
circular — the  other  at  the  upper  part  and  oblique :  it  is  therefore 
contended,  that  the  deceased  must  have  been  strangled  in  the  first 
instance,  and  afterwards  hanged.  The  possibility  of  a  prior  attempt 
being  made  by  a  suicide  to  strangle  himself,  and  thus  produce  the 
mark,  is  not  adverted  to.  "  Si  Ton  observe  les  deux  impressions," 
says  Mahon,  "  l'assassinat  est  alors  parfaitement  prouve."  It  is  for- 
tunate that  there  are  facts  on  record  to  oppose  to  this  very  positive 


350  CIRCUMSTANTIAL    EVIDENCE. 

statement.  One  of  the  first  cases  reported  by  Esquirol  is  that  of  a 
female  lunatic  who  committed  suicide  by  hanging  herself,  and  on 
whose  neck  two  distinct  impressions  were  seen — the  one  circular,  the 
other  oblique  !  These  appear  to  have  arisen  from  the  cord  having 
been  passed  twice  round  the  neck,  the  body  being  at  the  same  time 
partially  supported.  In  some  instances  a  presumption  of  homicidal 
interference  may  exist  if  there  are  two  distinct  impressions,  but  it 
cannot  be  admitted  that  they  establish  the  fact  of  murder. 

The  injury  done  to  the  neck  by  the  cord  or  ligature  can  rarely 
afford  any  clue  to  the  manner  in  which  hanging  took  place,  unless 
the  circumstances  under  which  the  body  is  found,  favor  the  presump- 
tion of  homicide  or  suicide.  Thus  the  laceration  of  the  muscles  and 
vessels  of  the  neck,  the  rupture  of  the  windpipe  and  the  displace- 
ment of  the  larynx,  the  stretching  of  the  ligaments  of  the  spine,  and 
effusion  of  blood  on  the  sheath  of  the  spinal  marrow,  may  be  observed 
in  suicidal  as  in  homicidal  hanging.  The  presumption,  however,  is 
obviously  in  favor  of  the  latter,  when  these  violent  injuries  are  found 
to  be  accompanied  by  fracture  or  displacement  of  the  vertebrae  of  the 
neck,  and  the  body  of  the  deceased  is  not  corpulent,  the  ligature  by 
which  he  is  suspended  is  not  of  a  nature  to  produce  them,  and  the 
fall  of  the  body  has  not  been  great. 

A  much-disputed  question  has  arisen  in  medical  jurisprudence, 
whether  the  vertebras  of  the  neck  can  become  fractured  or  displaced 
in  suicidal  hanging.  Most  medical  jurists  deny  the  possibility  of  this 
accident  occurring — the  displacement  or  fracture  of  these  vertebras 
being  rarely  observed,  even  in  criminal  executions,  when  the  greatest 
violence  has  been  used  by  the  executioner.  So  far  as  I  am  aware, 
there  is  no  case  of  suicide  on  record  in  which  such  an  injury  to  the 
neck  has  been  found. 

Circumstantial  Evidence. — In  all  doubtful  instances  we  should  not 
lose  sight  of  moral  and  circumstantial  evidence.  We  should  ascertain 
whether  the  individual  had  been  previously  disposed  to  commit  suicide 
or  not:  we  should  observe  whether  the  doors  and  windows  of  the  apart- 
ments had  been  secured  on  the  inside  or  on  the  outside ;  whether  the 
dress  of  the  deceased  is  at  all  torn  or  discomposed,  or  his  hair  dis- 
hevelled; whether  the  attitude  of  the  body  is  such  as  to  show  inter- 
ference after  death;  whether  there  are  marks  of  blood  about  the 
body,  or  the  ligature,  or  in  the  room  ;  whether  the  hands  are  bloody, 
or  present  marks  of  wounding  or  struggling ;  whether  the  rope  or 
ligature  corresponds  to  the  impression  seen  around  the  neck;  and 
lastly,  whether  the  cord  is  of  sufficient  strength  to  support  the 
weight  of  the  deceased.  The  strongest  evidence  of  homicide  is  often 
found  in  the  attitude  and  the  state  of  the  dress  of  the  dead  bod}- :  it 
may  or  may  not  indicate  interference  or  change  after  death  irrecon- 
cilable with  the  supposition  of  death  from  suicide  or  accident.  On 
this  point  the  minutest  circumstance  may  become  of  considerable 
importance  as  medical  evidence.  "When  there  are  indications  of 
violent  struggling,  the  dress  may  be  found  disordered,  unless  it  has 
been  smoothed  or  arranged  by  the  murderer  after  the  death  of  the 
deceased.     There  may  of  course  be  no  evidence  of  disorder  or  dis- 


EVIDENCE    FROM    THE    POSITION    OF    THE    BODY.        351 

composure  of  the  dress,  in  the  case  of  a  female,  when  the  body  is 
freely  suspended.  These  points  fall,  it  is  true,  more  within  the 
province  of  the  officers  of  justice  than  of  a  medical  practitioner;  but 
the  latter  is  generally  the  first  who  is  called  to  see  the  deceased,  and 
therefore,  unless  such  facts  are  noticed  by  him  on  his  visit,  they  may 
remain  altogether  unknown.  The  medical  opinion  of  the  actual 
cause  of  death,  however,  should  be  based  only  on  medical  facts,  but 
circumstantial  evidence  has  on  various  occasions  assisted  in  clearing 
up  a  doubtful  case.  Louis  states  that  on  removing  the  body  of  a 
man  who  was  found  hanging,  the  rope  was  observed  to  be  stained 
with  blood.  This  simple  circumstance  led  to  further  investigation, 
by  which  it  was  discovered  that  the  person  had  been  murdered,  and 
his  body  afterwards  suspended.  The  presence  of  marks  on  the  neck 
indicative  of  strangulation,  such  as  the  cord  was  not  likely  to  have 
produced,  may  lead  to  a  suspicion  that  the  hanging  followed  death. 

The  Position  of  the  Body. — Lastly,  it  has  been  contended  that  the 
position  of  the  dead  body  may  serve  to  distinguish  suicidal  from 
homicidal  hanging.  This  point  was  strenuously  argued  on  the  inves- 
tigation which  took  place  relative  to  the  death  of  the  Prince  de  Conde 
in  1830.  This  case  involves  two  glaring  errors  in  reference  to  me- 
dical evidence  on  death  from  hanging :  1st,  that  a  person  cannnt  die 
from  hanging  when  the  body  is  in  any  way  supported,  and  therefore 
that  murder  must  have  been  perpetrated ;  2dly,  that  in  all  cases  of 
death  from  hanging,  the  mark  produced  on  the  neck  by  the  cord  or 
ligature  must  be  discolored  or  ecchymosed.  If  not  ecchymosed,  it 
is  assumed  that  death  must  have  taken  place  from  some  other  cause, 
and  the  body  have  been  afterwards  suspended  for  the  concealment 
of  crime.  It  is  scarcely  necessary  to  state  that  these  propositions 
are  utterly  inconsistent  with  well-known  facts.  Since  this  trial, 
many  cases  have  been  recorded  in  which  death  has  taken  place  from 
hanging  when  the  feet  were  in  contact  with  the  ground,  or  the  per- 
sons were  almost  sitting  or  recumbent :  they  may  be  regarded  as 
mixed  cases  of  hanging  and  strangulation.  The  reports  of  eleven 
cases  of  suicidal  hanging  or  strangulation  which  I  have  collected 
within  a  few  years,  give  the  following  results:  in  three  the  deceased 
were  found  nearly  recumbent ;  in  four,  in  a  kneeling  posture — the 
body  being  more  or  less  supported  by  the  legs — and  in  four  the  per- 
sons were  found  sitting.  In  one  case  the  deceased,  a  prisoner,  was 
found  hanging  to  the  iron  bar  of  the  window  of  his  prison,  which 
was  so  low  that  he  was  almost  in  a  sitting  posture. 

Eemer  found  that  among  one  hundred  and  one  cases  of  suicidal 
hanging,  in  fourteen  the  body  was  either  standing  or  kneeling,  and 
in  one  instance  it  was  in  a  sitting  posture.  Dr.  Duchesne  has  pub- 
lished an  account  of  fifty-eight  cases  in  which  the  suspension  of  the 
body  was  partial — the  feet  or  trunk  being  more  or  less  supported. 
Twenty-six  of  these  cases  are  new.  The  reporter  draws  the  conclu- 
sion that  suicide  by  hanging  is  consistent  with  any  posture  of  the 
body,  even  when  resting  upon  the  two  feet.  ("  Ann.  d'llyg.,"  Oct.  1845, 
vol.  2,  pp.  141  and  346.)  Further  evidence  need  not  be  adduced  to  show 
how  unfounded  is  that  popular  opinion  which  would  attach  the  idea 


3o2       evidence   FROM   THE   POSITION"   of   the   body. 

of  homicidal  interference  to  cases  in  which  a  body  is  loosely  sus- 
pended, or  in  which  the  feet  are  in  contact  with  any  support.  We 
ought  rather  to  consider  these  facts  as  removing  a  suspicion  of  homi- 
cide ;  for  there  are  probably  few  murderers  who  would  suspend  their 
victims,  either  living  or  dead,  without  taking  care  that  the  suspen- 
sion was  not  partial  but  complete.  Besides,  the  facts  of  many  of 
these  cases  are  readily  explicable :  thus,  if  the  ligature  is  formed  of 
yielding  materials,  or  if  it  is  only  loosely  attached,  it  will  yield  to 
the  weight  of  the  body  after  death,  and  allow  the  feet  to  touch  the 
floor,  which  they  might  not  have  done  in  the  first  instance.  If  there 
is  reason  to  believe  that  the  body  has  not  altered  its  position  after 
suspension,  we  must  remember  the  facility  with  which  insensibility 
comes  on,  and  the  rapidity  with  which  death  commonly  ensues  in 
this  form  of  asphyxia.    (See  p.  338,  also  "  Med.  Gaz."  vol.  44,  p.  85.) 

The  Limbs  Secured  in  Suicidal  Hanging. — One  or  two  points  are 
worthy  of  notice  in  relation  to  this  medico-legal  question.  The 
hands  or  legs,  but  more  commonly  the  former,  have  been  found  tied 
in  cases  of  undoubted  suicidal  hanging  ("Ann.  d'Hvo."  1832,  vol.  1, 
p.  419);  and  yet  it  has  been  gravely  debated  whether  it  was  possible 
for  a  person  to  tie  or  bind  up  his  hands,  and  afterwards  hang  him- 
self! It  is  unnecessary  to  examine  the  ingenious  arguments  which 
have  been  urged  against  the  possibility  of  an  act  of  this  kind  being 
performed,  since  they  are  refuted  by  well  ascertained  facts. 

It  has  also  been  a  debated  question,  whether  corporeal  infirmity,  or 
some  peculiarity  affecting  the  hands,  might  not  interfere  with  the 
power  of  an  individual  to  suspend  himself.  This  question  can  be 
decided  only  by  reference  to  the  special  circumstances  of  the  case. 
In  the  case  of  the  Prince  de  Conde,  it  was  alleged  that  he  could  not 
have  hanged  himself,  in  consequence  of  a  defect  in  the  power  of  one 
hand ;  it  was  said  that  he  could  not  have  made  the  knots  in  which 
the  cravats,  by  which  he  was  suspended,  were  tied.  Allegations  of 
this  kind  appear  to  have  been  too  hastily  made  in  this  and  other  in- 
stances. A  determined  purpose  will  often  make  up  for  a  great  de- 
gree of  corporeal  infirmity ;  and  unless  we  make  full  allowance  for 
this  in  suicide,  we  shall  always  be  exposed  to  error  in  drawing  our 
conclusions.  Blindness  is  no  obstacle  to  this  mode  of  perpetrating 
suicide ;  and  in  reference  to  age,  suicide  by  hanging  has  been  perpe- 
trated by  a  boy  of  nine  and  by  a  man  of  ninety-seven  years  of  age. 

[Some  very  important  observations  and  experiments  with  reference 
to  the  eyes  of  persons  executed  by  hanging,  were  made  at  the  recent 
execution  of  Anton  Probst,  by  an  eminent  oculist,  Dr.  E.  Dyer,  of 
this  city,  who  has  very  kindly  furnished  me  with  the  following  ar- 
ticle upon  the  subject : — 

"  Fracture  of  the  crystalline  lens,  as  a  result  of  death  from  violent 
hanging,  has,  I  believe,  never  been  noticed.  The  following  ease  and 
experiments  show  that  it  is  possible,  and  that  it  has  probably  been 
overlooked  in  many  cases  where  post-mortem  examinations  have 
been  made : — 


EVIDENCE    FROM    THE    POSITION    OF    THE    BODY.        353 

"Anton  Probst  was  hung  in  Philadelphia,  June  8th,  1866,  set.  24. 
Weight,  17-i^  lbs.  The  drop  was  three  feet;  length  of  cord  five 
feet.  There  were  no  convulsions.  Previous  to  the  execution  both 
eves  were  examined  carefully  with  the  ophthalmoscope,  and  were 
found  normal.  Thirty-five  minutes  after  the  drop  fell  the  eyes  were 
again  examined  with  the  ophthalmoscope  by  an  electric  light  (char- 
coal points).  In  the  right  eye  there  was  seen  a  horizontal  line  run- 
ning across  the  lens ;  it  was  not  sharp,  but  from  it  minute  lines  ran 
up  and  down,  some  longer  and  some  shorter.  It  gave  exactly  the 
appearance  of  a  crack  in  a  clear  cake  of  ice.  As  the  eyeball  was 
rolled  downwards  it  was  evident  that  there  was  a  crack  or  rupture 
in  the  crystalline  lens,  which  extended  from  the  anterior  capsule 
backwards  to  the  middle  of  the  lens.  It  had  a  remarkable  opales- 
cent or  iridescent  appearance.  The  anterior  capsule  was  ruptured. 
This  fracture  was  about  a  line  below  the  horizontal  diameter  of  the 
lens.  In  the  left  eye  the  same  appearances  were  observed,  but  in  a 
less  degree.  The  capsule  was  evidently  ruptured,  but  the  rupture  of 
the  lens  substance  did  not  extend  so  deep.  The  eyes  were  removed 
and  carefully  dissected.  All  the  observations  made  with  the  oph- 
thalmoscope were  entirely  corroborated.  The  capsule  of  the  right 
eye  was  broken  from  one  edge  of  the  lens  to  the  other,  and  the  lens 
itself  was  broken  open  to  the  centre.  The  left  capsule  was  ruptured, 
and  in  the  lens  substance  the  rupture  extended  about  a  line  back- 
wards. 

"  Three  large  dogs  were  hung  in  the  following  manner :  The  rope 
was  adjusted  around  the  neck  and  made  fast  to  a  cross-beam.  A 
man  held  the  dog  up  to  the  beam  and  let  him  fall,  following  him 
with  his  hands,  and  as  the  rope  became  taut,  the  force  was  continued 
by  the  man's  pressing  the  dog  down  with  all  his  force.  This  added 
at  least  twenty  pounds  to  the  weight  of  the  dog.  All  the  dogs 
weighed  over  thirty  pounds.  Dog  No.  1  died  without  struggles. 
Both  lenses  were  fractured.  Dog  No.  2  died  hard,  and  with  convul- 
sions, which  lasted  8-10  minutes.  No  lesion  of  either  lens  was  ob- 
served. Dog  No.  3  died  with  a  few  spasms.  The  right  lens  was 
fractured ;  the  left  was  intact. 

"  It  will  be  observed  that  one  man  and  three  dogs  were  hung — 
four  subjects  in  all.  In  three  out  of  the  four  fracture  of  the  lens 
was  found.  In  two  of  the  four,  in  both  eyes,  and  in  one  in  a  single 
eye  only.  The  fracture  was  most  marked  on  the  side  opposite  the 
knot.  Of  the  eight  eyes  in  these  four  subjects,  five  showed  a  frac- 
ture of  the  capsule  of  the  lens  and  the  lens  substance  itself  in  a 
greater  or  less  degree.  For  a  more  detailed  account  of  these  cases 
see  '  New  York  Medical  Journal,'  vol.  iii.,  and  '  Transactions  of  the 
American  Ophthalmulogical  Society,'  third  year." — P.] 


23 


354:  CAUSE    OF     DEATH 


STRANGULATION. 


CHAPTER    XXX  Y  IT. 

Cause  of  death. — appearances  after  death. — was  death 
caused  by  strangulation,  or  mas  the  constriction  applied 
to  the  neck  after  death? — marks  of  violence. — accidental, 
homicidal,  and  suicidal  strangulation. 

Strangulation. —  Cause  of  Death. — Hanging  and  strangulation  are 
usually  treated  together,  and  some  medical  jurists  have  admitted  no, 
distinction  in  the  meaning  of  these  terms.  In  hanging  the  pheno- 
mena of  asphyxia  takes  place  in  consequence  of  the  suspension  of 
the  body,  while  in  strangulation  asphyxia  may  be  induced  not  only 
by  the  constriction  produced  by  a  ligature  round  the  neck  indepen- 
dently of  suspension,  but  by  the  simple  application  of  pressure, 
through  the  fingers  or  otherwise,  on  the  windpipe.  M.  Tardieu 
considers  that  the  two  modes  of  death  should  be  kept  distinct.  The 
external  and  internal  appearances  in  some  respects  differ ;  and  while 
the  proof  of  death  from  hanging  leads  to  the  strongest  presumption 
of  suicide,  the  proof  of  death  from  strangulation  is  equally  presump- 
tive of  murder.  (Sur  la  Strangulation,  "Ann.  d'Hyg."  1859,  vol.  1, 
p.  107.)  This  medical  jurist  defines  "strangulation  to  be  an  act  of 
violence,  in  which  constriction  is  applied  directly  to  the  neck,  either 
around  it  or  in  the  fore-part,  so  as  to  prevent  the  passage  of  air,  and 
thereby  suddenly  suspending  respiration  and  life."  This  definition 
obviously  includes  hanging,  and  every  person  who  is  hanged  may 
be  said  to  be  strangled;  but  while  there  is  only  one  method  of  pro- 
ducing death  by  hanging,  there  are  various  methods  of  producing 
death  from  strangulation.  A  person  may  be  strangled  by  the  use  of 
a  cord,  band,  or  ligature  drawn  tight  round  the  neck,  or  by  manual 
violence  to  the  front  of  the  neck,  whereby  respiration  is  prevented. 
The  cause  of  death  is  asphyxia  or  apnoea.  The  rapidity  with  which 
it  takes  place  will  depend  on  the  degree  and  situation  of  the  pressure, 
and  the  completeness  with  which  the  act  of  breathing  is  obstructed. 

M.  Faure  applied  a  ligature  forcibly  and  suddenly  to  the  neck  of 
a  middle-sized  dog.  For  fifty-five  seconds  the  animal  did  not  appear 
to  suffer;  but  he  suddenly  became  violently  agitated,  his  body  stif- 
fened, and  he  rolled  convulsively  on  the  ground.  A  bloody  froth 
issued  from  his  nostrils  and  throat,  and  lie  made  frequent  and  violent 
efforts  to  respire.  In  three  minutes  and  a  half  he  was  dead.  In  a 
second  experiment  an  elastic  tube  was  introduced  into  the  windpipe, 


IN    STRANGULATION.      APPEARANCES.  355 

which  admitted  of  being  gradually  closed  by  pressure.  The  animal 
could  bear  the  pressure  up  to  the  reduction  of  one-half  of  the  calibre 
of  the  tube  ;  but  beyond  this  he  suffered  greatly,  and  when  the  pres- 
sure was  increased  he  had  convulsions.  The  dog  died,  in  great 
suffering,  before  the  tube  was  completely  closed.  ("Ann.  d'Hyg." 
1859,  vol.  1,  p.  122.)  It  is  probable  that  human  beings  die  more 
quickly  than  animals,  especially  from  the  effects  of  manual  strangu- 
lation. A  sudden  and  violent  compression  of  the  windpipe  renders 
a  person  powerless  to  call  for  assistance  and  give  alarm,  and  it 
causes  almost  immediate  insensibility  and  death,  without  convul- 
sions. When  a  ligature  or  bandage  is  used  the  pressure  is  not  so 
complete,  and  death  takes  place  more  slowly  with  convulsive  move- 
ments. The  circulation  of  dark-colored  blood  continues  for  a  short 
interval  (about  four  minutes),  as  in  other  cases  of  asphyxia.  Owing 
to  this  the  face  and  lips,  in  accidental  strangulation,  have  been  ob- 
served to  acquire  a  dark  leaden  hue.  This  arises  partly  from  the 
arrest  of  the  current  of  venous  blood  as  the  result  of  compression  of 
the  vessels,  and  partly  from  the  circulation  of  uuaerated  blood. 
There  is  a  fair  chance  of  recovery  if  the  cause  of  constriction  is  re- 
moved, and  air  is  permitted  to  have  access  to  the  lungs  within  a 
period  of  five  minutes :  this  is  on  the  assumption  that  no  great  me- 
chanical injury  has  been  done  to  the  neck. 

In  the  act  of  strangulation  a  much  greater  degree  of  violence  is 
commonly  employed  than  is  necessary  to  cause  death  ;  and  hence 
tli.'  marks  produced  on  the  skin  of  the  neck  will  be,  generally  speak- 
ing, much  more  evident  than  in  hanging,  where  the  mere  weight  of 
the  body  is  the  medium  by  which  the  windpipe  is  compressed. 

Post-mortem  Appearances. — The  appearances  after  death  are  simi- 
lar to  those  of  hanging,  but  the  injury  done  to  the  parts  about  the 
neck  is  commonly  greater.  Externally. — If  much  force  has  been 
used  in  producing  the  constriction,  the  windpipe,  with  the  muscles 
and  vessels  in  the  fore-part  of  the  neck,  may  be  found  cut  or  lacer- 
ated, and  the  vertebrse  of  the  neck  may  be  fractured.  The  face  is 
commonly  livid  and  swollen,  the  eyes  wide  open,  prominent,  and 
congested,  and  the  pupils  are  dilated.  The  tongue  is  swollen,  dark- 
colored,  and  protruded;  it  is  sometimes  bitten  by  the  teeth,  and  a 
bloody  froth  escapes  from  the  mouth  and  nostrils.  The  principal 
external  signs  of  strangulation  are  seen  in  the  marks  on  the  neck 
produced  either  by  a  cord  or  manual  pressure.  M.  Tardieu  has 
described  another  appearance  which  might  be  overlooked.  This 
consists  in  the  presence  of  numerous  small  spots  of  ecchymosis  upon 
the  skin  of  the  face,  neck,  and  chest,  as  well  as  in  the  conjunctivas 
or  membranes  of  the  eyes.  These  parts  present  a  dotted  redness, 
which  has,  however,  been  met  with  in  other  cases  besides  death  from 
strangulation.     ("Ann.  d'Hyg."  1859,  vol.  1,  p.  125.) 

The  mark  on  the  neck  when  a  ligature  has  been  used  is  commonly 
described  as  a  depression,  wide  but  not  deep,  and  corresponding  in 
its  characters  to  the  form  and  thickness  of  the  ligature  and  the  mode 
in  which  it  has  been  secured.  Too  much  importance  must  not  be 
attached  to  this  supposed  correspondence  when  the  ligature  is  not 


356         MARK  PRODUCED  BY  THE  LIGATURE. 

forthcoming.  In  a  case  of  accidental  strangulation  which  I  saw  in 
November,  1864,  the  mark  round  the  neck  presented  the  appearance 
which  might  be  expected  from  the  use  of  a  narrow  cord.  But,  in 
this  instance,  a  soft  silk  neckerchief  was  the  means  of  constriction, 
and  the  peculiar  narrowness  of  the  mark  on  one  side,  was  owing  to 
the  great  tightness  with  which  it  had  been  drawn.  The  mark  or 
impression  produced  by  a  ligature  is  generally  circular,  from  the 
mode  in  which  the  pressure  is  produced.  It  may  be  situated  at  any 
part  of  the  neck,  but  it  is  more  commonly  below  the  windpipe.  In 
manual  strangulation  the  marks  of  bruising  and  ecchymosis  will  be 
in  the  front  of  the  neck,  chiefly  about  the  larynx  and  below  it. 
The  circular  direction  of  the  mark  produced  by  the  ligature  is  not 
an  absolute  indication  that  strangulation  has  taken  place  without 
suspension  of  the  body,  since  cases  of  hanging  have  occurred  in 
which  a  circular  mark  has  been  observed;  and  it  is  possible  that 
some  degree  of  obliquity  may  occasionally  exist  in  the  course  of 
the  depression  produced  by  a  ligature  in  strangulation.  A  medical 
jurist  ought,  therefore,  to  weigh  all  the  facts  connected  with  the 
position  of  the  body,  and  the  nature  and  direction  of  the  ligature, 
before  he  forms  an  opinion,  from  the  appearances  presented  by  the 
mark  on  the  neck,  whether  the  person  has  been  hanged  or  not. 
Greater  importance  is  to  be  attached  to  the  lividity,  ecchymosis.  and 
abrasion  of  the  skin  in  the  course  of  the  ligature,  than  to  the  circu- 
larity or  obliquity  of  the  depression  produced  by  it.  In  the  stran- 
gling of  a  living  person  by  a  cord,  it  is  scarcely  possible  that  a  mur- 
derer can  avoid  producing  on  the  neck  marks  of  severe  injury,  and 
in  the  existence  of  these  we  have  evidence  of  the  violent  mauner  in 
which  death  has  taken  place.  On  the  other  hand,  a  person  may  be 
strangled,  and  yet  the  ligature,  in  consequence  of  its  being  soft  and 
of  a  yielding  nature,  will  not  cause  a  perceptible  depression  or 
ecchymosis — scarcely  anything  more  than  a  slight  depression  of 
the  skin.  If  we  except  cases  of  suicide,  such  a  condition  must  be 
rave  ;  because  assailants  usually  produce  a  much  more  violent  con- 
striction of  the  neck  than  is  necessary  to  insure  the  death  of  a  per- 
son. The  general  lividity  of  the  bocby,  contraction  of  the  fingers, 
with  clenching  of  the  hands  and  swelling  and  protrusion  of  the 
tongue,  are  more  marked  in  strangulation  than  in  hanging.  A  thin 
mucous  froth  tinged  Avith  blood  is  occasionally  found  in  the  air- 
passages  in  both  cases.  In  some  instances  of  strangulation,  it  is 
said,  blood  has  escaped  from  one  or  both  ears  during  the  act ;  but  it 
is  not  a  usual  appearance.  In  two  well-marked  cases,  in  which  I 
was  consulted,  the  constriction  of  the  neck  was  carried  to  a  great 
degree,  but  there  was  no  bleeding  from  the  ears.  Dr.  Geoghegan 
has  informed  me  that  in  one  instance  of  suicidal  strangulation  which 
he  examined,  the  constriction  had  been  produced  by  a  ribbon,  and 
the  violence  applied  was  sufficient  to  produce  bleeding  from  one  ear: 
on  dissection  this  was  found  to  have  resulted  from  a  rupture  of  the 
membrane  of  the  drum  of  the  ear.  There  was  no  froth  at  the  mouth 
or  nostrils,  and  scarcely  any  lividitv  or  swelling  of  the  face.  It  was 
further  observed  that  the  mark  on  the  neck,  which  was  deep,  almost 


STRANGULATION.      INTERNAL    APPEARANCES.  357 

disappeared  on  the  removal  of  the  ligature.  Sir  W.  Wilde,  of  Dub- 
lin, met  with  a  case  in  which  rupture  of  the  membrane  of  the  drum 
of  the  ear,  with  effusion  of  blood,  was  caused  by  strangulation. 
Bleeding  from  the  ears,  as  a  result  of  rupture  of  the  membrane  of 
the  drum,  must,  however,  be  regarded  as  an  exceptional  appearance. 
Dr.  Chevers  does  not  mention  it  as  having  been  noticed  in  any  one 
of  the  numerous  cases  which  he  has  collected  in  his  Indian  experi- 
ence, although  bleeding  from  the  nostrils  had  been  observed.  ("  Med. 
Jur.  for  India,"  1856,  p.  374.)  Without  rupture  of  the  membrane 
of  the  drum,  blood  could  not  issue  from  the  ears,  and  in  order  that 
this  membrane  should  be  ruptured,  certain  conditions  not  commonly 
met  with  may  be  required. 

Internally. — In  a  case  which  occurred  to  Dr.  Fuller,  the  body  of  a 
woman  who  had  been  homicidally  strangled,  presented  the  following 
appearances.  The  skin  of  the  head,  face,  neck,  and  chest  was  darker 
than  natural,  and  discolored  underneath,  particularly  that  of  the 
scalp.  The  brain  was  suffused  with  dark  blood,  the  lungs  gorged 
and  of  a  dark  color,  the  bowels  of  a  dusky- red  color.  The  eyes  were 
somewhat  protruded  and  blood-shot,  the  lips  swollen  and  darker  than 
natural,  the  tongue  slightly  protruding  between  the  teeth,  and  froth 
issuing  from  the  nostrils.  There  was  a  mark  of  pressure  behind  the 
right  ear,  and  other  marks  on  the  neck  and  chest,  with  discoloration 
of  the  muscles.  (Chevers's  "  Medical  Jurisprudence  for  India,"  p. 
378;  see  also  p.  387.)  In  a  case  of  suicidal  strangulation  which  oc- 
curred at  Liverpool,  in  1863,  the  body  of  the  deceased  was  found — 
dead,  cold,  and  rigid — about  seven  hours  after  he  had  been  seen 
alive.  The  arms  were  fixed,  and  the  hands  raised  a  little  above  the 
breast.  Bound  the  neck,  just  below  the  cricoid  cartilage,  was  a  strip 
of  the  deceased's  shirt,  which  had  been  used  as  a  ligature  ;  it  was 
tied  at  the  back  of  the  neck.  There  was  slight  ecchymosis  in  the 
mark  beneath.  The  skin  of  the  face  had  a  dark  red-color,  and  was 
dotted  with  spots  of  a  deeper  red.  The  conjunctivas  were  ecchy- 
mosed,  and  some  blood  had  escaped  from  the  nose.  The  brain  was 
congested,  and  much  fluid  effused.  The  heart  was  empty  ;  the  lungs 
were  deep  in  color  (congested.)  ("Lancet,"  Aug.  15,  1863,  p.  183.) 
Many  of  the  cases  of  strangulation  which  have  presented  themselves, 
have  been  too  superficially  examined.  The  most  complete  account 
of  the  appearances  is  that  given  by  M.  Tardieu.  It  is  based  on  ob- 
servations made  in  twenty-eight  inspections.  ("  Ann.  d'Hyg."  1859, 
vol.  1,  p.  132.)  The  lining  membrane  of  the  larynx  and  windpipe 
was  more  or  less  reddened  from  congestion ;  sometimes  it  was  livid 
or  of  a  dark-red  color.  There  was  a  bloody  frofrh  extending  into 
the  air-tubes.  The  state  of  the  lungs  was  variable.  Contrary  to 
what  is  generally  alleged  to  be  characteristic  of  death  by  asphyxia, 
M.  Tardieu  found  these  organs  to  contain  but  little  blood.  Some- 
times they  were  congested,  at  other  times  normal.  There  were 
ruptures  of  the  superficial  air-cells,  producing  patches  of  emphysema, 
which  were  seen  singly  or  in  groups.  This  condition,  which  was 
rarely  absent,  gave  to  the  surface  of  the  lungs  the  appearance  of 
being  covered  with  white  layers  of  thin  false  membrane.     When 


353  STATE    OF    THE    HEART    AND    LUNGS. 

sse  patches  were  punctured,  air  escaped.  There  was  an  absence 
of  that  condition  of  the  lungs  which  lie  observed  in  death  from  sim- 
ple suffocation,  namely,  dotted  ecchymosis  on  the  surface,  imme- 
diately below  the  investing  membrane  (the  pleura.)  Throughout 
the  substance  of  the  lungs,  effusions  of  blood  varying  in  size  were, 
however,  generally  found,  provided  an  early  inspection  of  the  body 
was  made.  When  some  days  had  elapsed  the  lungs  were  found  pale 
or  congested,  without  any  ecchymosed  or  mottled  appearance.  The 
ruptured  air-cells  with  air  beneath  them,  were  still  visible  on  the 
surface. 

The  heart  presents  no  uniform  condition ;  it  is  sometimes  quite 
empty,  and  at  others,  it  contains  dark  fluid  blood.  The  brain  is  oc- 
casionally congested,  but  more  commonly  in  its  natural  state.  In 
one  instance  blood  was  found  effused  on  the  brain,  but  this  is  an  un- 
usual appearance.  It  has  also  been  stated  that  a  congested  state  of 
the  sexual  organs,  both  in  males  and  females,  was  one  of  the  appear- 
ances connected  with  strangulation,  but  this  has  not  been  confirmed 
by  careful  observers.  M.  Tardieu  met  with  nothing  to  call  for  notice 
in  this  respect  in  the  numerous  cases  which  he  examined.  The  in- 
voluntary discharge  of  feces,  urine,  and  seminal  fluid,  described  as 
one  of  the  characters  of  death  by  hanging,  may  equally  occur  in 
death  from  strangulation.  No  importance  can  be  attached  to  this  as 
a  sign  of  death  from  asphyxia  in  any  form.  It  frequently  occurs  in 
sudden  and  violent  death  from  any  cause,  and  there  are  many  in- 
stances of  death  from  asphyxia  in  which  it  is  not  observed.  Among 
the  occasional  appearances  of  violent  strangulation  may  be  mentioned 
injury  to  the  windpipe  and  the  muscles  of  the  neck  around  it.  One 
case  in  which  the  rings  of  the  windpipe  were  split  as  a  result  of 
pressure,  was  communicated  to  me  by  Dr.  Inman,  of  Liverpool. 
Several  instances  of  laceration  and  rupture  of  the  windpipe  are 
quoted  by  Dr.  Chevers.  (Op.  cit.  pp.  381,  884.)  In  one  instance  the 
ossified  thyroid  cartilage  had  been  broken  and  forced  inwards,  causing 
suffocation.  In  Reg.  v.  O'Brien  (Liverpool  Winter  Assizes,  1857,)  a 
case  of  alleged  murder  by  strangulation,  the  cartilage  of  the  wind- 
pipe was  broken ;  and  in  the  case  of  Pinckhard  the  windpipe  was 
broken  longitudinally.  In  reference  to  fractures  of  the  larynx,  see 
Casper,  "  Klinische  Novellen,"  1863,  p.  497.  In  suspected  homici- 
dal strangulation  it  is  always  proper  to  examine  the  contents  of  the 
stomach  for  narcotic  poison.  In  all  cases,  the  cord  or  ligature,  if 
forthcoming,  should  be  carefully  examined,  in  order  to  determine 
whether  it  bears  upon  it  marks  of  blood,  or  whether  hair  or  other 
substances  are  adhering  to  it.  A  portion  of  it  should  be  reserved 
for  the  purposes  of  identity.  In  two  instances  of  homicidal  strangu- 
lation, the  ligatures  found  round  the  dead  bodies  were  proved  to 
correspond  with  portions  of  the  same  material  found  in  the  possessii  m 
of  the  persons  who  were  charged  with  the  murders.  In  removing 
the  ligature  from  the  neck,  the  precise  mode  in  which  it  is  tied  or 
secured  should  be  noticed,  as  this  may  be  a  fact  of  importance  in 
reference  to  the  allegation  of  suicide. 

The  medico-legal  questions  relative  to  strangulation  are  of  the 


MEDICAL    PROOFS    OF    DEATH    FROM    STRANGULATION.      359 

same  nature  as  those  which  have  been  already  considered  in  treating 
of  hanging.  Thus,  in  examining  the  body  of  a  person  suspected  to 
have  been  strangled,  we  may  be  required  to  answer  the  following 
question : — 

Was  death  caused  by  strangulation,  or  was  the  constricting  force 
applied  to  the  neck  after  death?  Medical  jurists  have  hitherto  con- 
sidered that  the  internal  appearances  throw  no  light  upon  this  ques- 
tion. This  opinion  probably  arose  from  the  fact  that  inspections 
have  not  been  made  until  some  days  after  death,  when  the  peculiar 
appearances  of  strangulation  have  been  merged  in  those  of  putre- 
faction. The  state  of  the  lungs,  however,  may  be  considered  as 
characteristic.  It  would  be  impossible,  by  the  application  of  a  liga- 
ture round  the  neck  of  a  dead  body  to  produce  rupture  of  the  air- 
cells  on  the  surface  of  the  luno;s,  and  effusions  of  blood  in  their 
substance.  The  state  of  the  eyes  and  of  the  inside  of  the  larynx 
and  windpipe  in  persons  who  have  been  strangled  could  not  be  imi- 
tated by  any  constriction  of  the  neck  after  death :  no  bloody  mucous 
froth  would  be  found  in  the  wind-pipe  or  air-tubes.  The  external 
appearances  have  been  considered  to  furnish  more  accurate  means  of 
distinction.  Although  the  condition  of  the  neck  generally  yields 
the  strongest  evidence,  it  will  be  proper  to  seek  for  that  appearance 
of  dotted  redness  or  ecchymosis  in  the  skin  of  the  face,  neck,  and 
chest,  described  by  Tardieu.  The  state  of  the  eyes,  as  to  their  pro- 
minence and  the  congestion  of  the  membranes,  as  well  as  the  posi- 
tion of  the  tongue,  should  also  be  examined.  The  ecchymosis  about 
the  depression  on  the  neck,  when  a  ligature  has  been  employed,  with 
the  accompanying  swelling  and  lividity  of  the  face,  are  phenomena 
not  likely  to  be  simulated  in  a  dead  body  by  the  application  of  any 
degree  of  violence.  When  the  constriction  is  produced  within  a  few 
minutes  after  death,  an  ecchymosed  depression  may  result;  but  it  is 
improbable  that  there  should  be  any  lividity  or  swelling  of  the 
countenance.  Prof.  Casper  found  that  when  the  constricting  force 
was  not  applied  to  the  neck  until  six  hours  after  death,  the  mark 
indicative  of  vital  strangulation  could  not  be  produced.  It  is  doubt- 
ful whether  it  could  be  produced  in  the  dead  body  an  hour  after 
death.  The  period  cannot  be  determined  with  positive  certainty : 
the  results  would  probably  vary,  according  to  the  rapidity  with 
which  the  body  had  cooled. 

It  is  difficult  to  conceive  under  what  circumstances  an  attempt  to 
simulate  strangulation  in  a  recently  dead  body  could  be  made,  unless 
for  the  purpose  of  throwing  suspicion  upon  an  innocent  person  con- 
nected with  the  deceased.  When  an  individual  has  been  murdered, 
it  is  not  likely  that  the  murderer  would  attempt  to  produce  the 
appearances  of  strangulation  on  a  body  after  death,  under  the  idea 
of  concealing  his  crime;  for  strangulation  is  in  most  cases  an  actual 
result  of  homicide,  and  is  rarely  seen  as  an  act  of  suicide.  In  the 
absence  of  ecchymosis  from  the  neck  if  will  be  difficult  to  form  an 
opinion,  unless  from  circumstantial  evidence;  but  there  may  not  be 
an  ecchymosed  circle  ;  for  ;i  person  may  be  strangled  by  the  appli- 
cation of  pressure  to  the  windpipe  through  the  medium  of  the  linger- 


360  MEDICAL    PROOFS    OF 

nails,  or  of  any  hard  or  resisting  substance.  The  ecchymosis  in  such 
a  case  will  be  in  detached  spots  or  patches.  In  the  absence  of  all 
marks  of  violence  round  the  neck,  we  should  be  cautious  in  giving 
an  opinion  which  may  affect  the  life  of  an  accused  party;  for  it  is 
not  probable  that  homicidal  strangulation  could  be  accomplished 
without  the  production  of  some  appearances  of  violence  on  the  skin 
over  the  larynx  or  windpipe.  It  is  doubtful  whether  strangulation 
can  ever  take  place  without  some  mark  being  found  on  the  neck 
indicative  of  the  means  used.  The  bare  possibility  of  death  being 
caused  in  this  manner,  without  leaving  any  appreciable  trace  of  vio- 
lence, must  be  admitted ;  although  the  admission  scarcely  applies  to 
those  cases  which  require  medico-legal  investigation.  Suicides  and 
murderers  generally  employ  much  more  violence  than  is  necessary 
for  the  purpose  of  destruction— hence  detection  is  easy.  But  if  a 
soft  and  elastic  band  were  applied  to  the  neck  with  a  gradually  regu- 
lated force,  it  is  possible  that  a  person  might  die  strangled,  with- 
out any  external  sign  being  discovered  to  indicate  the  manner  of 
his  death.  Indian  surgeons  inform  us  that  the  Thugs,  and  other 
robbers  met  with  in  India,  are  thus  accustomed  to  destroy  their 
victims  with  the  dexterity  of  practised  murderers.  A  case  involving 
this  question  of  strangulation  without  marks  of  violence  on  the 
neck,  was  tried  in  France,  and  from  the  medical  evidence  decided  in 
the  affirmative.  ("  Gaz.  Med."  9  Mai,  1846,  p.  375.)  The  medical 
witness  should,  however,  be  prepared  to  consider  whether,  in  the 
absence  of  any  mark,  death  might  not  have  proceeded  from  another 
cause,  and  leave  it  to  the  authorities  of  the  law  to  decide,  from  cir- 
cumstances, in  favor  of  or  against  the  prisoner.  There  is,  I  conceive, 
nothing  to  justify  a  medical  witness  in  stating  that  death  has  pro- 
ceeded from  strangulation,  if  there  should  be  no  appearance  of 
lividity,  ecchymosis,  or  other  violence  about  the  neck  or  face  of  the 
deceased.  Congestion  in  the  organs  of  generation  is  an  appearance 
which  it  would  not  be  safe  to  take  as  evidence  of  death  from  stran- 
gulation. The  state  of  the  countenance  alone  will  scarcely  warrant 
the  expression  of  an  opinion ;  for  there  are  many  kinds  of  death  in 
which  the  features  may  become  livid  and  distorted  from  causes  totally 
unconnected  with  the  application  of  external  violence  to  the  throat, 
unless  accompanied  by  other  well-marked  signs  of  this  mode  of 
death.  So,  again,  the  eyes  and  tongue  may  be  protruded  as  a  result 
of  putrefactive  changes.  Let  not  a  witness,  then,  lend  himself  as 
an  instrument  for  the  condemnation  of  a  person  against  whom 
nothing  but  a  strong  suspicion  from  circumstances  may  be  raised, 
and  where  medical  evidence  is  unable  to  furnish  any  distinct  and 
conclusive  proofs  of  death  from  strangulation.  This  caution  is 
especially  necessary  in  reference  to  the  inspection  of  bodies  which 
are  in  a  state  of  putrefaction.  A  medical  man,  already  provided 
with  a  theory  of  the  cause  of  death  by  the  discovery  of  a  rope  or 
other  means  of  constriction,  may  easily  arrive  at  the  conclusion  that 
death  has  taken  place  from  strangulation.  The  absence  of  the  usual 
confirmatory  appearances  in  the  body  may  be  ascribed  to  decom- 
position, and  those  caused  by  decomposition  maybe  sot  down  to 


DEATH    FROM    STRANGULATION.  361 

strangulation.  When  there  is  obvious  mechanical  violence  to  the 
neck,  such  as  fracture  of  the  larynx  or  windpipe,  with  laceration  of 
the  muscles  beneath — a  visible  depression,  such  as  a  cord,  a  ligature, 
or  manual  pressure  would  produce,  a  medical  opinion  may  be  fairlv 
given  in  spite  of  putrefaction.  But  when,  in  a  putrefied  body, 
indistinct  marks  on  the  neck,  or  patches  of  discoloration,  are  relied 
upon  as  evidence  of  homicide,  there  is  great  risk  of  a  serious  medi- 
cal mistake. 

In  cases  of  alleged  drowning,  it  is  sometimes  the  practice  to  ask 
a  medical  witness  how  far  his  opinion  of  the  cause  of  death  has  been 
influenced  by  the  discovery  of  the  dead  body  in  or  near  water.  In 
cases  of  alleged  strangulation  a  similar  question  may  be  put  in 
reference  to  the  discovery  of  a  rope  or  ligature  round  the  neck  of 
the  deceased,  or  in  the  apartment  in  which  the  dead  body  is  found. 
A  medical  opinion  should  rest  upon  the  clear  and  obvious  effects 
produced  on  the  neck,  and  on  the  structures  below  the  skin,  and  not 
upon  the  mere  presence  of  a  cord  or  ligature.  This  might  be  put 
round  the  neck  of  a  dead  body,  or  near  to  it,  for  a  malicious  pur- 
pose. The  act  of  strangulation  should  be,  medically  speaking,  as 
distinctly  provable  without  the  production  of  a  rope,  as  the  act  of 
stabbing  without  the  production  of  the  knife  which  inflicted  the 
stab.  If  these  principles  are  not  strictly  adhered  to  in  practice, 
policemen  would  be  as  competent  as  medical  experts  to  give  evidence 
of  the  cause  of  death  in  cases  of  alleged  strangulation. 

It  is  scarcely  necessary  to  state  that  all  marks  of  violence  on  the 
body  of  a  supposed  strangled  person  should  be  accurately  noted,  as 
the  questions  respecting  them,  however  slight  the  marks  may  be, 
are  material.  The  witness  will  be  expected  to  state  whether  they 
were  inflicted  before  or  after  death :  if  before,  whether  they  were 
sufficient  to  account  for  death,  or  whether  they  were  such  as  to  be 
explicable  on  the  supposition  of  an  accidental,  suicidal,  or  homicidal 
origin.  It  should  be  observed  whether  there  exist  any  morbid 
changes,  sufficient  to  account  for  death,  in  either  of  the  three  great 
cavities  of  the  body,  as  this  kind  of  evidence  may  be  essential  in 
the  progress  of  the  case.  In  reference  to  females,  whether  children 
or  adults,  the  surgeon  should  not  neglect  to  examine  the  sexual 
organs — to  ascertain  whether  there  are  any  marks  of  violation. 
Cases  have  occurred  in  which  rape  has  been  perpetrated,  and  strangu- 
lation resorted  to  for  the  purpose  of  concealing  the  crime. 

Strangulation,  like  hanging,  is  occasionally  the  result  of  accident, 
but  the  occurrence  may  be  looked  upon  as  rare.  When  the  body  is 
not  suspended,  it  is  commonly  more  in  the  power  of  a  person  to 
assist  himself,  and  escape  from  the  constriction:  hence  cases  of  acci- 
dental strangulation  are  less  frequent  than  those  of  accidental  hang- 
ing. As  a  general  rule,  cases  in  which  the  constriction  of  the  neck 
has  been  produced  by  some  accident,  present  no  difficulty  to  a  medi- 
cal jurist,  provided  the  relations  of  the  body  to  surrounding  objects 
and  the  compressing  force  have  not  been  disturbed.  Should  it  hap- 
pen, however,  that  the  body  has  been  removed  from  the  place  in 


362  SUICIDAL    STRANGULATION. 

which  it  was  first  discovered,  or  the  ligature  taken  from  the  neck, 
we  can  only  establish  a  presumption  of  accident  from  the  descrip- 
tion given. 

When  a  charge  of  murder  is  instituted  against  a  person,  an  at- 
tempt is  not  unfrequently  made  by  counsel  for  the  defence,  to  show 
the  probability  that  the  deceased  might  have  fallen  while  in  a  state 
of  intoxication,  and  have  become  accidentally  strangled,  either  by  a 
tight  cravat  or  by  some  foreign  substance  exerting  pressure  on  the 
windpipe.  If  we  admit  the  possibility  of  an  occurrence  of  this 
nature,  we  must  not  lose  sight  of  the  existence  of  other  more  pro- 
bable modes  of  death,  nor  should  we  allow  our  judgment  to  be  so 
swayed  as  to  abandon  what  is  probable  for  that  which  is  merely 
possible. 

Suicidal  Strangulation. — This  mode  of  suicide  is  of  rare  occur- 
rence, and  except  under  particular  circumstances,  impossible.  The 
possibility  of  an  individual  strangling  himself  was  for  a  long  time 
denied  by  medical  jurists ;  for  it  was  presumed  that  when  the  force 
was  applied  by  the  hand,  all  power  would  be  lost  as  soon  as  the 
compression  of  the  windpipe  commenced.  This  reasoning,  which  is 
physiologically  correct,  is,  however,  only  applicable  to  those  cases 
in  which  the  windpipe  is  voluntarily  compressed  by  the  fingers. 
"When  a  person  determined  on  suicide  allows  the  windpipe  to  be 
compressed,  by  leaning  with  the  whole  weight  of  his  body  on  a  cord 
passed  round  his  neck  and  attached  to  a  fixed  point,  he  may  perish 
in  this  manner  almost  as  readily  as  if  he  had  hanged  himself;  for 
insensibility  and  death  will  soon  supervene.  In  the  chapter  on 
Hanging,  it  was  stated  that  suicides  were  often  found  with  their 
bodies  in  close  contact  with  the  ground ;  and  cases  are  reported  in 
which  strangulation  was  accomplished,  in  the  manner  above  de- 
scribed, while  the  suicide  was  in  a  sitting  or  kneeling  posture  (p. 
851).  On  other  occasions,  the  peculiar  disposition  or  nature  of  the 
ligature  has  enabled  a  person  bent  on  suicide  to  strangle  himself 
without  much  difficulty.  An  instance  is  related  by  Orfila,  in  which 
two  cravats,  that  were  twisted  several  times  round  the  neck  of  the 
deceased,  who  was  discovered  lying  on  his  bed,  had  effectually  served 
the  purpose  of  self-destruction.  ("Med.  Leg."  vol.  2,  p.  389.)  Some- 
times strangulation  has  been  suicidally  effected  by  a  rough  cord 
passed  repeatedly  round  the  neck,  and  tightened  by  being  pulled 
with  each  hand.  The  number  of  coils  would  still  cause  some  pres- 
sure to  be  exerted  even  when  the  grasp  was  relaxed  by  death.  i^See 
"Guy's  Hospital  Reports,"  Oct.  1851.)  Other  cases  are  related,  in 
which  suicides  have  succeeded  in  strangling  themselves  by  tighten- 
ing the  ligature  with  a  stick  (see  "Guy's  Hospital  Reports,"  Oct. 
1851) ;  or  when  the  ligature  was  formed  of  thick  and  rough  material, 
by  simply  tying  it  in  a  knot. 

Although  suicidal  strangulation  may  be  effected  under  unexpected 
circumstances,  yet  in  a  case  of  murder  by  strangulation,  it  would  not 
be  easy  to  simulate  suicide:  it  would  at  any  rate  require  great  3 
and  premeditated  contrivance  on  the  part  of  a  murderer,  so  to  dispose 
thj  body  of  his  victim,  or  to  place  it  in  such  a  relation  to  surround- 


HOMICIDAL    STRANGULATION.  303 

ing  objects,  as  to  render  a  suspicion  of  suicide  even  probable.  Thus, 
if  the  cord  or  ligature  should  be  found  loose  or  detached — if  the 
ecchymosis  or  mark  in  the  neck  should  not  accurately  correspond 
to  the  points  of  greatest  pressure — if,  moreover,  the  means  of  com- 
pression were  not  evident  when  the  body  was  first  discovered  and 
before  it  had  been  removed  from  its  situation,  there  would  be  fair 
grounds  for  presuming  that  the  act  was  homicidal.  In  those  cases 
in  which  strangulation  has  resulted  from  a  compression  of  the  wind- 
pipe by  the  fingers,  and  where  there  are  fixed  ecchymosed  marks 
indicative  of  direct  manual  violence,  we  have  the  strongest  presump- 
tive evidence  of  murder ;  for  neither  accident  nor  suicide  could  be 
urged  as  affording  a  satisfactory  explanation  of  their  presence. 

Homicidal  Strangulation. — Strangulation  occasionally  comes  before 
our  courts  as  a  question  of  murder ;  and  when  a  person  has  been 
tried  upon  a  charge  of  this  kind,  the  circumstances  have  been  com- 
monly so  clear,  as  to  render  the  duty  of  a  medical  Avitness  one  of  a 
simple  nature.  "When  the  cause  of  death  is  contested,  or  when  it  is 
contended  in  defence  that  the  strangulation  is  suicidal,  a  medical 
witness  must  be  prepared  to  give  his  reasons  for  affirming  that  the 
act  was  not  done  by  the  deceased  himself.  He  must  be  prepared  to 
meet  and  explain  the  differences  between  the  case  under  investiga- 
tion, and  those  reported  cases  which  are  admitted  to  have  been  sui- 
cidal. The  attitude  of  the  body,  the  condition  of  the  dress,  the 
means  of  strangulation,  the  presence  of  marks  of  violence  or  of  blood 
on  the  person  of  the  deceased — on  his  clothes  or  the  furniture  of  the 
room— or  on  the  rope  or  ligature,  are  circumstances  from  which,  if 
observed  at  the  time,  important  medical  inferences  may  be  drawn. 
As  a  rule,  whosoever  attempts  to  imitate  suicide  under  such  a  form 
of  murder  must,  when  the  facts  are  properly  investigated,  inevitably 
fail  in  his  object.  The  assassin  either  does  too  little,  or  he  does  too 
much.  In  one  case  of  murder  by  strangulation,  the  woman  who  per- 
petrated the  crime  had  been  a  nurse  in  an  infirmary,  and  accustomed 
to  lay  out  dead  bodies.  After  the  act  of  murder  she  appears  to  have 
carried  out  unthinkingly,  her  professional  practice,  by  smoothing 
the  clothes  under  the  body,  placing  the  legs  at  full  length,  the  arms 
out  straight  by  the  side,  and  the  hands  open  and  laid  out !  Such  a 
condition  of  the  body  was  quite  inexplicable  on  the  supposition  of 
suicide,  considering  the  amount  of  violence  which  must  have  at- 
tended the  strangulation.  In  another  case,  the  criminal  had  attempted 
to  make  the  death  appear  like  an  act  of  suicide  by  placing  the  lower 
end  of  the  rope  near  the  hand  of  the  deceased :  but  he  selected  the 
left  hand  when  the.  deceased  was  right-handed,  and  he  did  not  leave 
enough  rope  free  from  the  neck  for  either  hand  to  grasp  in  order  to 
produce  the  very  violent  constriction  of  the  neck  which  had  been 
caused  by  the  two  inner  coils.  Both  of  these  criminals  confessed 
their  crimes  before  execution. 

It  is  proper  to  notice,  in  this  place,  the  frequent  occurrence  within 
;i  recenl  period  of  what  are  called  "  Garotte  robberies?'  The  system 
of  murder  normally  pursued  by  the  Thugs  in  Fndia  appears  to  have 
been  imported  into  England,  and  many  lives  have  been  destroyed 


364:  MARKS    OF    VIOLENCE    OX    THE    BODY. 

in  the  manufacturing  districts  and  in  large  towns,  by  the  employment 
of  strangulation  for  the   purposes   of  robbery.     In  spite  of  many 
convictions,  there  is  reason  to  believe  that  many  criminals  still  set 
the  law  at  defiance.     The  rigorous  proof  required  of  facts  which 
under  these  assaults  can  rarely  admit  of  proof,  confers  complete  im- 
punity on  the  assailants.     The  attack  is  made  during  darkness :  the 
person  is  seized  by  the  windpipe  from  behind,  or  a  bandage  is  thrown 
around  his  neck ;  and  this  is  suddenly  tightened  while  accomplices 
are  engaged  in  perpetrating  robbery.     The  nature  of  the  assault  by 
pressure  on  the  windpipe,  renders  it  impossible  to  give  an  alarm  or 
call  for  assistance.     The  person  assaulted,  if  he  should  recover,  is 
seldom  able  to  identify  an  assailant :  he  is  attacked  from  behind,  is 
rendered  immediately  senseless  and  powerless,  and  can  rarely  offer 
resistance.     Recovery  or  death  in  such  cases  depends  on  the  lapse  of 
a  few  seconds,  more  or  less,  during  which  the  constriction  of  the  neck 
is  continued — on  the  degree  of  constriction,  and  on  the  age,  sex,  and 
strength  of  constitution  of  the  person  assaulted.     An  attempt  at 
strangulation,  as  in  garotting,  besides  inflicting  serious  local  injury 
to  the  windpipe  and  other  parts  near  to  it,  may  cause  a  state  of  in- 
sensibility which  may  continue  for  some  hours.     There  is  severe 
pain  in  the  throat,  with  difficulty  of  speaking  and  swallowing,  and 
if  the   larynx   be   seriously  injured   there  may  be   loss  of  voice. 
Dumbness,  however,  is  not  one  of  the  secondary  symptoms :  and  loss 
of  voice  is  usually  only  temporary  during  the  pressure.     By  the  21th 
and  25th  Victoria,  c.  100,  s.  14,  it  is  enacted,  inter  alia,  that  "who- 
soever shall  attempt  to  drown,  suffocate,  or  strangle  any  person  with 
intent  to  commit  murder,  shall,  whether  any  bodily  injury  be  effected 
or  not,  be  guilty  of  felony;  and  being  convicted  thereof  shall  be 
liable,  at  the  discretion  of  the  court,  to  be  kept  in  penal  servitude 
for  life,  or  for  any  term  not  less  than  three  years,  ...  or  to  be  im- 
prisoned for  any  term  not  exceeding  two  years."     As  the  intent  in 
these  cases  is  to  perpetrate  robbery,  and  not  murder,  another  section 
(21)  has  been  framed,  for  the  prevention  of  the  crime  of  garotting: 
"Whosoever  shall  by  any  means  whatsoever,  attempt  to  choke,  suf- 
focate, or  strangle  any  other  person,  or  shall,  by  any  means  calculated 
to  choke,  suffocate,  or  strangle,  attempt  to  render  any  other  person 
insensible,  unconscious,  or  incapable  of  resistance,  with  intent,  in  any 
of  such  cases,  to  enable  himself,  or  any  other  person,  to  commit,  or 
with  intent  in  any  of  such  cases  thereby  to  assist  any  other  person  in 
committing  any  indictable  offence,  shall  be   guilty  of  felony;  and. 
being  convicted  thereof  shall  be  liable,  at  the  discretion  of  the  court, 
to  be  kept  in  penal  servitude  for  life,  or  for  any  term  not  less  than 
three  years,  ...  or  to  be  imprisoned  for  any  term  not  exceeding  two 
years,"  &c. 

J  forks  of  Violence. — It  may  be  inquired  whether  marks  of  violence 
on  the  body,  or  blood-stains  on  the  clothes,  furniture,  or  in  the  apart- 
ment, do  not  afford  strong  evidence  of  homicidal  strangulation.  The 
answer  is — if  the  marks  of  violence  are  such  that  they  could  not 
possibly  have  arisen  from  any  accident  before  death,  or  that  they 
could  not  possibly  have  been  self-inflicted,  they  afford  the  strongest 


EVIDENCE    FKOM    MARKS    OF    VIOLENCE.  365 

evidence  of  murder.  But  the  cases  wherein  so  positive  an  answer 
can  be  returned  are  exceptions  to  the  rule.  It  is  not  always  in  our 
power  to  distinguish  accidental  or  self-inflicted  from  homicidal  vio- 
lence ;  an.d  we  are  always  bound  to  look  to  the  probability  of  acci- 
dent, or  of  previous  attempts  at  suicide,  being  the  source  of  those 
personal  injuries  which  may  be  apparent  on  a  strangled  body.  There 
may  be  several  marks  on  the  neck,  but  then  the  person  may  have 
tried  to  strangle  himself  more  than  once.  The  throat  may  be  cut ; 
there  may  be  a  deep-seated  stab  or  gunshot  wound,  involving  some 
of  the  important  organs  of  the  body ;  or  poison  may  be  found  in  the 
stomach  ;  but  in  a  purely  medical  point  of  view,  how  are  we  to  know 
that  the  deceased  did  not  actually  make  the  marks,  inflict  the  wounds, 
or  take  the  poison  before  he  succeeded  in  strangling  himself?  In 
the  chapters  ou  Drowning  and  Hanging,  we  have  seen  what  suicides 
can  do  when  they  are  desperately  bent  on  destroying  themselves. 
Wounds  and  personal  injuries  often  create  serious  difficulties  to  a 
medical  jurist,  which  it  requires  the  greatest  caution  and  prudence 
on  his  part  to  meet  and  explain.  The  prejudice  of  the  public  mind 
is  such,  that  the  discovery  of  a  strangled  person,  with  any  marks  of 
personal  injury  or  of  poisoning  in  his  stomach,  would,  inmost  cases, 
lead  to  a  charge  of  murder,  unless  the  facts  rendered  it  clearly  im- 
possible that  any  attempt  could  have  been  made  on  his  life.  It  is 
against  this  prejudice  that  a  medical  witness  must  strenuously  guard 
himself;  he  may  be  abused  for  not  joining  in  the  outcry  of  the  vul- 
gar, but  the  best  recompense  for  this  abuse  will  be  the  conviction 
that  he  is  interposing  the  shield  of  science  to  protect  a  possibly  in- 
nocent fellow-creature  from  the  senseless  denunciations  of  ignorance. 
Further,  before  a  charge  of  murder  by  strangulation  is  raised  against 
any  person  from  marks  or  appearances  found  on  a  dead  body,  care 
should  be  taken  that  they  admit  of  no  other  probable  explanation 
than  the  direct  application  of  violence.  Even  if  marks  indicative 
of  strangulation  are  discovered,  the  question  arises  whether  they 
may  not  have  been  produced  by  the  deceased  upon  himself  in  an 
attempt  at  suicide  which  may  have  failed.  If  the  body  of  a  person 
is  allowed  to  cool,  with  a  handkerchief,  band,  or  tightly-fitting  col- 
lar round  the  neck,  a  mark  resembling  that  of  strangulation  will  be 
produced.  Before  any  opinion  is  given  that  murder  has  been  per- 
petrated or  attempted,  the  medical  proofs  on  which  reliance  is  placed, 
should  be  clear,  distinct,  conclusive,  and  satisfactory. 

In  the  dead  bodies  of  infants  and  children,  in  whom  the  neck  is 
short,  a  mark  is  occasionally  seen  which  arises  from  the  bending  of 
the  head;  and  in  short-necked  persons  a  similar  mark  or  depression 
has  been  noticed  after  death,  in  front  of  the  neck.  These  marks  are 
then  rendered  more  prominently  by  their  assuming  a  livid  appear- 
ance. They  might,  at  first,  be  mistaken  for  marks  produced  by  a 
ligature  in  an  attempted  strangulation.  In  one  case  a  death  from 
apoplexy  was  attributed  to  homicidal  strangulation  from  a  cadaveric 
change  of  this  kind.  (Ann.  d'Hyg."  1859,  vol.  1,  p.  139,  and  vol.  26, 
p.  149.)  This  matter  was  set  right  by  the  late  M.  Ollivier.  Homi- 
cidal strangulation  may  be  perpetrated  on  the  weak  and  infirm  with 


366  CIRCUMSTANTIAL    EVIDENCE. 

out  causing  any  noise  or  creating  alarm.  In  the  first  place,  if  the 
throat  is  at  once  seized  and  firmly  compressed  no  cry  can  be  made,  nor 
any  noise  produced  to  excite  the  attention  of  those  who  are  near. 
In  June,  1857,  an  aged  woman  was  strangled  in  her  shop  by  an  ap- 
prentice in  so  short  a  time  and  with  such  facility,  that  her  husband, 
who  was  only  separated  from  her  by  a  slight  partition,  heard  no  noise 
or  disturbance  during  this  act  of  murder.  ("  Ann.  d'Hyg."  1859, 
vol.  1,  p.  157.) 

It  cannot  be  disputed  that  in  contested  questions  of  suicidal  or 
homicidal  strangulation,  rare  as  they  are,  we  must  be  often  greatly 
indebted  to  evidence  founded  on  circumstances,  as  well  as  to  moral 
presumptions.  How  far  a  medical  jurist  may  be  allowed  to  make 
use  of  these  in  the  formation  of  an  opinion,  it  will  be  for  the  court 
to  determine.  Generally  speaking,  his  duty  is  rigorously  confined 
to  the  furnishing  of  medical  evidence  from  medical  data  alone;  but 
instances  present  themselves  in  which  this  rule  must  be  departed 
from,  or  the  course  of  justice  will  be  impeded.  Besides,  there  are 
numerous  circumstances  of  a  collateral  nature  which  may  materially 
modify  a  medical  opinion.  Thus  the  sight  of  a  ligature,  the  state  of 
the  dress,  and  the  attitude  of  the  deceased  when  discovered,  although 
not  strictly  medical  circumstances,  bear  directly  upon  medical  opin- 
ions; and  that  evidence  ought  not  to  be  objected  to  which  is  partly 
founded  upon  facts  of  this  nature.  It  must  occur  to  all,  that  without 
circumstantial  evidence,  the  best  medical  opinion  in  these  cases  will 
often  amount  to  nothing.  It  may  be,  for  example,  no  more  than 
this:  the  case  is  either  one  of  homicide  or  suicide;  and  whj^  is  such 
an  indefinite  answer  to  be  returned?  Because,  in  the  abstract  view 
of  strangulation,  it  is  not  easy  to  determine  whether  a  ligature  was 
suicidally  applied  round  the  neck  or  not.  The  appearances  may  be 
in  many  cases  the  same,  and  where  they  are  different,  this  difference 
may  be  due  to  accident,  so  that  it  is  a  mistake  to  suppose  that  we 
must  look  to  medical  circumstances  alone  for  clearing  up  this  intri- 
cate question.  On  some  occasions  the  theory  of  homicide  or  suicide 
will  be  equally  consistent  with  the  facts. 

In  all  cases  of  fatal  strangulation  resulting  from  an  act  of  suicide, 
the  means  by  which  strangulation  was  produced  must  be  found  upon 
the  neck.  The  condition  of  the  mark  on  the  neck,  the  course  and 
direction  of  the  cord,  the  mode  in  which  it  was  secured  or  fixed  in 
order  to  produce  effective  pressure  on  the  windpipe,  the  amount  of 
injury  to  the  muscles  and  parts  beneath,  are  circumstances  from 
which,  if  observed  at  the  time,  a  correct  medical  opinion  may  gen- 
erally be  formed.  If  the  means  of  constriction  are  removed,  or  the 
cord  or  ligature  is  loosely  applied,  these  facts,  unless  explained,  are 
presumptive  of  homicidal  interference. 

There  is  another  condition  in  which  a  presumption  of  homicide 
will  be  justifiable.  A  man,  in  strangling  himself,  is  not  likely  to 
vary  the  means.  The  act  is  commonly  due  to  a  sudden  impulse,  if 
we  may  judge  from  the  moral  proofs  afforded  in  the  instances  on 
record.  The  article  which  is  nearest  to  the  suicide  is  seized,  and 
made  the  instrument  of  self-destruction.     It  has  already  been  stated 


IMPUTED    STRANGULATION.  367 

as  doubtful  whether  a  person  could  strangle  himself  by  the  mere 
application  of  the  finger  to  the  windpipe:  the  discovery  of  such 
marks  only  as  would  indicate  this  kind  of  strangulation,  therefore, 
renders  suicide  in  the  highest  degree  improbable.  But  these  marks 
may  be  sometimes  ascribed  to  the  deceased  having  fallen  with  his 
hand  possibly  applied  to  his  neck,  and  the  inference  will  be  drawn 
that  they  have  accidentally  resulted  from  the  pressure  of  his  own 
fingers.  This  is  an  improbable  mode  of  accounting  for  the  produc- 
tion of  ecchymosis  or  excoriation  of  the  skin  in  the  front  of  the 
neck.  If,  besides  these  marks  of  fingers,  we  find  a  circular  mark, 
with  a  ligature  still  around  the  neck,  the  presumption  of  murder 
becomes  very  strong.  It  may  be  said  that  a  person  might  at  first 
try  to  strangle  himself  with  his  fingers,  and,  not  succeeding,  might 
afterwards  employ  a  cord.  But  the  degree  to  which  the  coincidental 
impressions  exist  will  assuredly  in  general  remove  this  objection. 

Imputed  Strangulation. — Hitherto  the  subject  of  strangulation  has 
been  considered  in  reference  to  the  dead.  But  a  living  person  may 
charge  another  with  attempting  murder  under  such  circumstances, 
and  here  a  medical  jurist  will  have  the  not  very  arduous  duty  of 
detecting  and  exposing  the  imposture.  It  has  been  considered  so 
improbable  that  any  one  would  seriously  attempt  to  strangle  himself, 
and  then  impute  the  act  to  another,  that  medical  jurists  have  given 
but  little  attention  to  this  subject.  A  case  which  has  been  recently 
tried  in  France  (Affaire  Armand  et  Maurice  Rov:r,  March,  1864)  has 
shown  the  great  importance  of  it,  and  how  easily  medical  men  and 
the  public  may  be  deceived  by  a  plausible  story.  As  in  reference 
to  imputed  wounds,  so  in  these  cases  impostors  rarely  produce  such 
injury  to  themselves  as  to  place  their  lives  in  jeopardy.  The  cord 
is  loose  round  the  neck,  or  there  would  be  speedy  death;  it  is  not 
so  secured  as  to  press  with  great  force  on  the  air-passages,  to  cause 
the  tongue  to  protrude,  or  to  produce  lividity  of  the  face  and  neck, 
or  ecchymosis  in  the  conjunctivas  and  the  skin.  It  is  either  a  liga- 
ture or  a  rope  which  is  used  by  the  impostor:  he  does  not  commonly 
resort  to  manual  violence  to  his  throat.  The  marked  feature  of  a 
really  homicidal  attempt  is  in  the  great  amount  of  violence  done  to 
the  neck;  and  the  account  given  by  the  impostor  will  be  inconsist- 
ent in  its  details,  and  not  reconcilable  with  the  ordinary  effects  of 
homicidal  strangulation.  Tardieu  met  with  a  case,  in  which  a  }roung 
woman  of  good  social  position,  wishing  to  excite  some  public  sym- 
pathy, alleged  that  she  had  been  made  the  victim  of  a  political  con- 
spiracy. One  evening  she  was  found  at  the  door  of  her  room, 
apparently  in  a  very  alarming  state:  she  could  not  speak,  but  indi- 
cated, partly  by  gestures  and  partly  by  writing,  that  as  she  was 
entering  her  room  a  man  had  attempted  to  strangle  her  by  pressing 
his  hand  upon  her  neck,  and  at  the  same  time  had  stabbed  her  in 
the  chest  with  a  dagger.  On  close  examination  it  was  found  that 
the  two  stabs  had  penetrated  only  to  the  outer  clothing.  But  I  lie 
nio-t  singular  effect  of  the  alleged  attempt  at  strangulation  was  that, 
instead  of  producing  a  difficulty  of  speaking  and  alteration  of  the 
voice,  it  had  been  followed  by  complete  dumbness!     M.  Tardieu, 


3G8  IMPUTED    STRANGULATION". 

who  was  officially  authorized  to  examine  the  case,  could  find  on  the 
neck  no  trace  of  any  attempt  at  strangulation ;  and  on  assuring  the 
young  lady  that  the  loss  of  voice  under  such  circumstances  could 
not  last  for  more  than  a  minute,  she  at  once  admitted  that  there  was 
no  foundation  for  the  charge !  (>l  Ann.  dTIyg.,"  1859,  vol.  1,  p.  163.) 
On  this  occasion  no  person  was  accused :  but  the  case  is  different 
when,  for  the  purpose  of  extortion  or  other  base  motives,  one  or 
more  persons  are  charged  with  an  attempt  at  murder.  A  flagrant 
instance  of  this  kind  occurred  in  France,  in  which  a  wealthy  mer- 
chant of  Montpellier  was  charged  by  his  servant,  Maurice  Roux, 
with  having  attempted  to  murder  him  by  strangulation.  The  case 
was  tried  in  March,  1861,  before  the  Court  of  Assizes  of  the  Bouches 
du  Rhone ;  and,  fortunately  for  the  interests  of  justice  as  well  as  for 
the  credit  of  medico-legal  science  in  France,  it  ended  in  a  complete 
acquittal  of  the  accused.  (Affaire  Armand  et  Maurice  Roux,  Paris, 
1864.  "  Relation  Medico-legale  de  l'Affaire  Armand,"  &c,  par  A. 
Tardieu.  "  Annales  d  Hygiene  et  de  Mt'decine  Legale,"  1861,  vol. 
1,  p.  415.) 

It  may  be  observed  in  reference  to  these  imputed  cases,  that  men 
who  deliberately  strangle  others  either  draw  a  cord  tightly  or  se- 
cure it  by  a  knot.  The  pressure  to  the  neck  is  not  so  gentle  as  to 
leave  no  mark  whatever,  or  to  allow  the  strangled  person  to  breathe 
and  watch  all  that  goes  on  around  him.  Slight  marks  of  violence 
about  the  neck  should  be  viewed  with  great  suspicion  on  these  occa- 
sions. As  a  rule,  a  man  does  not  half-strangle  any  more  than  he 
half-stabs  or  half-poisons  another ;  but  the  impostor  stops  short  of 
this  stage,  as  he  has  no  intention  to  destroy  himself.  If,  as  is  most 
improbable  in  attempted  homicide,  the  cord  is  left  only  loosely  coiled 
around  the  neck,  the  person  assaulted  necessarily  retains  the  power 
of  breathing  and  calling  for  assistance;  but  if  the  hand  of  a  mur- 
derer has  been  at  work,  it  is  effectually  tightened,  and  the  person 
dies  in  a  few  minutes.  A  charge  of  this  kind,  where  there  can  be  no 
witness  but  the  person  making  it,  requires  to  be  supported,  not  by 
medical  probabilities  or  possibilities,  but  by  the  strongest  medical 
facts.  These  ought  to  show  that  there  are  marks  of  violence  on  the 
neck  such  as  an  assassin  would  be  likely  to  inflict,  and,  at  the  same 
time,  such  as  the  person  making  the  charge  would  not  be  likely  to 
produce,  or  have  the  power  of  producing  on  himself. 


CAUSE    OF    DEATH.  369 


SUFFOCATION. 


CHAPTEK    XXXVIII. 

Suffocation  from  mechanical  causes. — cause  of  death. — ap- 
pearances AFTER  DEATH.  —  EVIDENCE  OF  DEATH  FROM  SUFFO- 
CATION.— ACCIDENTAL,  SUICIDAL,  AND  HOMICIDAL  SUFFOCATION. — 
SMOTHERING. 

By  suffocation  we  are  to  understand  that  condition  in  which  air  is 
prevented  from  penetrating  into  the  lungs,  not  by  constriction  of  the 
windpipe,  but  by  some  mechanical  cause  operating  on  the  mouth 
externally,  or  on  the  throat,  windpipe,  or  air-passages  internally.  In 
this  sense  it  will  be  perceived  that  drowning  is  one  form  of  death 
from  suffocation,  the  water  being  an  effectual  medium  for  prevent- 
ing access  of  air  to  the  lungs. 

The  term  suffocation  is  applied  to  various  conditions  in  which  the 
symptoms  and  effects  differ.  There  may  be  a  simple  privation  of 
air ;  the  air  respired  may  not  be  renewed  for  the  want  of  proper  ven- 
tilation ;  or,  lastly,  the  air  which  is  breathed  may  be  mixed  with 
certain  noxious  gases  or  vapors,  which,  by  absorption  into  the  blood 
through  the  air-cells  of  the  lungs,  may  destroy  life  like  poisons. 
The  symptoms  preceding  death,  the  disposition  to  recovery,  and  the 
post-mortem  appearances  in  fatal  cases,  will  differ  under  these  cir- 
cumstances. It  will  be  sufficient  at  present  to  consider  the  most 
simple  form  of  suffocation  which  is  within  the  reach  of  experiment, 
namely,  that  which  depends  on  the  privation  of  air  by  substances 
blocking  up  the  air-passages,  or  by  the  covering  of  the  mouth  and 
nostrils.  •  The  Committee  of  the  Medico-Chirurgical  Society  per- 
formed a  series  of  experiments  on  dogs,  in  which  a  tube  was  inserted 
into  the  windpipe,  and  breathing  either  took  place  or  was  completely 
arrested,  according  to  whether  the  tube  was  kept  open  or  closed  by 
an  accurately  fitting  plug.  When  the  tube  was  closed  the  animal, 
after  a  variable  number  of  seconds,  made  strong  efforts  to  breathe ; 
and  when  these  ceased,  unless  air  was  speedily  admitted,  it  died. 
From  nine  experiments  on  the  dog,  the  average  duration  of  the  re- 
spiratory movements,  after  the  animal  had  been  completely  deprived 
of  air.  was  four  minutes  and  five  seconds.  The  average  duration  of 
the  heart's  action  was  seven  minutes  and  eleven  seconds;  and  it 
further  appeared  that,  on  an  average,  the  heart's  action  continued  for 
three  minutes  and  fifteen  seconds  after  the  animal  had  ceased  to  make 
respiratory  efforts.  In  respect  to  the  rapidity  with  which  death 
24 


370  VARIOUS    MODES    OF    SUFFOCATION. 

takes  place  in  animals,  the  following  conclusions  were  drawn:  1st, 
a  dog  may  be  deprived  of  air  during  a  period  of  three  minutes  and 
fifty  seconds,  and  afterwards  recover  without  the  application  of  arti- 
ficial means ;  and  2dly,  a  dog  is  unlikely  to  recover,  if  left  to  itself, 
after  having  been  deprived  of  air  during  a  period  of  four  minutes 
and  ten  seconds.  As  in  drowning,  the  shorter  the  interval  between 
the  last  respiratory  efforts  and  the  re-admission  of  air,  the  greater  the 
chance  of  recovery.     ("  Med.-Chir.  Trans."  1862,  vol.  45,  p.  454.) 

The  results  of  these  experiments  in  reference  to  the  duration  of 
life  under  privation  of  air  may  be  considered  applicable  to  a  human 
being.  It  is  not  likely  that  a  man  would  survive  under  these  cir- 
cumstances longer  than  a  dog,  and  it  may  be  fairly  inferred  that  the 
life  of  a  man  would  be  destroyed  in  from  four  to  five  minutes  after 
the  power  of  breathing  had  been  completely  arrested. 

There  are  many  varieties  of  death  by  suffocation,  all  of  which  are 
of  great  medico-legal  interest:  1.  The  close  application  of  the  hand 
over  the  mouth  and  nostrils,  or  the  placing  of  a  plaster  or  cloth  over 
these  parts,  combined  with  pressure  on  the  chest :  this  was  formerly 
not  an  unfrequent  form  of  homicidal  suffocation.  2.  Smothering, 
or  the  covering  of  the  head  and  face  with  articles  of  clothing,  &c, 
which  effectually  prevent  breathing.  3.  The  accidental  or  forcible 
introduction  of  foreign  bodies  into  the  mouth  and  throat.  4.  The 
flow  of  blood  into  the  windpipe  from  a  severe  wound  in  the  throat, 
or  from  the  bursting  of  a  bloodvessel  or  aneurismal  sac.  5.  In 
wounds  of  the  throat,  when  the  windpipe  is  completely  divided,  the 
lower  end  may  be  so  drawn  into  the  wound  as  to  produce  a  closure 
of  the  orifice,  and  intercept  the  passage  of  air.  One  or  other  of 
these  causes  frequently  operates  to  render  a  wound  in  the  throat 
fatal.  6.  The  plunging  of  the  face  into  mud,  snow,  dust,  feathers, 
or  similar  substances.  In  all  these  cases  death  takes  place  from 
asphyxia,  and  with  great  rapidity  if  the  chest  sustains  at  the  same 
time  any  degree  of  forcible  compression.  7.  Swelling  or  spasm  of 
the  glottis  produced  by  the  contact  of  corrosive  substances.  A  case 
was  referred  to  me,  in  July,  1848,  in  which  death  was  probably  thus 
caused  by  the  application  of  a  strong  solution  of  pernitrate  of  mer- 
cury to  an  ulcer  in  the  throat. 

Suffocation  may  arise  from  morbid  causes  operating  mechanically 
to  prevent  respiration,  such  as  a  diseased  state  of  the  parts  about  the 
throat,  an  enlargement  of  the  glands,  the  bursting  of  a  tonsillary 
abscess,  or  the  effusion  of  lymph,  blood,  or  pus  into  the  windpipe, 
or  about  the  opening  of  the  larynx  (rima  glottic!  is).  Any  of  these 
causes  may  suddenly  arrest  the  act  of  breathing,  a  fact  which  can 
only  be  determined  by  a  careful  examination  of  the  air-passages. 
Accidental  suffocation  may  arise  from  large  masses  of  food  blocking 
up  the  larynx.  If  the  glottis  (the  opening  of  the  windpipe)  be  com- 
pletely closed  by  food,  death  may  take  place  suddenly ;  although 
the  person  so  situated  may  be  capable  of  making  some  exertion  or 
of  moving  from  the  spot.  Dr.  Mackenzie  relates  a  case  in  which  a 
man  was  suddenly  choked  by  swallowing  a  large  piece  of  meat :  he 
immediately  walked  across  the  street  to  a  chemist's  shop,  and  soon 


ACCIDENTAL    SUFFOCATION    FROM    FOOD.  371 

after  entering  it,  he  fell  clown  in  a  state  of  insensibility.  After  death 
the  throat  was  found  to  be  filled  with  a  piece  of  beef,  which  rested 
on  the  glottis,  and  had  pressed  the  epiglottis  forward.  Part  of  the 
mass  had  entered  the  windpipe  through  the  rima  glottidis,  and  had 
thus  caused  death  by  suffocation.  It  is  probable  that,  in  this  and 
similar  cases,  the  foreign  body  does  not  so  completely  close  the 
aperture  as  to  prevent  some  degree  of  respiration,  but  the  blood 
being  imperfectly  aerated,  asphyxia  is  speedily  induced.  ("  Ed. 
Month.  Jour."  July,  1851,  p.  68.)  In  a  case  which  occurred  in  April, 
1858,  a  youth,  set.  17,  lost  his  life  owing  to  an  oyster  becoming  im- 
pacted in  the  air-passages  during  the  act  of  swallowing. 

A  person  has  been  wrongly  charged  with  causing  the  death  of 
another,  when  the  cause  was  really  owing  to  the  impaction  of  food 
in  the  larynx.  A  remarkable  instance  of  this  kind  (which  is  re- 
ported in  the  "Lancet"  for  March  9,  1850,  p.  313),  occurred  at  Hill- 
ingdon.  Deceased  had  had  a  quarrel  with  the  accused,  who  was  his 
son-in-law,  and  they  were  seen  to  fall  to  the  ground  together,  while 
struggling  and  fighting.  They  were  separated.  About  two  hours 
afterwards  the  deceased,  who  appeared  quite  well,  was  observed  to 
rise  from  the  dinner-table  and  leave  the  room.  He  was  found  lean- 
ing against  the  cottage,  as  if  in  a  falling  position,  and  he  expired  in 
two  or  three  minutes !  The  person  with  whom  deceased  had  been 
fighting  was  charged  with  manslaughter  before  a  magistrate.  At 
the  inquest  the  medical  witness  stated  that  he  found  the  organs  of 
the  body,  excepting  the  brain,  in  a  very  healthy  state.  The  brain 
was  excessively  congested,  and  he  attributed  death  to  apoplexy. 
The  coroner  desired  the  witness  to  examine  the  mouth  and  throat 
(which  he  had  omitted  to  do  at  the  inspection),  as  from  the  sudden- 
ness of  death  after  eating,  he  (the  coroner)  thought  the  man  might 
have  been  choked.  This  opinion  turned  out  to  be  correct.  A  large 
piece  of  meat  was  found  wedged  in  the  opening  of  the  throat ;  this 
had  caused  death  by  suffocation.  It  had  not  completely  closed  the 
air-passages  in  the  first  instance :  hence  the  man  was  able  to  move 
from  the  dinner-table.  The  person  accused  of  manslaughter  was 
discharged.  A  medical  jurist,  however,  must  not  lose  sight  of  the 
fact  that  a  foreign  substance  may  be  homicidally  impacted  in  the 
larynx,  and  that,  except  by  a  careful  examination  of  the  body,  death 
may  be  wrongly  assigned  to  accident.  A  case  reported  by  Dr.  Lit- 
tlejohn  is  in  this  respect  instructive.  In  examining  the  body  of  a 
woman  who  it  was  stated  had  died  suddenly,  he  found  a  quart-bottle 
cork  inserted  tightly  into  the  upper  part  of  the  larynx.  The  sealed 
end  was  uppermost,  and  was  roughened  by  the  passage  of  the  screw. 
Fractures  of  the  ribs  were  found,  and  it  was  quite  clear  that  deceased 
had  not  died  a  natural  death.  It  was  suggested  that  the  deceased, 
while  extracting  the  cork  from  the  bottle  with  her  teeth,  might,  by 
the  sudden  impetus  of  the  contained  fluids,  have  drawn  it  into  the 
position  in  which  it  was  found.  But  this  theory  was  negatived  by 
the  sealed  end  of  the  cork  being  uppermost  in  the  throat,  as  well  as 
by  the  structure  of  the  parts.  The  medical  opinion  was  that  the 
cork  must  have  been  forcibly  placed  there  by  another  person,  while 


372  POST-MORTEM    APPEARANCES. 

the  woman  was  in  a  helpless  state  of  intoxication.  There  was  no 
reason  to  doubt  that  this  was  a  deliberate  act  of  murder.  Five  per- 
sons were  present  with  the  deceased  at  the  time  of  her  death,  but  it 
was  impossible  to  fix  with  certainty  upon  the  person  who  had  com- 
mitted the  act,  and  the  man  on  whom  the  strongest  suspicion  fell 
was  acquitted  on  a  verdict  of  "not  proven."  ("Ed.  Med.  Jour." 
Dec.  1855,  p.  511 ;  and  for  a  report  of  the  trial,  the  same  journal, 
p.  540.) 

In  suffocation,  death  takes  place  from  apnoea  or  asphyxia;  and 
this  occurs  with  a  rapidity  proportioned  to  the  degree  of  impediment 
existing  to  the  passage  of  the  air.  There  does  not  seem  to  be  any 
reason  to  attribute  death  to  apoplexy.  The  congestion  of  the  cere- 
bral vessels  may  be  regarded  as  a  consequence  of  the  disturbance  of 
the  functions  of  the  lungs.  If  the  veins  of  the  neck  were  opened, 
so  as  to  prevent  an  accumulation  of  blood  in  the  vessels  of  the  brain,  it 
is  pretty  certain  that  the  prevention  of  respiration  would  destroy  life 
under  the  same  circumstances,  and  within  the  same  period  of  time ; 
therefore  we  may  regard  death  from  suffocation  as  resulting  from 
pure  asphyxia.  In  treating  a  case  of  suffocation  we  have  simply  to 
allow  of  the  renewal  of  air  by  removing,  if  this  be  possible,  the  me- 
chanical obstacle  to  respiration.  The  results  of  experiments  on  dogs 
show  that,  even  with  a  perfect  closure  of  the  windpipe,  an  animal 
may  recover  spontaneously  after  nearly  four  minutes'  deprivation  of 
air ;  and  there  is  every  reason  to  believe  that  a  human  being  might 
recover  after  the  same  length  of  time.  If  five  minutes  have  elapsed 
there  will  be  but  little  hope  of  recovery.  In  drowning  the  chances 
of  recovery  continue  only  for  half  the  period  observed  in  suffoca- 
tion ;  the  lungs  are  injured,  and  the  water  by  which  they  are  pene- 
trated forms  a  physical  obstacle  to  the  free  admission  of  air.  In 
hanging  and  strangulation  there  is  sometimes  great  violence  done  to 
the  parts  about  the  neck.  In  suffocation  these  accidental  obstacles 
to  recovery  do  not  exist :  the  surgeon  has  simply  to  readmit  the  air 
into  the  lungs.  All  experiments  go  to  show  that,  even  in  this  form 
of  asphyxia,  which  is  most  favorable  for  recovery,  the  complete 
suspension  of  respiration  for  Jive  minutes  is  fatal.  Hanging  and 
strangulation  prove  fatal  from  asphyxia  in  the  same  period  of  time, 
and  drowning  probably  within  half  this  period. 

Post-mortem  Appearances. — There  are  rarely  any  considerable  marks 
of  violence  externally.  When  the  body  has  become  perfectly  cold, 
there  may  be  patches  of  lividity  diffused  over  the  skin ;  but  these 
are  not  always  present.  The  lips  are  livid ;  the  skin  of  the  face  and 
neck  may  be  pale,  or  present  a  dusky-violet  tint,  with  small  patches 
of  ecchymosis.  The  eyes  are  congested ;  there  is  a  mucous  froth 
about  the  lips  and  mouth.  The  mouth,  throat,  and  parts  about  the 
windpipe  should  be  carefully  examined  for  foreign  substances.  In- 
ternally the  lungs  and  right  cavities  of  the  heart  may  be  found  dis- 
tended with  blood.  The  state  of  the  lungs  and  heart  is,  however, 
subject  to  variation.  The  lungs  are  not  necessarily  found  congested ; 
and  sometimes,  as  in  a  case  referred  to  me  in  November,  1864,  one 
lung  may  be  found  congested  and  the  other  not.     M.  Tardieu  states, 


STATE    OF    THE    LUNGS.  373 

from  his  observations,  that  the  lungs  are  of  a  reddish  color,  some- 
times even  pale,  not  distended,  and  presenting,  occasionally,  only  a 
slight  degree  of  congestion  at  the  base  and  posteriorly.  A  special 
character  which  he  states  he  has  invariably  noticed  in  these  organs 
consists  in  the  presence  of  small  ecchymosed  spots  or  patches  be- 
neath the  pleura  or  investing  membrane.  He  describes  these  spots 
as  of  a  dark  color,  and  varying  in  size  from  a  pin's  head  to  a  lentil. 
In  the  adult  they  are  of  still  larger  size.  Their  number  is  variable ; 
sometimes  five  or  six  may  be  found,  at  others  twenty  or  thirty ;  and 
in  other  cases  the  surface  of  the  lungs  may  be  so  studded  with  them 
as  to  give  to  it  a  granite-like  appearance.  These  spots  of  ecchymosis 
are  sometimes  agglomerated,  at  other  times  separated,  but  their 
outline  is  generally  distinct  and  well-defined  on  the  surface  of  the 
lungs.  They  are  most  frequently  seen  at  the  root  of  the  lungs,  at 
its  base,  and  about  its  lower  margin.  They  are  owing  to  small  effu- 
sions of  blood  from  ruptured  vessels,  like  true  ecchymosis.  They 
ma,y  be  distinguished  so  long  as  the  tissue  of  the  lung  remains  un- 
changed. M.  Tardieu  states  that  he  has  seen  these  subpleural  ecchy- 
moses  in  the  body  of  an  infant,  ten  months  after  death!  ("Ann. 
d'Hyg."  1855,  vol.  2,  p.  379.)  He  admits,  however,  that  they  may 
also  be  found  in  the  bodies  of  children  that  have  not  breathed ; 
hence  no  inference  of  death  from  suffocation  should  be  drawn  from 
this  appearance  in  the  lungs  of  children,  unless  they  have  actually 
received  air.  In  three  instances  he  met  with  this  appearance  in 
lungs  which  sank  in  water,  and  had  all  the  usual  characters  of  these 
organs  in  a  foetal  state.  The  children  had  been  born  living,  prema- 
turely, and  under  conditions  in  which  life  by  respiration  could  not 
be  perfectly  established :  one  of  them  had  made  several  cries  with- 
out effectually  receiving  air  into  the  lungs  (loc.  cit.).  (See  Casper's 
"  Klinische  Novellen,"  1863,  p.  471.)  This  struggle  to  breathe  may 
have  produced  the  appearance  resembling  that  of  suffocation;  in 
new-born  children  that  die  from  suffocation  the  thymus  gland  has 
been  found  in  a  similar  condition. 

This  dotted  appearance  of  the  surface  of  the  lungs  in  suffocation 
is  not  attended  with  the  apoplectic  effusions  in  their  substance  which 
are  met  with  in  death  from  strangulation.  Emphysema,  or  escape 
of  air  from  rupture  of  the  air-cells,  is  occasionally  observed.  The 
more  rapidly  suffocation  has  taken  place  the  more  strongly  marked 
is  this  appearance  of  ecchymosed  spots.  On  the  other  hand,  when 
the  interruption  of  breathing  has  been  slow  and  gradual,  the  sub- 
stance of  the  lungs  is  more  congested  with  blood,  and  then  these  dots 
or  patches  are  merged  in  the  general  violet  color  of  the  surface  of 
the  organs.  The  lining-membrane  of  the  windpipe  and  larger  air- 
tubes  is  sometimes  pale,  but  commonly  dark-colored  when  the  lungs 
are  congested.  In  the  air-passages  there  is  occasionally  a  frothy 
reddish-colored  liquid  in  small  vesicles. 

The  heart  presents  no  special  appearance  indicative  of  the  mode  of 
death,  if  we  except  the  presence  of  small  spots  of  ecchymosis  found 
below  the  investing  membrane,  like  those  met  with  on  the  lungs. 
They  have  been  found  near  the  roots  or  origin  of  the  great  vessels, 


37-i       PROOFS  OF  DEATH  FROM  SUFFOCATION. 

but  are  not  so  frequently  observed  in  this  organ  as  in  the  lungs. 
The  blood  is  generally  dark  and  fluid ;  sometimes  coagula  are  met 
with.  The  stomach  and  intestines  have  been  observed  to  present 
patches  of  lividity.  Casper  has  found  the  kidneys  more  strongly 
congested  with  blood  than  the  liver,  spleen,  and  other  organs.  The 
vessels  of  the  brain  are  sometimes  congested,  but  at  other  times  they 
do  not  appear  to  be  more  than  ordinarily  full.  Their  condition  may 
be  affected  by  the  congested  state  of  the  lungs,  as  well  as  by  the 
slowness  or  rapidity  with  which  death  takes  place.  Other  appear- 
ances which  have  been  described  are  of  an  accidental  nature,  and 
are  not  connected  with  death  from  suffocation. 

In  a  case  of  alleged  murder  by  suffocation,  respecting  which  I 
was  consulted  in  December,  1857,  the  following  appearances  were 
met  with.  The  body  was  lying  on  the  bed :  the  right  leg  was  drawn 
up  towards  the  body — the  right  arm  was  bent,  with  the  hand  directed 
towards  the  face  ;  the  left  hand  was  lying  upon  the  chest.  The  lips 
were  livid,  the  tongue  protruded  and  swollen,  and  there  was  a  bloody 
fluid  issuing  from  the  nostrils.  There  was  no  mark  of  constriction 
on  the  neck ;  the  eyes  were  half-open ;  the  body  was  rigid  and  still 
warm.  The  face  and  neck  were  much  swollen,  and  the  skin  of  these 
parts,  as  well  as  of  the  chest,  abdomen,  arms  and  legs,  was  covered 
with  dark  livid  patches.  The  brain  was  gorged  with  venous  blood. 
The  heart  was  soft  and  flaccid,  and  its  cavities  were  empty.  The 
mucous  membrane  as  well  as  the  tissues  of  the  air-passages  were 
much  congested  with  dark  liquid  blood :  the  blood  was  everywhere 
liquid.  The  stomach  contained  a  small  quantity  of  a  dark-colored 
liquid,  and  the  greater  end  was  reddened.  The  spleen  was  congested. 
The  emptiness  of  the  cavities  of  the  heart  was  at  first  considered  to 
be  inconsistent  with  death  from  asphyxia:  but  this  condition  of  the 
heart  is  occasionally  found.  It  may  be  stated  that  in  this  case  the 
deceased,  a  female,  was  greatly  exhausted  by  sickness  and  purging. 
On  the  second  day  of  her  illness  she  was  found  dead  in  the  state 
described,  and  her  husband  was  charged  with  having  suffocated  her. 

Evidence  of  Death  from  Suffocation. — In  medical  jurisprudence 
there  is  not,  perhaps,  an  instance  in  which  we  have  fewer  medical 
data  upon  which  to  base  an  opinion  than  in  a  case  of  alleged  death 
from  suffocation.  The  inspection  of  the  body  of  a  person  suffocated, 
if  we  except  the  peculiar  condition  of  the  surface  of  the  lungs  lately 
pointed  out  by  M.  Tardieu,  presents  so  little  that  is  peculiar,  that  a 
medical  man,  unless  his  suspicions  have  been  roused  by  circumstan- 
tial evidence,  or  by  the  discovery  of  foreign  substances  in  the  air- 
passages,  would  probably  pass  it  over  as  a  case  of  death  without 
any  assignable  cause — -in  other  words,  from  natural  causes.  In  ex- 
amining the  body  of  the  woman  Campbell,  who  was  suffocated  by 
Burke  in  Edinburgh,  Dr.  Christison  was  unable  to  come  to  any  con- 
clusion respecting  the  cause  of  death  until  some  light  had  been 
thrown  on  the  case  by  collateral  evidence.  On  this  occasion  a  vio- 
lent death  was  suspected,  because  there  were  marks  of  violence 
externally,  and  the  face  of  the  deceased  presented  some  of  the  char- 
acters of  strangulation.     These  conditions,  however,  are  by  no  means 


CAUSES    OF    ACCIDENTAL    SUFFOCATION.  375 

essential  to  death  from  suffocation,  and  when  they  exist  they  can 
only  be  regarded  as  purely  accidental  accompaniments.  Appear- 
ances similar  to  those  found  in  the  bodies  of  suffocated  persons,  if 
we  except  the  dotted  ecchymosis  on  the  lungs,  are  frequently  met 
with  in  inspections  when  death  has  taken  place  as  a  consequence  of 
disease  or  accident.  They  can,  therefore,  furnish  no  conclusive  evi- 
dence of  the  kind  of  death;  they  scarcely  permit  a  witness  to 
establish  a  presumption  on  the  subject,  until,  by  a  careful  examina- 
tion of  the  body,  he  has  ascertained  that  there  is  no  other  cause  of 
death  depending  on  organic  disease  or  on  violence.  Medical  evi- 
dence may,  however,  be  serviceable  in  some  instances.  Thus,  let 
the  general  evidence  establish  that  a  deceased  person  has  probably 
been  suffocated,  the  witness  may  have  it  in  his  power  to  state  that 
the  appearances  in  the  body  are  consistent  with  this  kind  of  death  ; 
that  the  body  is  in  all  respects  healthy  and  sound,  and  that  death 
was  probably  sudden — as  where,  for  instance,  undigested  food  is 
discovered  in  the  stomach.  The  presence  of  ecchymosis  on  the  sur- 
face of  the  lungs  may  justify  a  strong  opinion  of  death  by  suffoca- 
tion when  no  other  cause  is  apparent.  In  all  cases  of  this  description, 
we  must  bear  in  mind  that  an  opinion  relative  to  the  supposed  cause 
of  death  is  to  be  formed  from  the  medical  circumstances,  and  from 
what  we  have  ourselves  seen,  unless  it  be  otherwise  allowed  by  the 
court.  From  this  want  of  clear  evidence,  great  difference  of  opinion 
on  the  cause  of  death  frequently  exists  among  medical  witnesses. 

Accidental  suffocation  is  not  unfrequent;  and  there  are  various 
conditions  under  which  a  person  may  die  suffocated  only  discover- 
able after  death.  1.  Diseases  about  the  tongue,  larynx,  or  throat 
may  have  advanced  to  such  an  extent  as  effectually  to  prevent 
breathing.  2.  The  deceased  may  have  fallen,  and  the  mouth  become 
covered  with  dust  or  other  substances ;  and  if  helpless,  as  in  the  case 
of  an  infant  or  an  aged  person,  or  of  one  who  is  intoxicated,  death 
may  thus  easily  take  place.  A  child  was  found  dead  in  a  room, 
with  its  face  in  the  ashes  under  a  grate:  it  had  fallen  during  the 
absence  of  the  mother,  and,  from  its  helpless  condition,  had  speedily 
become  suffocated.  Some  of  the  ashes  were  found  in  the  windpipe. 
("Med.  Gaz.,"  vol.  17,  p.  642.)  For  a  case  in  which  suffocation  was 
caused  by  a  pea,  see  the  same  journal,  vol.  29,  p.  146.  In  trials  for 
murder  or  manslaughter,  a  medical  opinion  respecting  the  accidental 
suffocation  of  a  drunken  person,  under  similar  circumstances,  is 
occasionally  required.  These  persons,  it  must  be  remembered,  are 
generally  as  helpless  as  children :  if  they  fall  in  a  position  so  that 
the  mouth  is  covered,  they  may  be  so  powerless  from  intoxication 
as  not  to  be  able  to  escape.  3.  A  portion  of  food  may  have  re- 
mained fixed  in  the  larynx  or  throat.  Children  are  sometimes  acci- 
dentally suffocated  by  drinking  boiling  water  from  a  tea-kettle. 
The  parts  about  the  larynx  then  become  swollen  from  the  action  of 
the  hot  water,  and  breathing  cannot  take  place.  4.  Accidental  suffo- 
cation is  not  uncommon  among  infants,  when  they  sleep  with  adult 
persons.  A  child  may  be  in  this  way  speedily  destroyed.  Even  the 
close  wrapping  of  a  child's  head  in  a  shawl  to  protect  it  from  cold 


376  HOMICIDAL    SUFFOCATION. 

may  effectually  kill  it,  without  any  convulsive  struggles  to  indicate 
the  danger  to  which  it  is  exposed  (p.  378).  Convulsions  by  no 
means  necessarily  attend  on  death  from  suffocation. 

Those  instances  of  accidental  suffocation  which  depend  on  disease, 
or  on  the  impaction  of  food,  are  easily  known  by  a  careful  exami- 
nation of  the  parts  about  the  throat :  generally  speaking,  they  pre- 
sent no  difficulty.  In  other  instances — when  a  child  or  a  drunken 
person  is  presumed  to  have  been  suffocated  owing  to  the  position  in 
which  he  has  fallen,  evidence  as  to  the  position  of  the  body,  or  even 
the  actual  sight  of  the  body,  is  necessary  before  forming  an  opinion. 
The  following  questions  may  here  arise :  Was  the  position  such  as 
to  be  explicable  on  the  supposition  of  accident  ?  Was  it  not  such 
a  position  as  might  have  been  given  to  it  by  a  murderer  ?  Could 
not  the  deceased  have  had  strength  or  presence  of  mind  to  escape  ? 
Could  he  have  been  actually  suffocated  in  the  position  in  which  his 
body  was  discovered  ?  A  little  reflection  upon  the  circumstances — 
for  here  something  more  than  medical  circumstance  will  be  re- 
quired— may  enable  us  to  give  satisfactory  answers  to  these  ques- 
tions. 

Some  singular  cases  are  on  record,  in  which  persons  have  wilfully 
destroyed  themselves  by  blocking  up  the  throat  mechanically.  An 
instance  of  this  form  of  suicide  is  reported  in  the  "  Edin.  Med.  and 
Surg.  Jour."  April,  1842.  A  woman  confined  in  prison  forced  a 
hard  cotton-plug  into  the  back  of  her  throat.  The  cavities  of  the 
chest  and  abdomen  had  been  already  examined,  and  a  medical  certi- 
ficate given  that  the  deceased  had  died  of  apoplexy !  The  body  was 
sent  to  one  of  the  anatomical  schools,  and  on  re-inspection  it  was 
accidentally  found  that  the  throat  was  firmly  blocked  up  with  a  plug 
of  spindle  cotton. 

Homicide  by  suffocation  is  not  very  common,  although  it  is  a 
ready  means  of  perpetrating  murder.  Hitherto  the  cases  which  have 
come  before  our  courts  have  been  those  either  of  infants,  of  the 
aged  and  infirm,  or  of  persons  enfeebled  by  illness.  In  regard  to 
the  latter,  the  rigorous  administration  of  the  law  has  succeeded  in 
putting  a  check  to  this  crime ;  but  with  respect  to  children,  it  pro- 
bably yet  continues.  Death  by  suffocation  is  most  difficult  to  detect ; 
and,  unless  the  assailant  has  employed  an  unnecessary  degree  of 
violence,  it  is  probable  that  the  crime  may  pass  altogether  unsus- 
pected. Homicide  by  suffocation  would  not  be  attempted  on  healthy 
adult  persons,  unless  they  were  in  a  state  of  intoxication,  and  thereby 
rendered  defenceless.  It  is  certain  that  most  individuals  would 
have  it  in  their  power,  unless  greatly  incapacitated  by  disease  or 
intoxication,  to  offer  such  a  degree  of  resistance  as  would  leave 
upon  their  bodies  indubitable  evidence  of  murderous  violence. 
Death  by  suffocation  may  be  considered  as  presumptive  of  homicide, 
unless  the  facts  are  clearly  referable  to  accident.  Accidental  suffo- 
cation is,  however,  so  palpable  from  the  position  of  the  body  and 
other  circumstances,  that  when  death  is  clearly  traced  to  this  cause, 
it  is  not  easy  to  conceive  a  case  in  which  it  would  be  difficult  to  dis- 
tinguish it  from  one  of  actual  murder.     In  some  instances,  the  very 


SMOTHERING.  377 

means  that  have  been  adopted  to  produce  suffocation  may  forbid  the 
supposition  of  accident,  and  clearly  establish  the  fact  of  homicide. 

The  suffocation  of  new-born  children,  by  the  introduction  of 
substances  into  the  mouth,  is  not  unfrequent.  The  unnecessary 
force  employed  generally  leaves  traces  of  violence,  which  may  be 
easily  discovered  by  a  careful  examination,  even  should  it  happen 
that  the  substance  used  for  the  murderous  purpose  has  been  removed. 

It  is  necessary  to  point  out  a  dangerous  practice  common  among 
ignorant  nurses,  which,  without  exciting  suspicion  on  the  part  of  a 
coroner  or  medical  witness,  may  be  an  occasional  cause  of  death  in 
infants.  In  order  to  quiet  a  child,  and  to  enable  a  nurse  to  sleep 
without  disturbance,  a  bag  made  of  wash-leather  or  rag,  containing 
sugar,  is  thrust  into  the  child's  mouth.  It  is  thus  completely  gagged, 
and  the  child  soon  becomes  quiet,  respiring  chiefly  through  the 
nostrils.  If  these  by  any  accident  become  obstructed,  or  by  the  act 
of  aspiration  the  bag  should  fall  to  the  back  of  the  throat,  death  by 
suffocation  must  inevitably  result,  the  infant  being  perfectly  help- 
less !  The  suspension  of  breathing  may  be  so  gradual  that  the  child 
may  die  without  crying  or  convulsions.  The  removal  of  the  bag 
from  the  mouth,  as  no  violence  had  been  used,  will  remove  every 
trace  of  the  cause  of  death ;  and,  in  order  to  exculpate  herself,  the 
guilty  person  may  ascribe  death  to  "  fits."  In  one  instance,  within 
my  knowledge,  an  infant  was  timely  saved  by  the  mother  having 
discovered,  while  the  nurse  was  sleeping,  a  mass  of  wash-leather 
projecting  from  its  mouth.  The  woman  awoke,  and  attempted  to 
remove  and  conceal  the  leather,  but  she  was  detected  in  the  act. 
The  detection  of  this  dangerous  practice  can  only  be  a  matter  of 
pure  accident :  hence  a  fatal  case  can  be  rarely  the  subject  of  a  cor- 
oner's inquest,  and  even  then  medical  evidence  may  fail  to  throw  any 
light  upon  the  cause  of  death.  In  one  instance  only  have  I  known 
it  to  give  rise  to  a  criminal  charge — {Reg.  v.  Cox,  Warwick  Lent 
Assizes,  1848).  The  mother,  a  pauper  female,  was  tried  for  the 
attempt  to  suffocate  her  infant,  eleven  days  old.  The  child  was  dis- 
covered by  another  person  with  a  piece  of  rag  hanging* from  its 
mouth.  It  was  livid  in  the  face,  but  when  the  rag  was  removed  it 
made  a  violent  gasp,  and  recovered  its  breath.  There  was  no  malice 
on  the  part  of  the  prisoner,  but  it  was  made  a  strong  point  in  her 
favor  that  instances  had  occurred  in  the  workhouse,  in  which  women 
had  with  impunity  put  rags  with  sugar  into  the  mouths  of  infants 
in  order  to  soothe  and  keep  them  quiet !  The  jury  acquitted  her. 
The  admitted  practice  of  infantile  suffocation  in  the  Warwick  work- 
house appears  to  have  passed  without  reprimand  or  even  comment, 
although  this  plan  of  soothing  infants  is  just  as  likely  to  be  fatal  to 
them  as  that  of  encircling  their  necks  with  tight  ligatures. 

Smothering. 

Smothering  is  a  variety  of  suffocation,  and  consists  in  the  mere 
covering  of  the  mouth  and  nostrils  in  any  way  so  as  to  prevent  the 
free  ingress  and  egress  of  air.     Like  drowning,  hanging,  or  strangu- 


378  POST-MORTEM    APPEARANCES 

lation,  it  produces  death  by  asphyxia.  In  new-born  infants  it  is  not 
an  unusual  occurrence,  sometimes  originating  in  accident,  and  at 
others  in  criminal  design.  An  infant  may  be  speedily  destroyed  by 
smothering.  If  the  mouth  be  only  lightly  covered  with  clothing, 
or  slightly  compressed,  so  that  respiration  is  interrupted,  as  in  the 
act  of  carrying  a  child  in  the  arms,  this  will  suffice  to  cause  death  ; 
and,  as  it  has  been  already  remarked,  death  may  take  place  without 
being  preceded  by  convulsions  or  other  striking  symptoms.  Smother- 
ing is  not  often  resorted  to  as  a  means  of  perpetrating  murder,  ex- 
cept in  infants,  or  in  debilitated  and  infirm  adults.  In  a  case  which 
occurred  at  Ayr,  a  woman  was  charged  with  the  murder  of  her  child 
by  smothering  it  in  her  shawl.  She  was  travelling  in  a  steamboat : 
it  was  a  cold  stormy  day,  and  she  had  wrapped  the  shawl  closely 
round  the  head  of  the  child.  There  could  be  no  doubt,  from  the 
moral  circumstances,  that  she  had  intended  to  kill  it ;  but  the  defence 
was  that  she  had  merely  intended  to  protect  the  child  from  the  cold, 
and  it  was  suffocated  before  she  was  aware  of  it.  There  were  no 
facts  to  exclude  this  defence,  and  the  woman  was  acquitted.  But 
children  may  be  thus  accidentally  destroyed,  through  the  ignorance 
of  persons  who  nurse  them. 

According  to  the  late  Mr.  Wakley,  infants  are  frequently  found 
dead  owing  to  their  being  suckled  at  night  while  the  woman  is  in 
bed.  The  child's  face  is  pressed  on  the  breast :  mother  and  child 
fall  fast  asleep ;  the  head  slips  beneath  the  clothes,  and  the  child  is 
then  quietly  suffocated.  There  is  no  mark  of  pressure  or  violence  on 
the  body.  ("  Lancet,"  Jan.  16, 1858,  p.  69.)  A  case,  apparently  of  this 
kind,  was  communicated  to  me  by  Mr.  Nason  in  Sept.  1860.  The 
child  (five  days  old)  died  quietly  on  its  mother's  arm  while  lying  in 
bed.  There  was  much  lividity  about  the  head,  neck,  and  back ;  .but 
there  were  no  marks  of  violence.  The  bronchial  tabes  of  the  right 
lung  contained  bright  florid  blood.  The  left  lung  was  gorged  with 
blood,  but  none  had  escaped.  The  heart  was  firmly  contracted,  and 
there  was  only  a  small  quantity  of  blood  in  its  right  cavities. 

The  appearances  presented  by  the  bodies  of  children  who  have 
died  under  these  circumstances  may  be  thus  described  from  actual 
cases :  Externally :  features  placid ;  lips  congested :  eyes  not  unduly 
prominent;  conjunctivas  rather  reddened ;  hands  clenched ;  patches 
of  ecchymosis  sometimes  found  on  the  skin.  Internally:  Head — 
patches  of  effused  blood  here  and  there  beneath  the  pericranium ; 
great  congestion  of  the  pia  mater,  accompanied  by  numberless  effu- 
sions of  blood,  varying  in  size  from  a  pin's  point  to  a  silver  penny 
in  superficial  extent;  a  little  clear  fluid  in  the  ventricles;  some 
frothy  mucus  in  the  windpipe  and  bronchi,  with  redness  of  their 
lining-membrane.  The  lungs  are  much  congested  and  crepitant, 
whilst  beneath  the  pleuree  blood  had  been  everywhere  effused,  pre- 
senting numerous  small  bright-red  patches,  and  fine  points:  all  the 
blood  of  the  substance  of  the  lungs  was  within  its  vessels.  The 
pericardium  contained  some  serum,  and  was  spotted  in  its  whole  ox- 
tent  after  the  manner  described;  the  vasa  vasorum  of  the  heart's 
great  vessels  and  thoracic  aorta  were  minutely  injected.     The  right 


IN    DEATH    FROM    SMOTHERING.  379 

cavities  of  the  heart  in  all  the  cases  contained  dark  liquid  blood  ; 
the  left  cavities  were  nearly  empty ;  the  tissue  of  the  organ  was  free 
from  effused  blood.  The  surface  only  of  the  thymus  gland  was  mot- 
tled like  the  heart. 

There  is  a  prevalent  notion  that  congestion  of  the  lungs  is  an  in- 
variable accompaniment  of  death  from  suffocation,  and  where  this 
was  not  found,  it  has  been  hastily  assumed  that  death  had  taken 
place  from  some  other  cause.  Some  remarks  on  this  post-mortem 
appearance  have  been  made  in  the  chapter  on  drowning ;  and  it  is 
desirable,  in  reference  to  future  cases  to  point  out  the  fallacy  involved 
in  the  assumption  that  congestion  of  the  lungs  is  necessarily  present 
in  death  from  suffocation.  Mr.  Watson  observes  that  the  gorged 
state  of  the  right  side  of  the  heart  and  lungs  is  greatest  where  the 
act  of  suffocation  (asphyxia)  has  been  slow  and  gradual,  by  the  access 
of  air  to  the  lungs  not  having  been  completely  prevented.  When, 
on  the  other  hand,  death  has  taken  place  quickly  or  suddenly  from 
this  cause,  there  is  little  or  no  unusual  congestion  of  blood  in  the 
lungs  or  heart.  ("On  Homicide,"  p.  115.)  At  page  118  he  describes 
a  case  of  death  from  suffocation  in  which  the  lungs  were  natural ; 
and  in  the  case  of  Campbell,  for  whose  murder  by  suffocation  Burke 
was  convicted  and  executed  in  1828-9,  Dr.  Christison  and  Mr.  Nevv- 
bigging  found  the  organs  within  the  chest  perfectly  natural,  the  lungs 
remarkably  so,  and  unusually  free  from  infiltration.  The  blood  in  the 
heart  and  great  vessels  as  well  as  throughout  the  body  was  fluid  and 
black.  ("Ed.  Med.  and  Surg.  Jour."  vol.  31,  p.  239.)  Again,  in  the 
case  oi  Carlo  Ferrari,  for  the  murder  of  whom  Bishop  and  Williams 
were  convicted  and  executed  in  London  in  1831,  the  lungs  were  quite 
healthy,  and  not  congested;  the  heart  was  rather  small,  contracted, 
and  its  four  cavities  were  perfectly  empty.  Taylor's  "Elements  of 
Medical  Jurisprudence,"  1836,  p.  292.)  The  prisoners  in  this  case 
confessed  that  they  destroyed  the  deceased  by  suffocation.  From 
these  facts  it  will  be  perceived  that  the  actual  state  of  the  lungs  and 
heart  in  the  bodies  of  those  who  have  been  notoriously  murdered 
by  suffocation,  is  that  which  has  been  wrongly  pronounced  to  be  in- 
consistent with  this  mode  of  death. 

In  reference  to  the  case  of  Campbell,  Dr.  Christison  observes  "that 
the  conviction  in  the  public  mind  that  a  well-informed  medical  man 
should  always  be  able  to  detect  death  by  suffocation  simply  by  an 
inspection  of  the  body  and  without  a  knowledge  of  collateral  cir- 
cumstances is  erroneous,  and  may  have  the  pernicious  tendency  of 
throwing  inspectors  off  their  guard,  by  leading  them  to  expect 
strongly-marked  appearances  in  every  case  of  death  from  suffocation. 
That  such  appearances  are  very  far  from  being  always  present  ought 
to  be  distinctly  understood  by  every  medical  man  who  is  required 
to  inspect  a  body  and  give  an  opinion  of  the  cause  of  death."  (Op. 
cit.  p.  243.)  At  the  same  time,  in  the  absence  of  marked  appearances 
to  indicate  violent  death,  due  caution  should  be  used  by  a  medical 
witness  in  expressing  an  opinion.  At  the  trial  of  the  prisoner 
Burke,  Dr.  Christison  restricted  his  opinion  by  stating  that  death  by 
violence  was,  from  the  medical  circumstances  alone,  very  probable ;  a 


380  SUFFOCATION    BY    GASES. 

degree  of  caution  which  on  similar  occasions  it  will  be  desirable 
for  a  medical  witness  to  imitate.  Under  the  rule  of  English  juris- 
prudence, by  which  accused  persons  are  not  allowed  to  be  interro- 
gated, it  is  not  possible  to  carry  medical  evidence  further  than  this. 
There  is  nothing  in  the  act  of  suffocation,  as  there  is  in  wounds, 
poisoning,  hanging,  or  strangulation,  by  which  the  hand  of  a  crimi- 
nal can  be  clearly  and  unequivocally  traced. 


CHAPTER    XXXIX. 

Gaseous  poisons. — carbonic  acid. — symptoms. — appearances. — 

analysis. — effects  of  charcoal-vapor. — carbonic  oxide. 

coal  and  coke  vapor. — sulphurous  acid. — vapors  of  lime, 

cement,  and  brick-kilns. — confined  air. coal-gas. — carbu- 

retted   hydrogen. — sulphuretted  hydrogen. — effluvia  of 
drains  and  sewers. 

Mode  of  Action  of  Gaseous  Poisons. — In  following  common  language, 
a  medical  jurist  is  compelled  to  apply  the  term  suffocation  to  another 
variety  of  death,  namely,  to  that  of  poisoning  by  gases.  Physiolo- 
gical accuracy  must  here  be  sacrificed,  in  order  that  we  may  make 
ourselves  generally  intelligible.  Thus,  if  a  person  die  from  the  ef- 
fects of  carbonic  acid,  of  confined  air,  of  sulphuretted  hydrogen,  or 
of  other  noxious  gases,  he  is  commonly  said  to  die  suffocated. 
Strictly  speaking,  he  dies  poisoned — as  much  so  as  if  he  had  taken 
oxalic  or  hydrocyanic  acid.  The  only  differences  are  :  1.  That  the 
poison,  instead  of  being  liquid  or  solid,  is  gaseous ;  and  2.  Instead 
of  being  applied  to  the  mucous  membrane  of  the  stomach,  it  affects 
that  of  the  air-cells  of  the  lungs.  In  the  action  of  arseniuretted  hy- 
drogen we  have  a  clear  instance  of  poisoning  by  a  gas,  and  in  the 
respiration  of  the  narcotic  vapors  of  chloroform  and  ether  we  have 
also  illustrations  of  this  form  of  poisoning.  Owing  to  the  fact  that 
the  poisonous  material  is  in  a  finely-divided  state,  and  that  in  the 
air-cells  of  the  lungs  it  meets  at  once  with  a  large  absorbing  surface, 
and  instantly  enters  the  blood,  the  effects  are  more  rapid,  andcasteris 
paribus,  more  powerful.  It  has  been  remarked,  too,  that  some  (and 
probably  all)  of  these  aerial  poisons  have  an  accumulative  action, 
i.  e.,  their  effects  continue  to  increase  for  a  short  period,  even  after  a 
person  has  ceased  to  respire  them. 

The  Cause  of  Death  Mistaken. — The  greater  number  of  the  poison- 
ous gases  are  chiefly  complex  products  of  art,  and  are  never  likely 
to  be  met  with  in  the  atmosphere  so  abundantly  as  to  produce  inju- 
rious consequences;  hence  fatal  accidents  arising  from  their  inhala- 
tion, most  commonly  occur  under  circumstances  which  can  leave  no 
question  respecting  the  real  cause  of  death.  The  peculiar  effects  of 
all  of  these  it  will  not  be  necessary  to  describe  in  this  place;  but 


THE    CAUSE    OF    DEATH    MISTAKEN.  381 

there  are  two  a  knowledge  of  the  properties  and  operation  of  which 
may,  on  certain  occasions,  be  required  of  a  medical  jurist ;  these  are 
the  carbonic  acid  and  sulphuretted  hydrogen  gases.  Agents 
of  this  description  can  rarely  be. employed  with  any  certainty  as  in- 
struments of  murder ;  and  if  they  were  so  employed,  the  fact  could 
be  established  only  by  circumstantial  evidence.  One  alleged  instance 
of  murder  by  carbonic  acid  is,  however,  reported  by  M.  Devergie. 
("  Ann.  d'Hyg."  1837,  vol.  1,  p.  201.)  Death,  when  arising  from  the 
respiration  of  any  of  the  gases,  is  generally  attributable  to  suicide 
or  accident.  In  France  it  is  by  no  means  uncommon  for  a  person  to 
commit  self-destruction  by  sleeping  in  a  closed  apartment,  in  which 
charcoal  has  been  suffered  to  burn ;  while  in  England  accidental 
deaths  are  sometimes  heard  of,  where  coal  or  coke  has  been  employed 
as  fuel  in  small  and  ill-ventilated  rooms.  On  such  occasions  a  per- 
son may  be  found  dead  without  any  apparent  cause  to  the  casual 
observer.  The  face  may  appear  pale  or  livid,  and  the  skin  may  be 
covered  with  patches  of  lividity.  The  discovery  of  a  body  under 
these  circumstances  will  commonly  be  sufficient  in  the  eyes  of  the 
vulgar,  to  create  a  suspicion  of  murder ;  and  some  person,  with  whom 
the  deceased  may  have  been  at  that  period  on  bad  terms,  will  per- 
haps be  pointed  out  as  the  murderer.  In  such  a  case,  it  is  obvious 
that  the  establishment  of  the  innocence  of  the  accused,  will  depend 
entirely  on  the  discrimination  and  judgment  of  a  medical  practi- 
tioner. An  instance,  illustrative  of  the  consequences  of  this  popu- 
lar prejudice,  occurred  in  London  in  1823.  Six  persons  were  lodg- 
ing in  the  same  apartment,  where  they  were  all  in  the  habit  of  sleep- 
ing. One  morning  an  alarm  was  given  by  one  of  them,  a  female, 
who  stated  that  on  rising  she  found  her  companions  dead.  Four 
were  discovered  to  be  really  dead,  but  the  fifth,  a  married  man,  whose 
wife  was  one  of  the  victims,  was  recovering.  He  was  known  to 
have  been  on  intimate  terms  with-the  woman  who  gave  the  alarm, 
and  it  was  immediately  supposed  that  they  had  conspired  together  to 
destroy  the  whole  party,  in  order  to  get  rid  of  the  wife.  The  woman 
who  was  accused  of  the  crime  was  imprisoned,  and  an  account  of 
the  supposed  barbarous  murder  was  soon  printed  and  circulated  in 
the  metropolis.  Many  articles  of  food  about  the  house  were  analyzed 
in  order  to  discover  whether  they  contained  poison,  when  the  cir- 
cumstances were  explained  by  the  man  stating  that  he  had  placed  a 
pan  of  burning  coals  between  the  two  beds  before  going  to  sleep, 
and  that  the  doors  and  windows  of  the  apartment  were  closed. 
(Christison,  p.  583.)  A  set  of  cases  of  a  similar  kind,  in  which 
there  was  at  first  a  strong  suspicion  of  poisoning,  has  been  reported 
in  the  "  Medical  Gazette,"  by  Mr.  Smith,  of  Liverpool  (vol.  3(5,  p. 
937;  see  also  "Ann.  d'Hyg.''  1843,  vol.  2,  p.  56). 

Carbonic  Acid. 

This  gas  is  freely  liberated  in  respiration,  combustion,  and  fer- 
mentation;  it  is  also  produced  in  the  calcination  of  chalk  or  lime- 
stone, and  is  sometimes  diffused  through  the  shafts  and  galleries  of 


382  CARBONIC    ACID.      SYMPTOMS. 

coal-mines,  where  it  is  commonly  called  "  choke-damp."  Carbonic- 
acid  gas  is  likewise  met  with  in  wells,  cellars,  and  other  excavations 
in  the  earth.  In  these  cases  it  is  generally  found  most  abundantly 
on  the  soil,  or  at  the  lower  part  of  the  well :  and  it  appears  to  pro- 
ceed from  the  decomposition  of  animal  and  vegetable  matters  con- 
fined in  such  situations.  The  slow  evaporation  of  water  strongly 
charged  with  the  gas,  while  trickling  over  the  sides  of  these  exca- 
vations, may  likewise  assist  in  contaminating  the  air.  Damp  sawdust 
or  straw  slowly  absorbs  oxygen  from  a  confined  atmosphere,  and 
sets  free  carbonic  acid. 

Sir  Humphrey  Davy  believed  that  carbonic  acid,  in  a  perfectly 
pure  state,  did  not  pass  into  the  trachea  when  an  attempt  was  made 
to  respire  it ;  the  glottis  seemed  to  close  spasmodically  at  the  moment 
that  the  gas  came  in  contact  with  it.  On  diluting  the  carbonic  acid 
with  about  twice  its  volume  of  air,  he  found  that  he  could  breathe 
it :  but  it  soon  produced  symptoms  of  giddiness  and  somnolency. 
In  a  diluted  state  there  is  no  doubt  that  it  penetrates  into  the  lungs. 
and  that  it  is  absorbed  and  circulated  with  the  blood.  In  estimating 
the  effects  of  this  gas  when  mixed  with  air,  a  distinction  must  be 
made.  The  gas  may  be  simply  added  to  the  air,  or  it  may  be  pro- 
duced at  the  expense  of.  the  oxygen  in  the  inclosed  space  or  apart- 
ment. In  the  latter  case,  it  must  be  remembered  that  every  volume 
of  carbonic  acid  thus  produced  represents  an  equal  volume  of  oxygen 
removed.  Such  an  atmosphere  is,  therefore,  more  destructive  than 
another  in  which  the  air  and  gas  are  in  simple  admixture.  If  we 
assume  that  in  each  case  the  noxious  atmosphere  contains  10  per 
cent,  of  carbonic  acid,  then  in  one  instance  there  will  be  7  per  cent, 
more  of  oxygen  and  7  per  cent,  less  of  nitrogen  than  in  the  other, 
since  the  production  of  10  parts  of  carbonic  acid  as  a  result  of  com- 
bustion implies  the  loss  of  10  parts  of  oxygen.  This  difference  in 
the  proportions  may  not  be,  practically  speaking,  correct,  because 
there  is  no  apartment  sufficiently  closed  to  prevent  air  rushing  in 
from  the  exterior  while  combustion  is  going  on  within  it ;  but,  never- 
theless, the  above  statement  may  be  taken  as  an  approximation  to 
the  truth. 

The  statements  made  by  chemists  and  physiologists,  respecting  the 
proportion  of  carbonic  acid  in  air  required  to  produce  noxious  or 
fatal  effects  on  human  beings,  are  very  conflictiug.  Small  animals, 
such  as  birds  and  mice,  have  been  generally  made  the  subject  of 
experiments,  but  the  results  thus  obtained  cannot  be  satisfactorily 
applied  to  show  the  relative  action  of  carbonic  acid  on  man.  Ber- 
zelius  stated  that  a  proportion  of  5  per  cent,  in  air  was  not  injurious, 
and  that  such  a  mixture  might  be  usefully  employed  in  the  treat- 
ment of  consumption.  ("  Traite  de  Chimie,"  t.  2,  p.  83.)  Allen  and 
Pepys  inferred,  from  their  experiments  on  guinea-pigs,  that  10. per 
cent,  of  the  gas  would  prove  fatal  to  man.  In  the  more  recent  ex- 
periments of  Bernard  this  inference  is  corroborated  by  the  fact  that 
a  bird  died  in  two-and-a-half  hours  in  an  atmosphere  consisting  (in 
100  parts)  of  9.5  of  carbonic  acid,  28  of  oxygen,  62.5  of  nitrogen. 
("Les  Substances  Toxiques,"  1857,  p.  135.)     In  this  case  the  pro- 


POISONOUS    PROPORTIONS.  383 

portion  was  less  than  10  per  cent.,  while  the  proportion  of  oxygen 
was  7  per  cent,  more  than  that  existing  in  the  atmosphere.  On  the 
other  hand,  Demarquay  says  that  one  part  of  carbonic  acid  and  three 
parts  of  air  (25  per  cent.)  produce  in  man  but  slight  discomfort  after 
being  breathed  for  some  time.  According  to  this  writer,  most  of  the 
accidents  caused  by  charcoal-vapor,  confined  air,  and  gases  in  fer- 
menting vats,  are  wrongly  ascribed  to  carbonic  acid,  and  should  be 
attributed  to  carbonic  oxide,  sulphuretted  hydrogen,  alcoholic  vapors, 
or  other  gases  not  yet  understood.  ("  Chem.  News,"  Aug.  4,  1865.) 
Those  who  have  employed  mixtures  of  carbonic  acid  and  air  for 
anaesthetic  purposes  have  stated  that  air  containing  20  per  cent,  of 
carbonic  acid  may  be  breathed  without  any  injurious  effects.  Such 
a  mixture  would  be  composed  (in  100  parts)  of  20  of  carbonic  acid, 
16  of  oxygen,  and  64  of  nitrogen.  In  this  mixture,  if  carefully 
made,  oxy-combustion  cannot  be  maintained ;  hence,  if  there  was  no 
error  in  the  above  proportions,  it  follows  that  a  man  can  breathe 
with  safety  and  live  in  air  in  which  a  candle  will  not  burn.  Ber- 
nard's carefully  performed  experiments  are  adverse  to  these  state- 
ments. He  found  that  animals  died  in  atmospheres  in  which  the 
proportion  of  carbonic  acid  varied  from  12  to  18  per  cent.,  while  the 
amount  of  oxygen  varied  from  5  to  30  per  cent.  ("Les  Substances 
Toxiques,"  p.  140.)  When  it  is  asserted  that  a  person  can  thus 
breathe  with  impunity  proportions  which  are  fatal  to  life,  it  would 
be  desirable  to  know  how  such  mixtures  were  made,  and  whether 
proper  care  had  been  taken  to  prevent  respiration  of  air  by  the 
mouth  and  nostrils  while  the  supposed  poisonous  mixture  was  being- 
inhaled.  Such  statements,  founded  on  imperfect  experiments,  are 
highly  mischievous,  for  they  may  lead  to  death  in  cases  in  which 
the  mixture  is  accurately  made,  and  administered  to  a  person  whose 
mouth  and  nostrils  are  closed  against  the  ordinary  atmosphere.  If 
air  can  be  breathed  simultaneously,  there  is  an  end  of  the  alleged 
poisonous  proportion. 

Symptoms. — The  symptoms  of  poisoning  by  carbonic  acid  vary 
according  to  the  proportion  in  the  air  which  is  breathed.  In  a  con- 
centrated state  there  is  sudden  insensibility,  followed  by  death,  unless 
the  person  is  immediately  removed  into  pure  air.  When  the  air  is 
gradually  poisoned,  and  contains  its  lowest  poisonous  proportion, 
insensibility  comes  on  more  slowly,  and  as  in  ordinary  narcotic  poi- 
soning is  preceded  by  giddiness,  somnolency,  and  loss  of  muscular 
power.  When  the  gas  is  in  a  fatal  proportion  the  symptoms  com- 
monly observed  are  as  follows:  A  sensation  of  great  weight  in  the 
head,  a  sense  of  pressure  in  the  temples,  a  ringing  in  the  ears,  with 
a  pungent  sensation  in  the  nose ;  a  strong  tendency  to  sleep,  accom- 
panied by  giddiness,  and  so  great  a  loss  of  muscular  power  that,  if 
the  person  be  at  the  time  in  an  erect  posture,  he  instantly  falls  to 
the  ground  as  if  struck.  The  breathing,  which  is  observed  to  be  at 
first  difficult  and  stertorous  (snoring),  becomes  suspended.  The  ac- 
tion of  the  heart,  which  on  the  first  accession  of  the  symptoms  is 
very  violent,  soon  ceases :  sensibility  is  lost,  and  the  person  now 
falls  into  a  profound  coma,  or  state  of  apparent  death.     The  warmth 


38-4  POST-MORTEM    APPEARANCES. 

of  the  body  still  continues :  the  limbs  are  relaxed  and  flexible,  but 
they  have  been  observed  in  some  instances  to  become  rigid,  or  even 
occasionally  convulsed.  The  countenance  is  livid  or  of  a  leaden 
color,  especially  about  the  eyelids  and  lips,  but  on  some  occasions 
it  has  been  pale  and  placid.  The  access  of  these  symptoms  is  stated 
to  have  been  sometimes  accompanied  by  a  pleasing  sensation  of  de- 
lirium, while  at  others  the  most  acute  pains  have  been  suffered.  In 
some  instances  there  appears  to  have  been  irritability  of  the  stomach, 
for  the  affected  person  has  vomited  the  contents  of  his  stomach 
in  a  semi-digested  state.  Those  who  have  been  resuscitated  have 
felt  pain  in  the  head,  or  pain  and  soreness  over  the  body  for  several 
days :  while,  in  a  few  severe  cases,  paralysis  of  the  muscles  of  the 
face  has  supervened  on  recovery. 

Post-mortem  Apjiearances. — In  some  instances  the  face  has  been 
found  livid  and  swollen  and  the  features  distorted,  but  more  gene- 
rally it  has  been  pale  and  placid,  as  if  the  person  had  died  without 
a  struggle  in  the  position  in  which  his  body  was  found.  The  skin 
is  sometimes  livid,  or  presents  patches  of  lividity,  and  the  limbs  are 
quite  flaccid.  The  pupils  have  been  found  dilated.  Internally,  the 
venous  system  is  filled  with  liquid  blood  of  a  dark  color.  In  death 
from  carbonic  acid  as  a  result  of  combustion,  the  blood  has  some- 
times had  a  light-red  color.  The  vessels  of  the  lungs  and  brain  are 
observed  to  be  especially  in  a  state  of  congestion.  The  tongue  ap- 
pears swollen,  and  sometimes  the  mucous  membrane  of  the  intestinal 
canal  presents  dark  ecchymosed  patches.  The  following  appearances 
were  met  with  thirty  hours  after  death  in  the  bodies  of  two  adults, 
male  and  female,  who  died  from  the  accidental  introduction  of  car- 
bonic acid  into  their  bedroom  from  burning  ashes.  Externally  there 
was  nothing  unnatural,  excepting  a  few  slight  discolorations  on  the 
back  of  the  man ;  internally  there  was  congestion  of  the  membranes 
and  great  vessels  of  the  brain.  Each  lateral  ventricle  contained 
about  half-an-ounce  of  clear  serum;  the  lungs  were  gorged  with 
dark  blood :  and  the  lining  membrane  of  the  air-tubes  (bronchi)  was 
slightly  reddened.  The  left  sides  of  the  heart  were  nearly  empty  : 
the  right  contained  a  quantity  of  dark  half-coagulated  blood.  The 
stomachs  were  healthy.  The  bodies  were  found  on  the  floor  of  the 
bedroom  in  easy  positions.  The  deceased  persons  had  had  the  power 
to  get  out  of  bed,  but  were  unable  to  escape  from  the  chamber.  It 
will  be  perceived  from  this  description  that  there  is  nothing  very 
characteristic  in  the  appearances,  and  thus  it  is  always  easy  to  as- 
cribe death  to  apoplexy  or  some  other  cause ;  but  it  should  be  re- 
membered that  carbonic  acid  itself  is  a  narcotic  poison,  inducing 
cerebral  congestion  and  apoplexy. 

Analysis. — Sometimes  a  medical  jurist  may  be  required  to  state, 
for  the  purposes  of  justice  the  nature  of  the  gaseous  mixture  in 
which  a  person  may  have  died.  There  will  be  no  difficulty  in  de- 
termining whether  carbonic  acid  is  or  is  not  the  deleterious  agent  in 
such  a  mixture.  When  it  exists  in  a  confined  atmosphere  its  pre- 
sence may  be  identified,  if  previously  collected  in  a  proper  vessel,  by  ( 
the  following  characters  :   1.  It  extinguishes  a  taper  if  the  propor- 


DEATH    FROM    CARBONIC    ACID.  385 

tion  be  above  12  or  15  per  cent.  2.  Lime-water,  or  a  solution  of 
subacetate  of  lead,  is  instantly  precipitated  white  when  poured  into 
a  jar  of  the  gas  ;  and  the  precipitate  thus  formed  may  be  collected 
by  filtration,  and  proved  to  possess  the  well-known  properties  of 
carbonate  of  lime  or  lead.  Air  containing  only  1  per  cent,  of  car- 
bonic acid  affects  lime-water:  if  it  amounts  to  2  per  cent,  a  few 
cubic  inches  will  suffice  to  show  its  presence  by  the  lime-water  test. 
The  pro-portion  in  which  carbonic  acid  exists  in  a  mixture  may  be 
determined  by  introducing  into  a  measured  quantity,  in  a  graduated 
tube  over  mercury,  a  strong  solution  of  potash.  Absorption  will 
take  place  after  a  certain  time,  and  the  degree  of  absorption  will  in- 
dicate the  proportion  of  carbonic  acid  present.  When  this  gas  exists 
in  a  confined  spot,  as  in  a  well  or  cellar,  it  may  be  got  rid  of  by 
placing  within  the  stratum,  a  pan  containing  the  hydrate  of  lime 
loosely  mixed  with  water  ;  by  exciting  combustion  at  the  mouth  of 
the  pit;  or,  what  is  better  when  available,  by  a  jet  of  high-pressure 
steam.  Lives  are  often  successively  lost  on  these  occasions,  in  con- 
sequence of  one  person  descending  after  another,  in  the  foolish  ex- 
pectation of  at  least  being  able  to  attach  a  rope  to  the  body  of  his 
companion.  The  moment  that  the  mouth  comes  within  the  level  of 
the  invisible  stratum  of  gas,  muscular  power  is  lost,  and  the  person 
commonly  sinks  lifeless.  Carbonic  acid  may  be  collected  for  the 
purpose  of  testing  by  lowering  a  bottle  filled  with  fine  sand,  by 
means  of  a  string  attached  to  the  neck,  and  guiding  the  bottle  by 
another  string  attached  to  its  base.  When  the  bottle  is  within  the 
stratum,  it  should  be  turned  with  its  mouth  downwards ;  and  when 
the  sand  has  fallen  out,  it  may  be  rapidly  raised,  with  its  mouth  up- 
wards, by  pulling  the  string  attached  to  the  neck. 

Combustion  in  Mixtures  containing  Carbonic  Acid. — In  reference  to 
suffocation  by  carbonic  acid,  there  is  one  circumstance  which  requires 
attention.  It  is  a  matter  of  popular  belief — and,  in  fact,  it  is  gener- 
ally asserted  by  writers  on  asphyxia — that  the  burning  of  a  candle 
in  a  suspected  mixture  of  carbonic  acid  and  air,  is  a  satisfactory 
proof  that  it  may  be  respired  with  safety.  The  results  of  some 
experiments  on  this  subject  have  led  me  to  the  conclusion  that  a 
candle  will  barn  in  air  which  is  combined  with  even  10  or  12  per 
cent,  of  its  volume  of  carbonic  acid  gas;  and  although  such  mix- 
tures might  not  prove  immediately  fatal  to  man,  yet  they  would  soon 
give  rise  to  giddiness,  insensibility,  and  ultimately  death,  in  those 
who,  after  having  been  once  immersed  in  them,  did  not  hasten  to 
quit  the  spot.  In  air  containing  a  smaller  proportion  than  this  (5  or 
6  per  cent.),  a  candle  will  readily  burn,  but  it  is  probable  that  such  a 
mixture  could  not  be  long  respired  without  causing  serious  symp- 
toms ;  hence  the  burning  of  a  candle  can  be  no  criterion  of  safety  against 
the  effects  of  carbonic  acid.  It  is  true  that  in  gaseous  mixtures, 
where  a  candle  is  extinguished,  it  would  not  be  safe  to  venture  ;  but 
the  converse  of  this  proposition  is  not  true — namely,  that  a  mixture 
in  which  a  candle  burns  may  be  always  respired  with  safety.  It  has 
been  observed  on  several  occasions  that  the  combustion  of  charcoal 
25 


386  CHAECOAL    VAPOR. 

lias  been  maintained  in  a  room  in  which  persons  have  been  found  in 
a  state  of  insensibility  from  breathing  the  vapors. 

Charcoal-vapor.     Carbonic  Oxide. 

The  vapor  extricated  during  the  combustion  of  charcoal  is  not 
pure  carbonic  acid,  but  a  mixture  of  gases.  It  operates  fatally  when 
respired,  partly  in  consequence  of  the  carbonic  acid  contained  in  it, 
and  partly  from  the  presence  of  a  variable  proportion  of  carbonic 
oxide.  The  proportion  of  these  gases,  however,  is  subject  to  varia- 
tion, according  to  whether  the  combustion  is  vivid  or  not.  When 
the  charcoal  burns  vividly,  the  quantity  of  carbonic  acid  was  found 
by  Orfila  to  be  less  than  when  it  is  either  nearly  extinguished-  or 
beginning  to  burn.  In  the  former  case  the  carbonic  acid  was  in  the 
proportion  of  about  11  per  cent,  by  volume — in  the  latter  the  pro- 
portion amounted  to  about  14  per  cent.  Leblanc  found  that  charcoal 
burning  in  the  open  air  produced  about  §  per  cent,  of  carbonic  oxide. 
There  is  no  doubt  that  a  low  or  imperfect  combustion  is  more  favor- 
able to  the  production  of  this  gas,  and  it  is  considered  to  operate 
more  powerfully  on  the  body  than  carbonic  acid.  According  to 
Leblanc  a  bird  was  killed  instantly  by  breathing  an  air  containing 
4  or  5  per  cent,  of  carbonic  oxide ;  only  1  per  cent,  sufficed  to  cause 
death  in  two  minutes.  ("Ann.  d'Hyg."  1843,  vol.  2,  p.  54.)  Char- 
coal-vapor may  be  regarded  as  a  mixture  of  carbonic  acid,  carbonic 
oxide,  aqueous  vapor,  and  air  partially  deoxidized.  There  is  also 
associated  with  it,  at  a  low  temperature,  a  small  quantity  of  car- 
buretted  hydrogen.  This  does  not  appear  to  take  any  part  in  the 
fatal  effects  produced  by  the  vapor  :  these  are  owing  to  the  action  of 
carbonic  acid  and  carbonic  oxide,  and  according  to  Bernard  a  mixture 
of  the  two  is  more  destructive  than  either  gas  separately.  ("  Les 
Substances  Toxiques,"  p.  212.)  M.  Leblanc  endeavors  to  determine 
the  proportion  of  the  gases  in  charcoal-vapor  when  this  was  in  such 
a  condition  as  to  prove  fatal  to  animal  life.  The  vapor  was  conducted 
from  some  fully  ignited  fuel  into  an  inclosed  space  in  which  there 
was  a  middle-sized  dog  whose  condition  could  be  watched.  In  ten 
minutes  the  animal  fell  exhausted,  and  in  twenty  minutes  it  died, 
after  some  hard  breathiug.  A  candle  burnt  with  its  usual  brightness 
in  the  closed  room,  and  it  was  only  ten  minutes  after  the  death  of 
the  dog,  that  the  flame  of  the  candle,  from  becoming  paler  and  paler, 
was  extinguished.  The  air  of  the  chamber  was  at  this  time  collected 
and  analyzed :  it  contained,  in  100  parts — carbonic  acid,  4.61 ;  car- 
bonic oxide,  0.54;  carbur  tted  hydrogen,  0.04;  oxygen,  19.19;  and 
nitrogen,  75.62.  It  would  thus  appear  that  less  than  5  per  cent,  of 
carbonic  acid  is  fatal  to  life  when  so  little  as  \  per  cent,  of  carbonic 
oxide  is  mixed  with  it.  (Bernard,  op.  cit.  p.  159.)  The  burning  of 
a  candle  under  the  circumstances  will  also  show  that  oxy-combustion 
may  be  maintained  in  a  mixture  by  which  an  animal  is  killed,  and 
therefore  that  combustion  can  furnish  no  criterion  of  safety  in  apart- 
ments in  which  charcoal  has  been  burnt. 

Symptoms  and  Appearances  after  Death. — The  following  case,  illus- 


SYMPTOMS    AND    APPEARANCES.  387 

trating  the  effects  of  charcoal-vapor,  occurred  to  Mr.  Collambell. 
("  Med.  Gaz."  vol.  27,  p.  693.)  In  January,  1841,  a  man  was  engaged 
to  clean  the  windows  of  three  small  rooms  on  the  basement-floor  of 
a  house.  The  first  room  had  a  door  opening  into  a  court-yard;  the 
others  merely  communicated  with  each  other  by  a  central  door,  and 
there  was  no  fireplace  in  any  one  of  them.  A  brazier  of  burning 
charcoal  had  been  placed  in  the  outer  room  for  the  purpose  of  drying 
it,  but  it  appeared  that  the  deceased  had  shut  the  outer  door,  and  had 
removed  the  brazier  into  the  inner  room  of  the  three,  leaving  the 
communicating  doors  open.  In  two  hours  the  man  was  found  quite 
dead,  lying  on  the  floor  of  the  middle  room.  The  countenance  was 
pale,  as  well  as  the  whole  of  the  skin;  the  eyes  were  bright  and 
staring,  the  pupils  widely  dilated,  the  lips  bloodless,  the  jaws  firmly 
fixed,  the  tongue  protruding,  and  the  face  and  the  limbs  were  cold. 
Some  frothy  mucus  had  escaped  from  the  mouth.  The  person  who 
discovered  the  deceased  found  the  ashes  in  the  brazier  still  burning, 
and  he  experienced  great  oppression  in  breathing.  An  inquest  was 
held,  but  without  an  inspection  of  the  body,  and  a  verdict  of  "acci- 
dental death"  returned.  The  body  was  afterwards  privately  inspected 
by  Dr.  Collambell.  On  opening  the  head  the  vessels  on  the  surface 
of  the  brain  were  found  much  distended  with  dark  liquid  blood ;  the 
pia  mater  was  bedewed  with  serum.  The  brain  was  of  unusually 
firm  consistency,  and  numerous  bloody  points  appeared  on  making 
a  section  of  it.  The  lateral  ventricles  were  distended  with  about  an 
ounce  and  a  half  of  pale  serum,  and  the  vessels  of  the  plexus 
choroides  were  much  congested.  The  cerebellum  was  firm,  and 
presented  on  section  numerous  bloody  points.  About  two  ounces  of 
serum,  tinged  with  blood,  were  collected  from  the  base  of  the  skull. 
The  lungs  had  a  slate  color.  On  the  left  side  of  the  chest  there  were 
eight  ounces  of  serum  tinged  with  blood,  and  nearly  an  equal 
quantity  on  the  right  side.  On  cutting  into  the  organs,  a  large 
quantity  of  serous  fluid,  mixed  with  blood,  escaped.  The  bronchial 
tubes  were  filled  with  a  frothy  fluid  tinged  with  blood.  The  peri- 
cardium contained  an  ounce  of  pale  serum ;  the  heart  was  enlarged, 
its  cavities  contained  no  blood ;  the  liver  and  kidneys  were,  however, 
much  gorged.  There  was  no  doubt  that  the  cause  of  death  was  the 
inhalation  of  charcoal- vapor ;  and  it  is  probable  that  the  man  died 
from  respiring  but  a  comparatively  small  proportion.  The  capacity 
of  the  chambers  must  have  nearly  reached  two  thousand  cubic  feet ; 
the  deceased  had  been  there  only  two  hours,  and  when  the  person 
who  discovered  him  entered  the  rooms,  the  air  was  not  so  vitiated 
but  that  he  could  breathe,  although  with  some  oppression.  The  fuel 
was  then  in  a  state  of  combustion.  In  a  case  of  death  from  charcoal- 
vapor,  which  was  referred  to  me  for  examination  in  1851,  there  was 
a  considerable  effusion  of  blood  in  the  submucous  tissue  of  the 
stomach.  This  appearance  led  to  a  strong  suspicion  of  irritant 
poisoning.  A  full  investigation  of  the  circumstances,  however, 
showed  that  the  suspicion  was  unfounded.  The  vapor  had  descended 
through  a  flue  communicating  with  the  bedroom  in  which  deceased 
slept  with  her  husband ;  it  destroyed  the  wife,  and  nearly  killed  the 


388  CHARCOAL    VAPOR. 

husband.  A  stove  with  burning  charcoal  had  been  placed  in  the 
room  above  that  in  which  the  couple  slept,  and  an  iron  pipe  conveyed 
the  products  of  combustion  into  a  flue,  whence  they  descended  into 
the  bedroom  and  caused  the  fatal  accident.  In  one  fatal  case  there 
was  copious  bleeding  from  the  nose.  ("Med.  Gaz."  vol.  47,  p.  412.) 
In  a  case  which  occurred  to  M.  Guerard  the  liver  and  spleen  were 
found  gorged  with  a  dark  liquid  blood;  the  heart  was  collapsed  and 
its  cavities  were  empty,  but  liquid  and  dark-colored  blood  flowed 
from  the  large  vessels.  The  windpipe  and  bronchi  had  a  red  color, 
and  were  filled  with  frothy  mucus.  The  membranes  of  the  brain 
were  congested,  and  the  sinuses  gorged  with  fluid  blood.  The  face 
was  pale,  the  eyelids  were  closed,  and  the  pupils  natural.  There 
were  livid  patches  over  the  body.  ("  Ann.  d'Hyg."  1843,  vol.  2,  p.  57.) 
It  often  excites  surprise  on  these  occasions  that  no  exertion  is 
made  to  escape,  when  it  would  apparently  require  but  slight  efforts 
on  the  part  of  the  person  affected.  The  action  of  this  vapor  is  very 
insidious ;  one  of  its  first  effects  is  to  create  an  utter  prostration  of 
strength,  so  that  even  on  a  person  awake  and  active,  the  gas  may 
speedily  produce  a  perfect  inability  to  move  or  to  call  for  assistance. 
For  a  case  illustrative  of  t»he  dangerous  effect  of  the  diluted  vapor, 
see  "Ed.  Med.  and  Surg.  Journ."  vol.  1,  p.  541.  In  this  instance  a 
charcoal  brazier  was  left,  only  for  a  short  time,  in  the  cell  of  a  prison. 
It  was  removed,  and  the  prisoners  went  to  sleep.  They  experienced 
no  particular  effects  at  first,  but  after  some  hours  two  were  found 
dead.  Thus,  then,  an  atmosphere  which  can  be  breathed  for  a  short 
time  with  impunity  may  ultimately  destroy  life. 

M.  Devergie  has  shown  that  the  smothered  combustion  of  wood 
may  lead  to  the  evolution  of  a  noxious  vapor  (carbonic  oxide),  and 
give  rise  to  dangerous  consequences.  ("  Ann.  d'Hyg.,"  1835,  vol.  1, 
p.  442.)  His  remarks  have  been  recently  confirmed  by  two  cases 
published  by  MM.  Bayard  and  Tardieu.  A  man  and  his  wife  were 
found  dead  in  bed.  There  was  a  smoky  vapor  in  the  apartment,  but 
no  fire  had  been  lighted  in  the  grate,  and  the  chimney  was  blocked 
up.  The  planks  of  the  floor  were  widely  separated,  and  there  was 
a  large  hole  in  the  boards  at  the  foot  of  the  bed  communicating  with 
the  apartment  below.  It  was  found,  on  examination,  that  some  joists 
connected  with  the  flue  of  an  iron  plate,  which  had  been  heated  for 
making  confectionery  the  previous  day,  were  in  a  smouldering  state  : 
that  the  vapor  had  entered  the  bedroom  of  the  deceased  through  the 
crevices  in  the  floor,  and,  not  finding  a  vent  by  the  chimney,  had  led 
to  these  fatal  results.  It  is  remarkable  that  the  source  of  combus- 
tion was  nearly  nine  yards  distant,  and  one  person,  who  slept  nearer 
to  the  flue  of  the  iron  plate,  entirely  escaped.  In  the  body  of  the 
husband  the  skin  was  of  a  reddish  tint,  the  blood  liquid,  the  cavities 
of  the  heart  empty,  the  lungs  gorged,  and  there  were  no  subpleural 
ecchymoses.  In  the  body  of  the  wife  there  was  less  redness  of  the 
skin,  the  blood  was  coagulated  in  the  cavities  of  the  heart,  princi- 
pally on  the  right  side  extending  to  the  vessels;  less  engorgement  of 
the  lungs,  and  a  great  number  of  subpleural  ecchymoses,  indicating 
that  strong  efforts  had  been  made  to  respire.     There  was  at  first  a 


CARBONIC    OXIDE.  389 

rumor  of  poisoning,  which  was  only  removed  by  a  close  examina- 
tion of  the  locality.     ("Ann.  d'Hyg.,"  Oct.  1845,  p.  369.) 

It  may  be  observed  in  reference  to  this  vapor,  that  when  produced 
from  burning  charcoal  or  wood — in  spite  of  the  great  density  of  car- 
bonic acid,  the  noxious  gas  is  diffused  rapidly  throughout  the  whole 
of  an  apartment.  This  is  owing  partly  to  the  effect  of  the  heated 
current  of  air,  and  partly  to  the  law  of  the  diffusion  of  gases, 
whereby  heavy  and  light  gases  are  soon  uniformly  intermixed. 

Carbonic  Oxide. — The  noxious  effects  of  the  vapor  of  burning 
charcoal  are  considered  to  be  partly  due  to  the  presence  of  carbonic 
oxide.  The  action  of  this  gas  upon  animal  life  has  been  made  a 
subject  of  experiment  by  Bernard  ("Lecons  sur  les  Substances  Tox- 
iques,"  p.  16-4.)  An  atmosphere  containing  from  5  to  6  per  cent,  of 
it  will  destroy  life.  The  blood  is  brightened  in  color  by  this  gas, 
while  it  is  darkened  by  carbonic  acid.  Bernard  has  observed  that 
this  bright  color  has  been  retained  for  three  weeks ;  and  he  consid- 
ers the  mode  of  action  of  this  gaseous  poison  to  be,  that  it  prevents 
the  arterial  blood  of  the  body  from  becoming  venous,  while  carbonic 
acid  operates  by  preventing  the  venous  blood  from  becoming  arterial. 
(Op.  cit.,  pp.  182,  195.) 

This  condition  of  the  blood  as  a  result  of  the  action  of  carbonic 
oxide  may  occasion  some  doubt  of  the  cause  of  death,  in  cases  of 
suffocation  by  fire.  In  April,  1858,  an  inquiry  took  place  into  the 
cause  of  death  of  fourteen  persons,  owing  to  a  fire  in  a  house  in 
Bloomsbury.  The  medical  witness,  on  examining  the  bodies,  found 
a  redness  of  the  muscles  and  a  redness  of  the  blood.  He  therefore 
thought  that  death  was  not  caused  by  suffocation,  but  from  the  inha- 
lation of  arsenical  vapors,  owing  to  some  minerals  containing  arsenic 
having  been  partially  consumed  during  the  fire.  But  there  was  a 
total  want  of  evidence  to  show  that  the  vapors  of  arsenic,  when 
breathed,  would  cause  death  so  speedily  as  the  noxious  gases  evolved 
by  fire,  or  that  they  would  redden  the  blood  and  muscles.  On  the 
other  hand,  the  respiration  of  carbonic  oxide  would  explain  these 
facts.  It  is  worthy  of  remark  that  in  many  of  the  observed  cases 
of  death  from  charcoal-vapor,  the  blood  has  had  a  darker  color  than 
natural :  the  greater  solubility  of  carbonic  acid,  and  the  larger  pro- 
portion in  which  it  is  produced,  may  account  for  this  effect. 

The  action  of  carbonic  oxide  on  the  body  is  that  of  a  pure  nar- 
cotic poison.  M.  Tourdes  has  ascertained  that  rabbits  died  in  twenty- 
three  minutes,  when  kept  in  an  atmosphere  containing  l-15th  of  its 
volume  of  pure  carbonic  oxide ;  when  the  proportion  was  l-30th 
they  died  in  thirty-seven  minutes,  and  when  l-8th  in  seven  minutes. 
Dr.  Letheby  states  that  in  his  experiments  a  mixture  of  J  per  cent, 
killed  small  birds  in  three  minutes,  and  of  1  per  cent,  in  about  half 
this  time.  The  animals  showed  no  sign  of  pain:  they  fell  in  a  state 
of  insensibility,  and  either  died  at  once,  without  convulsions,  or  they 
gradually  passed  into  a  state  of  profound  coma.  He  found,  on  in- 
spection, that  the  blood  was  redder  than  usual,  that  the  muscles  of 
the  heart  were  somewhat  gorged,  and  that  the  brain  was  congested. 
("Lancet,"  March  1,  1862,  p.  219.)     I)r.  Hoppe-Seyler  states  that 


390  VAPORS    OF    COAL    AND    COKE. 

animals  which  had  been  made  to  breathe  carbonic  oxide  were  restored 
by  continuing  for  some  time  artificial  respiration,  and  under  these 
circumstances,  the  gas  was  expired  as  carbonic  acid,  having  under- 
gone further  oxidation  in  the  blood.  This  writer  has  suggested  a 
method  for  detecting  the  presence  of  carbonic  oxide  in  the  blood  by 
spectral  analysis.    ("  Chem.  News,"  Aug.  1,  1865,  p.  58.) 

Coal  and  Coke  Yapors.    Sulphuric  Acid. 

Products  from  Burning  Coal  and  Colce. — The  gases  extricated  in 
the  smothered  combustion  of  coal  or  coke  are  of  a  compound  nature. 
In  addition  to  carbonic  acid  and  carbonic  oxide,  we  may  expect  to 
find  in  the  atmosphere  of  a  close  room  in  whic  such  a  combustion 
has  been  going  on,  sulphurous  acid  gas,  and  from  coal,  in  addition 
to  this,  the  sulphuretted  and  carburetted  hydrogen  gases.  These 
emanations  are  equally  fatal  to  life ;  but  in  consequence  of  their 
very  irritating  properties  they  give  warning  of  their  presence,  and 
are  therefore  less  liable  to  occasion  fatal  accidents.  From  an  acci- 
dent which  occurred  at  Colchester  a  few  years  since,  in  which  two 
children  lost  their  lives,  it  would  appear  that  some  persons  are  so 
ignorant  as  to  believe  that  the  vapor  of  coke  is  less  fatal  than  the 
vapor  of  charcoal.  The  sulphurous  acid  gas,  when  existing  in  a 
small  proportion  in  air,  has  the  effect  of  irritating  the  air-passages 
so  violently  that,  if  accidentally  respired,  it  would  commonly  compel 
the  person  to  leave  the  spot  before  the  vapors  had  become  sufficiently 
concentrated  to  destroy  life.  Nevertheless,  accidents  from  the  com- 
bustion of  coal  and  coke  sometimes  occur. 

/Symptoms  and  Appearances. — The  following  cases  will  convey  a 
knowledge  of  the  symptoms  and  appearances  which  may  be  met  with 
on  these  occasions.  Some  years  since  four  persons,  in  a  state  of 
asphyxia,  were  brought  into  Gay's  Hospital.  It  appeared  that  on 
the  previous  evening  they  had  shut  themselves  up  in  the  forecastle 
of  a  coal-brig,  and  had  made  a  fire.  About  six  or  seven  o'clock  on 
the  same  evening,  some  of  the  crew  accidentally  placed  a  covering 
over  the  flue  on  the  outside,  and  thus  stopped  the  escape  of  smoke 
from  the  fire,  which  was  made  of  a  kind  of  coal  containing  much 
sulphur.  Early  in  the  morning  one  of  the  crew,  on  opening  the 
hatches,  observed  three  of  the  inmates  lying  on  the  floor  senseless 
and  frothing  at  the  mouth,  and  the  fourth  in  his  crib  in  a  similar 
condition.  The  air  in  the  place  was  most  offensive.  After  the  men 
were  brought  on  deck  one  of  them,  aged  21,  began  to  recover,  and 
when  brought  to  the  hospital  he  seemed  only  giddy,  as  if  intoxi- 
cated ;  he  soon  completely  recovered.  Another,  aged  40,  after  breath- 
ing oxvgen-gas  and  having  brandy  and  ammonia  administered  to 
him,  showed  no  symptoms  of  recovery,  but  died  in  a  few  hours.  A 
third,  aged  17,  soon  began  to  rally,  and  in  a  short  time  he  was  able 
to  answer  questions ;  he  declared  that  at  the  time  of  the  accident  he 
felt  no  pain,  sense  of  oppression,  or  weight,  either  in  his  head  or 
chest.  The  fourth,  aged  15,  died  the  following  day.  having  shown 
no  symptoms  of  rallying.     Stimulants  were  administered  and  warm 


VAPORS    OF    LIME    AND    BRICK-KILNS.  391 

fomentations  were  used,  but  all  efforts  to  produce  reaction  failed. 
The  appearances  presented  by  these  persons  when  brought  in,  were 
as  follows :  The  lips  were  purple,  the  countenance  was  livid,  and 
the  surface  of  the  body  cold;  the  hands  and  nails  were  purple;  the 
breathing  was  quick  and  short — the  pulse  small,  quick,  and  feeble ; 
the  pupils  were  fixed,  and  there  was  total  insensibility.  The  body 
of  the  man  aged  40  was  inspected  four  hours  after  death.  The  mem- 
branes of  the  brain  were  congested,  and  there  was  a  large  quantity 
of  fluid  under  the  arachnoid  or  middle  membrane ;  the  sinuses  were 
gorged  with  blood ;  the  lungs  were  in  a  state  of  great  congestion,  as 
were  also  the  right  cavities  of  the  heart.  It  was  remarked  that,  in 
its  congested  condition,  this  corpse  was  similar  in  appearance  to  that 
of  an  executed  culprit.  The  body  of  the  lad  aged  15  was  inspected 
about  thirty-three  hours  after  death.  Under  the  pia  mater  or  inner 
membrane  of  the  brain  was  observed  one  small  ecchymosed  spot; 
in  the  substance  of  the  brain  there  were  more  bloody  points  than 
usual :  a  small  quantity  of  fluid  was  found  under  the  arachnoid  mem- 
brane, and  the  sinuses  were  full  of  coagulated  blood.  The  lungs 
showed  no  congestion,  but  the  right  cavities  of  the  heart  were  much 
distended  with  blood.  (For  a  report  of  cases  of  recovery  from  the 
effects  of  coal- vapor,  see  "Med.  Gaz."  vol.  9,  p.  935;  also  "Dub.  Med. 
Press,"  Jan.  31,  1849,  p.  69,  and  "Med.  Gaz,"  vol.  43,  p.  937.) 

Vapors  of  Lime,  Brick,  and  Cement-Kilns. 

Gaseous  Products  from  Lime-hurning . — In  the  burning  of  lime  car- 
bonic acid  is  given  out  abundantly,  but,  owing  to  the  nature  of  the  fuel 
used,  carbonic  oxide  and  sulphurous  acid  are  mixed  with  it.  Per- 
sons who  have  incautiously  slept  in  the  neighborhood  of  a  burning 
lime-kiln  during  a  winter's  night,  have  been  destroyed  by  the  respi- 
ration of  these  vapors.  The  discovery  of  a  dead  body  in  such  a 
situation  would  commonly  suffice  to  indicate  the  real  cause  of  death ; 
but  a  practitioner  ought  not  to  be  the  less  prepared  to  show  that 
there  existed  no  other  apparent  cause  of  death  about  the  person.  It 
is  obvious  that  a  person  might  be  murdered,  and  the  body  placed 
subsequently  near  a  kiln  by  the  murderer  in  order  to  avert  suspi- 
cion. If  there  are  no  marks  of  external  violence,  the  stomach  should 
be  carefully  examined  for  poison ;  in  the  absence  of  all  external  and 
internal  injuries,  medical  evidence  will  avail  but  little ;  for  a  person 
might  be  criminally  suffocated,  and  his  body,  if  found  under  the 
circumstances  above  stated,  would  present  scarcely  any  appearances 
upon  which  a  medical  opinion  could  be  securely  based.  The  vapors 
of  brick-kilns  are  equally  deleterious,  the  principal  agent  being  car- 
bonic acid  mixed  with  carbonic  oxide ;  although  I  have  found 
that,  according  to  the  stage  of  combustion  of  the  fuel,  ammonia, 
hydrochloric  acid,  sulphuretted  hydrogen,  and  sulphurous  acid  may 
be  evolved.  In  September,  1842,  two  boys  were  found  dead  on  a 
brick-kiln  near  London,  whither  they  had  gone  for  the  purpose  of 
roasting  potatoes.  Although  the  cause  of  death  in  both  cases  was 
clearly  suffocation,  in  one  instance  the  body  was  extremely  livid, 


392  EFFECTS    OF    CONFIXED    AIR. 

while  in  the  other  there  was  no  lividity  whatever !  Such  accidents 
are  frequent :  in  November,  1814,  an  inquest  was  held  at  Manchester 
on  the  body  of  a  man  who  had  died  under  similar  circumstances. 
The  vapors  of  cement-kilns  are  quite  as  noxious  as  those  of  brick- 
kilns: carbonic  and  sulphurous  acids  predominate  in  them. 

Coxfixed  Am. 

Symptoms  and  Effects. — An  animal  confined  within  a  certain  quan- 
tity of  air,  which  it  is  compelled  to  breathe,  will  soon  fall  into  a 
state  of  lifelessness.  A  human  being  in  the  same  way  may  be 
suffocated,  if  confined  in  a  close  apartment  where  the  air  is  not  sub- 
ject to  change  or  renewal,  while  the  products  of  respiration  are  accu- 
mulated ;  and  the  effects  are  hastened  Avhen  a  number  of  persons 
are  crowded  together  in  a  small  space.  The  change  which  air,  thus 
contaminated  by  breathing,  undergoes  may  be  very  simply  stated. 
The  quantity  of  nitrogen  in  100  parts  will  remain  nearly  the  same ; 
the  quantity  of  oxygen  will  probably  vary  from  8  to  12  per  cent., 
while  the  remainder  will  be  made  up  chiefly  of  carbonic  acid.  If 
many  persons  are  crowded  together  the  air  will  acquire  a  high  tem- 
perature, and  will  be  saturated  with  aqueous  vapor  which  contains 
decomposing  animal  matter  derived  from  the  lungs  and  skin.  From 
this  statement,  it  is  evident  that  air  which  has  been  contaminated  by 
continued  respiration  will  operate  fatally  on  the  human  body,  partly 
in  consequence  of  its  being  deficient  in  oxygen,  and  partly  from  the 
noxious  effects  of  the  carbonic  acid  contained  in  it.  The  proportion 
in  which  carbonic  acid  exists  in  respired  air  is  subject  to  variation : 
according  to  the  experiments  of  Allen  and  Pepys,  it  never  exceeds 
10  per  cent,  by  volume  of  the  mixture,  how  frequently  soever  it 
may  have  been  received  into  and  expelled  from  the  lungs.  The  in- 
fluence of  respiration  on  air  may  be  thus  stated :  An  adult  consumes 
from  one  to  two  gallons  of  air  per  minute,  and  the  air  expired  con- 
tains from  4  to  5  per  cent,  of  carbonic  acid  ;  but  it  is  a  remarkable 
fact  that,  when  a  person  continues  to  breathe  the  same  air,  the  pro- 
portion of  carbonic  acid  expelled  is  reduced  at  each  successive  re- 
spiration. When  the  amount  in  air  has  reached  10  or  12  per  cent, 
no  more  is  thrown  off  by  the  lungs,  and  the  blood  is  no  longer 
depurated.  For  healthy  existence  a  human  being  requires  20  cubic 
feet  or  125  gallons  of  air  per  hour.  A  common  candle  will  consume 
as  much  as  two  gallons  of  air  per  minute,  or  render  that  quant ity 
of  air  unfit  for  respiration.  Dalton  found  that  the  air  in  crowded 
rooms  contained  about  1  per  cent,  of  carbonic  acid,  the  atmospheric 
proportion  being  therefore  increased  nearly  twenty-fold.  It  is  cer- 
tain that  insensibility  and  death  would  ensue  in  a  human  adult  before 
the  whole  of  the  oxygen  of  the  confined  air  had  disappeared:  but 
the  opportunity  can  rarely  present  itself  analyzing  such  a  contami- 
nated mixture,  and  hence  it  is  impossible  to  specify  the  exact  pro- 
portion in  which  carbonic  acid  would  exist  when  the  confined  air 
proved  fatal  to  persons  who  had  respired  it.  M.  Lassaigne  has  shown, 
by  direct  experiment,  that  the  carbonic  acid  in  the  air  of  close  rooms 


COAL-GAS.      CARBUKETTED    HYDROGEN.  393 

is  not  collected  on  the  floor,  but  equally  diffused  throughout.  The 
whole  mass  of  air  is,  in  fact,  vitiated,  and  requires  renewal.  ("  Med. 
Gaz."  vol.  38,  p.  351 ;  see  also  "  Report  on  Mines,"  1864,  App.  B,  p. 
196,  and  "  Chemical  News,"  Feb.  17,  1865,  p.  79.) 

Coal-Gas.    Carburetted  Hydrogen. 

Coal-gas  is  a  compound  which  acts  directly  as  a  poison  when  re- 
spired. Many  fatal  accidents  have  occurred  from  the  respiration  of 
air  contaminated  with  it.  Its  composition  is  subject  to  much  varia- 
tion, according  to  circumstances.  Mitscherlich  found  that  it  was 
principally  composed  of  light  carburetted  hydrogen,  hydrogen,  and 
carbonic  oxide,  in  the  proportions  of  66  per  cent,  of  the  first,  21.3 
of  the  second,  and  11  of  the  third.  M.  Tourdes  found  that  the  pro- 
portions of  light  carburetted  hydrogen  and  carbonic  oxide  were 
nearly  equal,  i.  e.,  about  22  per  cent.  An  analysis  of  coal-gas  as 
supplied  to  London  shows  that  in  1000  parts  it  contains — of  hydro- 
gen, 461.3  ;  of  light  carburetted  hydrogen,  389.3  ;  carbonic  oxide, 
56.2;  olefiant  gas,  38.6;  watery  vapor,  24.8;  nitrogen,  22.2;  car- 
bonic acid,  4.6.  The  difference  in  composition  depends  on  the  heat 
to  which  the  gas  has  been  submitted.  Some  consider  that  carbonic 
oxide  is  the  poisonous  principle ;  but  there  is  no  doubt  that  the 
hydrocarbons  also  have  a  specially  noxious  influence,  although  the 
use  of  the  safety-lamp  in  mines  proves  that  a  mixture  of  light  car- 
buretted hydrogen  with  air  in  an  explosive  proportion,  may  be 
respired  without  producing  serious  effects. 

Symptoms  and  Appearances  after  Death. — The  symptoms  produced 
by  coal-gas,  when  mixed  in  a  large  proportion  with  air,  are — giddi- 
ness, headache,  nausea  with  vomiting,  confusion,  of  intellect,  loss  of 
consciousness,  general  weakness  and  depression,  partial  paralysis, 
convulsions,  and  the  usual  phenomena  of  asphyxia.  The  appear- 
ances after  death  will  be  understood  from  the  following  cases.  In 
January,  1841,  a  family  residing  at  Strasburg  respired  for  forty  hours 
an  atmosphere  contaminated  with  coal-gas,  which  had  escaped  from 
a  pipe  passing  near  the  cellar  of  the  house  in  which  they  lodged. 
On  the  discovery  of  the  accident  four  of  the  family  were  found  dead. 
The  father  and  mother  still  breathed,  but,  in  spite  of  treatment,  the 
father  died  in  twenty-four  hours :  the  mother  recovered.  When  the 
five  bodies  were  inspected  there  was  a  great  difference  in  the  appear- 
ances ;  but  the  principal  changes  observed  were,  congestion  of  the 
brain  and  its  membranes — the  pia  mater  (inner  membrane)  being 
gorged  with  blood,  and  the  whole  surface  of  the  brain  intensely  red. 
In  three  of  the  cases  there  was  an  effusion  of  blood  (coagulated)  on 
the  dura  mater  and  in  the  spinal  canal.  The  lining-membrane  of 
the  air-passages  was  strongly  injected,  and  there  was  spread  over  it 
a  thick  viscid  froth  tinged  with  blood ;  the  substance  of  the  lungs 
was  of  a  bright-red  color,  and  the  blood  in  the  vessels  was  coagu- 
lated. ("  Ann.  d'Hyg."  Jan.  1842.)  In  two  cases  communicated  by 
Mr.  Teale  to  the  "Guy's  Hospital  Eeports"  (No.  8),  there  was  found 
congestion  of  the  brain  and  its  membranes,  with  injection  of  the 


394  EFFECTS    OF    COAL-GAS. 

lining-membrane  of  the  air-passages;  the  blood  was  remarkably 
liquid.  An  aged  female  and  her  granddaughter,  who  had  been  an- 
noyed by  the  escape  of  gas  during  the  day,  retired  to  bed,  and  thev 
were  found  dead  about  twelve  hours  afterwards. 

Mr.  Bloxam  has  published  a  case  of  poisoning  by  coal-gas,  which 
shows  how  easily  life  may  be  destroyed  by  it.  The  appearances  in 
the  body  are  more  fully  described  than  usual.  In  November,  1861, 
Mr.  Bloxam  saw  the  deceased,  who  was  a  gas-fitter:  he  was  sup- 
ported in  a  sitting  posture  on  the  floor.  The  man  had  accidentally 
respired  coal-gas  while  connecting  a  tube  with  a  meter.  The  skin 
was  cold,  the  cornea  glazed,  and  the  face  pale  and  placid ;  there  was 
some  froth  about  the  mouth,  the  pupils  were  rather  dilated,  and  the 
limbs  supple.  There  was  a  strong  smell  of  gas  in  the  place.  He 
was  working  in  a  closet,  and  he  was  found  insensible  on  the  top  of 
a  pair  of  steps  in  a  sitting  posture — his  head  on  one  side,  his  arms 
hanging  down,  and  his  back  leaning  against  the  wall,  in  the  attitude 
in  which  he  was  engaged  at  his  work.  He  had  evidently  died  quietly 
and  placidly  on  his  seat,  and  had  made  no  attempt  to  descend  the 
steps.  He  was  last  seen  alive  an  hour  before  he  was  found  dead, 
and  he  no  doubt  died  rapidly  from  the  inhalation  of  the  gas.  An 
inspection  of  the  body  was  made  twenty-four  hours  after  death. 
Externally  the  skin  of  the  face  and  upper  part  of  the  body  was 
pale — rigidity  was-  well-marked,  and  there  was  general  lividity  of 
the  back  of  the  body  as  well  as  of  the  limbs.  The  blood  was  every- 
where fluid.  The  brain  and  its  membranes  were  not  congested,  but 
were  rather  pale  than  otherwise ;  the  ventricles  contained  a  pale 
serum.  The  brain  and  cerebellum  were  apparently  healthy.  There 
was  a  strong  odor  of  coal-gas  on  exposing  the  brain.  The  lungs 
were  of  a  dark-red  color,  and  did  not  collapse  on  raising  the  chest- 
bone  ;  they  were  dark  at  the  back  of  the  lobes  from  gravitation  of 
blood  ;  their  structure  was  healthy.  The  windpipe  and  bronchi  con- 
tained frothy  mucus  in  some  quantity.  A  powerful  ordor  of  gas 
was  perceived  on  compressing  the  lungs.  The  heart  was  healthy  ; 
the  right  cavities  were  distended  with  blood — the  left  were  nearly 
empty ;  the  blood  was  everywhere  black.  There  was  congestion  of 
the  abdominal  viscera,  but  no  other  unusual  appearance.  ("  Med. 
Chir.  Trans."  1862,  vol.  45,  p.  103.) 

In  the  cases  above  related,  the  effects  produced  by  coal-gas  were 
owing  to  the  long-continued  respiration  of  it  in  a  diluted  state.  The 
quantity  contained  in  the  air  of  the  rooms  must  have  been  very 
small :  in  M.  Tourdes'  case  it  was  probably  not  more  than  8  or  9 
per  cent.,  because  at  a  little  above  this  proportion  the  mixture  with 
air  becomes  explosive ;  and  there  had  been  no  explosion  in  this  case, 
although  in  the  apartment  in  which  the  person  was  found  dead,  a 
stove  had  been  for  a  long  time  in  active  combustion,  and  a  candle 
had  been  completely  burnt  out.  In  Mr.  Teale's  cases  those  who 
entered  the  house  perceived  a  strong  smell  of  coal-gas,  but  still  the 
air  could  be  breathed.  Coal-gas  therefore,  like  other  aerial  poisons, 
may  destroy  life  if  long  respired,  although  so  diluted  as  not  to  pro- 
duce any  serious  effects  in  the  first  instance!     This  gas  owes  its 


SYMPTOMS    CAUSED    BY    SULPHURETTED    HYDROGEN.      395 

peculiar  odor  to  the  vapor  of  naphtha :  the  odor  begins  to  be  per- 
ceptible in  air  when  the  gas  forms  only  the  1000th  part,  it  is  easily 
perceived  when  forming  the  700th  part,  but  the  odor  is  strongly 
marked  when  it  forms  the  150th  part  (Tourdes).  In  most  houses  in 
which  gas  is  burnt,  the  odor,  owing  to  leakage,  is  plainly  perceived ; 
and  it  is  a  serious  question  whether  health  and  life  may  not  often  be 
affected  by  the  long-continued  respiration  of  an  atmosphere  contain- 
ing but  a  small  proportion.  The  odor  will  always  convey  a  suffi- 
cient warning  against  its  poisonous  effects.  It  should  be  known 
that  this  gas  will  penetrate  into  dwellings  in  an  insidious  manner. 
In  Mr.  Teale's  cases,  the  pipe  from  which  the  gas  had  escaped  was 
situated  about  ten  feet  from  the  wall  of  the  bedroom  where  the 
females  slept :  the  gas  had  permeated  through  the  loose  earth  and 
rubbish,  and  had  entered  the  apartment  through  the  floor.  I  have 
notes  of  several  other  cases  in  which  coal-gas  has  thus  destroyed  life 
by  leakage  into  bedrooms. 

It  is  impossible  to  determine  exactly  what  proportion  of  this  gas 
in  air  will  destroy  life.  An  atmosphere  containing  from  7  to  12 
per  cent,  has  been  found  to  destroy  dogs  and  rabbits  in  a  few  min- 
utes ;  when  the  proportion  was  from  1|  to  2  per  cent,  it  had  little  or 
no  effect.  With  respect  to  man,  it  may  destroy  life  if  long  respired 
when  forming  about  9  per  cent.,  i.  e.  when  it  is  in  less  than  an  ex- 
plosive proportion.  (See  "  British  and  Foreign  Med.  Eev."  vol.  20, 
p.  253;  also,  "Ann.  d'Hyg."  1830,  vol.  1,  p.  457.)  Dr.  Aldis 
observed  in  his  experiments  that  in  ordinary  coal-gas  mixed  with 
air,  rats  were  rendered  insensible  in  half  a  minute,  and  died  in  a 
minute  and  a  half  to  two  minutes.  There  was  before  death  spasmo- 
dic action  of  the  diaphragm.  The  gas  was  allowed  to  enter  slowly 
into  a  bell-jar  of  air  in  which  the  animals  were  placed.  ("  Med. 
and  Chir.  Trans."  1862,  vol.  45,  p.  100.) 

Sulphuretted  Hydrogen. 

This  gas  has  a  more  powerful  action  on  the  body  than  either  car- 
bonic acid  or  charcoal-vapor.  Persons  are  sometimes  accidentally 
killed  by  it;  but  the  very  offensive  odor  which  a  small  portion  of  it 
communicates  to  a  large  quantity  of  air  is  sufficient  to  announce  its 
presence,  and  thus,  with  due  caution,  to  prevent  any  dangerous  con- 
sequences. Sulphuretted  hydrogen  gas,  when  respired  in  its  pure 
state,  is  instantaneously  fatal.  It  exerts  equally  deleterious  effects 
upon  all  animals,  and  through  all  the  textures  of  the  body,  but  espe- 
cially through  the  lungs. 

Symptoms. — The  symptoms  produced  by  sulphuretted  hydrogen 
on  the  human  body  vary  according  to  the  degree  of  concentration  in 
which  it  is  respired.  When  breathed  in  a  moderately  diluted  state, 
the  person  speedily  falls  inanimate.  An  immediate  removal  to  pure 
air,  and  the  application  of  stimulants,  with  cold  affusion,  may,  how- 
ever, suffice  to  restore  life.  According  to  the  account  given  by  those 
who  have  recovered,  this  state  of  inanimation  is  preceded  by  a  sense 
of  weight  in  the  stomach  and  in  the  temples ;  also  by  giddiness, 


396  SULPHURETTED  HYDROGEN. 

nausea,  sudden  weakness,  and  loss  of  motion  and  sensation.  If  the 
gas  in  a  still  less  concentrated  state  be  respired  for  some  time,  coma, 
insensibility,  or  tetanus  with  delirium  supervenes,  preceded  by  con- 
vulsions, or  pain  and  weakness  over  the  whole  of  the  body.  The 
skin  in  such  cases  is  commonly  cold,  the  pulse  irregular,  and  the 
respiration  laborious.  When  the  air  is  but  slightly  contaminated 
with  the  gas  it  may  be  breathed  for  a  long  time  without  producing 
any  serious  symptoms ;  sometimes  there  is  a  feeling  of  nausea  or 
sickness,  accompanied  by  pain  in  the  head,  or  diffused  pains  in  the 
abdomen.  These  symptoms  are  often  observed  to  affect  those  who 
are  engaged  in  chemical  manipulations  with  this  gas.  Sulphuretted 
hydrogen  appears  to  act  like  a  narcotic  poison  when  highly  concen- 
trated, but  like  a  narcotico-irritant  when  much  diluted  with  air.  It 
is  absorbed  into  the  blood,  to  which  it  gives  a  brownish-black  color, 
and  it  is  in  this  state  circulated  throughout  the  body.  In  all  cases  a 
noxious  atmosphere  containing  this  gas  is  indicated  by  an  offensive 
smell  producing  nausea  and  sickness.  For  a  case  of  poisoning  by 
this  gas,  in  which  the  person  recovered,  see  "  Medical  Gazette,"  vol. 
48,  p.  871. 

Appearances  after  Death. — On  examining  the  bodies  of  persons  Avho 
have  died  from  the  effects  of  sulphuretted  hydrogen,  when  respired 
in  a  concentrated  form,  and  the  inspection  is  recent,  the  following- 
appearances  have  been  observed :  The  mucous  membrane  of  the  nose 
and  throat  is  commonly  covered  by  a  brownish  viscid  fluid.  An 
offensive  odor  is  exhaled  from  all  the  cavities  and  soft  parts  of  the 
body.  These  exhalations,  if  received  into  the  lungs  of  those  engaged 
in  making  the  inspection,  sometimes  give  rise  to  nausea  and  other 
unpleasant  symptoms,  and  may  even  cause  syncope  or  asphyxia. 
The  muscles  of  the  body  are  of  a  dark  color,  and  are  not  susceptible 
of  the  galvanic  stimulus.  The  lungs,  liver,  and  the  soft  organs 
generally,  are  distended  with  black  liquid  blood.  There  is  also  great 
congestion  about  the  right  side  of  the  heart,  and  the  blood  has  been 
found  everywhere  liquid  and  dark-colored:  the  body  rapidly  under- 
goes the  putrefactive  process.  "When  death  has  occurred  from  the 
respiration  of  this  gas  in  a  more  diluted  form,  the  appearances  are 
less  marked.  There  is  then  general  congestion  of  the  internal  organs, 
with  a  dark  and  liquid  state  of  the  blood.  In  fact,  in  such  cases  the 
appearances  can  scarcely  be  distinguished  from  those  produced  by 
carbonic  acid.  Four  men  lost  their  lives  in  the  Fleet  Lane  Sewer  in 
February,  1861 :  they  were  found  dead,  and  there  was  no  doubt  that 
sulphuretted  hydrogen  was  the  cause  of  death.  An  account  of  the 
appearances  presented  by  the  bodies  is  given  in  the  "  Lancet"  by  Mr. 
Holden  and  Dr.  Letheby  (February  23, 1861,  p.  187).  The  eyes  and 
mouth  were  open,  the  lips  and  tongue  livid,  the  pupils  widely  dilated, 
the  blood  black  and  fluid,  the  lungs  congested,  the  heart  full  of  black 
fluid  blood,  the  right  side  gorged,  and  there  was  a  bloody  froth  in 
the  windpipe.  In  the  brain  the  large  vessels  of  the  dura  mater  were 
full  of  black  fluid  blood. 

In  June,  1857,  six  persons  lost  their  lives,  at  Cleator  Moor,  near 
Whitehaven,  by  the  respiration  of  sulphuretted  hydrogen  in  a  diluted 


POST    MORTEM    APPEARANCES.  397 

form,  by  reason  of  their  having  slept  in  small  close  ill-ventilated 
rooms,  into  which  the  gas  had  penetrated.  Three  of  the  deceased 
persons — a  husband,  wife,  and  child,  of  one  family  [Armstrong) — had 
retired  to  rest,  in  their  usual  health,  on  the  night  of  the  9th  of  June. 
Two  of  them  were  found  the  next  morning  dead  in  bed,  and  a  third 
(the  child)  was  found  in  a  state  of  insensibility,  and  lingered  until 
the  afternoon  of  the  same  day,  when  she  died.  The  fourth,  a  healthy 
adult,  retired  to  sleep  in  his  bed,  with  his  door  closed,  and  he  was 
found  dead  in  an  hour.  The  fifth,  a  child,  was  taken  ill  on  the 
morning  of  the  11th,  and  died  the  same  day.  The  sixth  was  taken 
ill  on  the  morning  of  the  10th,  and  died  on  the  12th  of  June. 

The  symptoms  complained  of  by  some  who  recovered  were  nausea, 
sickness,  giddiness,  and  insensibility.  On  inspection  of  the  body  of 
one  child,  the  pupils  were  found  dilated — viscid  mucus  escaped  from 
the  nostrils — there  was  congestion  of  the  lungs  and  kidneys,  as  well 
as  of  the  membranes  of  the  brain.  In  the  adult  who  died  in  an  hour, 
the  pupils  were  natural,  the  jaws  firmly  clenched,  the  fingers  con- 
tracted, and  the  nails  blue ;  there  was  great  cadaveric  lividity,  and 
a  quantity  of  fluid  with  frothy  mucus  issued  from  the  nostrils  and 
mouth.  The  lungs  were  much  congested,  and  serum  was  effused  in 
the  cavity  of  the  chest.  The  heart  contained  a  little  fluid  blood,  and 
was  somewhat  flaccid.  The  membrane  of  the  windpipe  and  gullet 
was  redder  than  natural.  In  the  windpipe  there  was  frothy  mucus. 
The  stomach,  as  well  as  the  large  and  small  intestines,  were  highly 
congested,  but  otherwise  healthy.  The  brain  and  its  membranes 
were  greatly  engorged  with  blood,  which,  as  in  the  body  generally, 
was  very  dark  and  fluid.  Mr.  J.  B.  Wilson,  who  examined  the  body 
of  the  child,  drew  the  conclusion,  which  was  confirmed  by  the 
subsequent  inquiry,  that  death  had  been  caused  by  sulphuretted 
hydrogen.  Dr.  Thompson,  who  examined  the  body  of  the  man,  also 
inferred  that  some  noxious  gas  or  gases  had  destroyed  life.  Having 
been  required  by  the  Home  Office  to  investigate  the  cause  of  death 
in  these  cases,  I  visited  Cleator  on  the  22d  of  June,  and  found  that 
the  cottages  in  which  the  accidents  had  occurred,  were  built  upon  a 
heap  of  iron-slag,  which  also  abutted  on  the  premises  behind.  This 
slag  contained,  among  other  matters,  sulphide  of  iron  and  sulphide 
of  calcium.  A  foul  smell,  compared  to  that  of  cinders  extinguished 
by  water,  had  for  some  time  been  perceived  about  the  rooms,  chiefly 
at  night,  when  the  doors  and  windows  were  closed ;  and  the  day 
before  the  occurrence  a  heavy  storm  of  rain  had  washed  through 
the  slag-heap,  and  aggravated  the  effects.  The  heap  of  slag  was 
burning  in  certain  parts,  and  sulphuretted  hydrogen  was  evolved  in 
large  quantities  at  a  depth  of  a  few  feet  below.  At  the  time  of  my 
visit,  i.  e.  a  fortnight  after  the  deaths,  on  removing  the  flags  in  the 
lower  rooms,  the  slag  below  was  found  damp,  and  sulphuretted  hy- 
drogen was  still  issuing  from  it.  The  white-lead  paint  in  the  closets 
was  partly  converted  into  black  sulphuret,  and  this  chemical  change 
was  found  in  patches  on  the  chamber-door  of  one  small  room  in  which 
two  persons  had  died. 

The  symptoms,  so  far  as  they  were  observed  in  the  living,  the 


398  EFFLUVIA    OF    DRAINS    AND    SEWERS. 

appearances  in  the  dead  bodies,  and  the  chemical  nature  of  the  wet 
slag  beneath  the  foundation,  left  no  reasonable  doubt  that  during  the 
night,  with  the  doors  and  windows  closed,  sulphuretted  hydrogen 
had  escaped  in  sufficient  quantity  to  poison  the  air  and  destroy  life, 
and  a  verdict  was  returned  to  this  effect.  A  suggestion  was  made 
that  carbonic  acid  might  have  caused  the  symptoms  and  death,  but 
there  was  no  source  of  carbonic  acid  but  the  breath ;  and  there  is,  I 
believe,  no  instance  known  of  any  adult  having  breathed  himself  to 
death  in  an  hour,  in  a  room  containing  600  feet  of  cubic  air — not  to 
mention  that  persons  had  slept  in  similar  rooms-in  the  same  row  of 
cottages,  at  a  distance  from  the  slag  heap,  without  perishing  from 
such  a  cause.  Another  theory  was  put  forward,  to  the  effect  that 
carbonic  oxide  in  the  vapors  of  some  blast-furnaces  had  found  its 
way  into  the  rooms  where  these  persons  had  died ;  but  the  nature 
of  the  locality  and  the  distance  of  the  furnaces  rendered  this  impos- 
sible. Persons  who  had  left  their  windows  open,  whereby  these  va- 
pors might  have  entered,  escaped,  while  the  deaths  occurred  only  in 
those  houses  in  which  the  doors  and  windows  were  completely  closed. 
It  is  highly  probable  that  the  sulphuretted  hydrogen  was  mixed  with 
other  gases  and  vapors,  as  it  is  never  found  pure  except  in  a  chemical 
laboratory  ;  but  the  circumstances  proved,  left  no  doubt  that  this  gas 
was  the  principal  agent  of  death.  This  seems  to  have  been  clearly 
established  by  the  fact,  that  after  a  channel  had  been  cut  through 
the  slag-heap,  and  the  slag  removed,  no  casualty  took  place. 

As  in  reference  to  carbonic  acid,  an  atmosphere  which  may  be 
breathed  for  a  short  time  with  impunity  will  ultimately  destroy  life. 
Sulphuretted  hydrogen  in  a  fatal  proportion,  however  diluted  or 
mixed  with  other  vapors,  would  always  be  indicated  by  a  disagree- 
able smell ;  although  from  habit,  as  well  as  probably  from  the  effects 
of  the  gas  on  the  nervous  system,  this  offensive  smell  might  not  be 
perceived  when  a  person  had  remained  for  a  short  time  in  the  poi- 
soned atmosphere.  In  the  cases  of  the  Halls,  which  occurred  at 
Sheffield  in  1852,  there  is  reason  to  believe  that  the  deaths  of  two 
persons  were  caused  by  the  smouldering  of  ashes  in  a  cesspool 
("  Association  Medical  Journal,"  April,  1853,  p.  280.)  Mr.  Haywood 
considered  that  carbonic  acid  was  the  agent  in  this  case,  although  it 
is  probable,  from  the  nature  of  the  materials  in  which  combustion 
was  going  on,  that  sulphuretted  hydrogen  and  other  gases  and  vapors 
were  simultaneously  evolved. 

Effluvia  of  Drains  and  Sewers. — The  most  common  form  of  acci- 
dental poisoning  by  sulphuretted  hydrogen  (for  it  is  rare  that  a  case 
occurs  which  is  not  purely  accidental)  is  witnessed  among  nightmen 
and  others  who  are  engaged  in  cleaning  out  drains  and  sewers,  or  in 
the  removal  of  nightsoil.  These  accidents  are  much  more  frequent 
in  France  than  in  England,  the  soil  being  often  allowed  to  collect  in 
such  quantities  in  Paris  and  other  large  continental  cities,  as  to  ren- 
der its  removal  a  highly  dangerous  occupation  for  the  workmen. 
According  to  the  results  of  Thenard's  observations,  there  are  two 
species  of  compound  gases,  or  mechanical  mixtures  of  gases  which 
are  commonly  met  with  in  the  exhalations  of  privies.     The  first 


DETECTION    OF    SULPHURETTED    HYDROGEN.  399 

compound  consists  of  a  large  proportion  of  atmospheric  air  holding 
diffused  through  it,  in  the  form  of  vapor,  the  hydrosulphate  of  ammo- 
nia (sulphide  of  ammonium).  The  hydrosulphate  is  contained 
abundantly  in  the  water  of  the  soil,  and  is  constantly  rising  from  it 
in  vapor,  and  diffusing  itself  in  the  surrounding  atmosphere.  It  is 
this  vapor  which  gives  the  unpleasant  and  pungent  odor  to  the  efflu- 
via, and  causes  an  increased  secretion  of  tears  in  those  who  un- 
guardedly expose  themselves  to  such  exhalations.  The  symptoms 
produced  by  the  respiration  of  this  gaseous  mixture,  when  in  a  con- 
centrated state,  bear  a  close  resemblance  to  those  which  result  from 
the  action  of  sulphuretted  hydrogen  gas.  If  a  person  is  but  slightly 
affected,  he  will  probably  complain  of  nausea  and  sickness :  his  skin 
will  be  cold,  his  respiration  free  but  irregular ;  the  pulse  is  com- 
monly frequent,  and  the  voluntary  muscles,  especially  those  of  the 
chest,  are  affected  by  spasmodic  twitchings.  If  more  strongly 
affected,  he  loses  all  power  of  sense  and  motion ;  the  skin  becomes 
cold,  the  lips  and  face  assume  a  violet  hue,  the  mouth  is  covered  by 
a  bloody  and  frothy  mucus ;  the  pulse  is  small,  frequent,  and  irregular 
— the  breathing  hurried,  laborious,  and  convulsive ;  and  the  limbs 
and  trunk  are  in  a  state  of  general  relaxation.  If  still  more  severely 
affected,  death  may  take  place  immediately ;  or  should  the  person 
survive  a  few  hours,  in  addition  to  the  above  symptoms  there  will 
be  short  but  violent  spasmodic  twitchings  of  the  muscles,  sometimes 
even  accompanied  by  tetanic  spasms.  (See  "Ann.  d'Hyg."  1829, 
vol.  2,  p.  70.)  If  the  person  is  sensible  he  will  commonly  suffer  the 
most  severe  pain,  and  the  pulse  may  become  so  quick  and  irregular 
that  it  cannot  be  counted.  "When  the  symptoms  are  of  such  a  for- 
midable nature,  it  is  rare  that  a  recovery  takes  place.  The  appear- 
ances met  with  on  making  an  examination  of  the  body  are  similar  to 
those  observed  in  death  from  sulphuretted  hydrogen.  The  inspec- 
tion should  be  made  with  caution,  for  a  too-frequent  respiration  of 
the  poisonous  exhalations  may  seriously  affect  those  who  under- 
take it. 

[The  epidemic  which  affected  so  many  of  the  visitors  of  the  Na- 
tional Hotel  in  Washington,  D.  C,  during  the  winter  and  spring  of 
1857,  and  well  known  in  the  United  States  as  the  "National  Hotel 
Disease,"  affords  a  remarkable  illustration  of  this  form  of  atmos- 
pheric poisoning,  in  which  a  large  number  of  persons  of  both  sexes 
were  attacked  with  violent  irritation  of  the  alimentary  canal,  gene- 
rally of  the  large  intestine ;  many  having  died,  after  variable  periods 
of  illness,  and  in  some  instances,  after  repeated  relapses.  The  symp- 
toms of  irritation  of  the  stomach  and  bowels  presented  so  generally 
by  the  guests  of  this  hotel,  at  a  time  of  high  political  excitement, 
gave  rise  to  a  suspicion  of  metallic  poisoning,  which  for  a  while  be- 
came the  popular  belief.  The  evidence  presented  at  the  inquest  of 
the  local  Board  of  Health,  however,  entirely  contradicted  this  theory, 
and  showed  not  only  that  no  irritant  poison  could  have  been  used  in 
the  food,  and  that  the  symptoms  were  not  those  of  metallic  irritation, 
but  that  they  were  those  of  poisoning  by  sewer  emanations ;  and 
that  such  emanations  had  been  present  to  a  dangerous  extent  in  the 


400  SEWER    GASES: 

most  frequented  parts  of  the  house,  during  the  whole  of  the  three 
months  of  the  epidemic  visitation.  The  officers  of  the  Board  of 
Health  discovered  a  stream  of  sewer  gas  which  was  flowing  through 
a  defective  inlet,  from  a  badly  working  culvert,  directly  into  the 
cellar  of  the  hotel,  with  force  enough  to  extinguish  a  lighted  candle. 
Abundant  evidence  from  other  sources,  equally  indisputable,  might 
be  presented  in  corroboration.  Kepeated  instances  occurred  of  indi- 
viduals being  taken  ill  after  a  visit  to  the  hotel,  who  had  neither 
eaten  nor  drunk  anything  while  in  the  house ;  and  the  offensive 
smell  observed  throughout  the  building,  especially  in  the  lower 
rooms,  had  been  very  generally  observed.  This  fetor  was  aggravated 
during  the  prevalence  of  cold  weather ;  at  which  time  the  windows 
and  doors  were  closed,  and  the  disease  increased  in  violence.  The 
pathological  condition  was  ascertained  to  be  that  of  ulcerative  di- 
arrhoea, "  a  superficial  erythematous  or  catarrhal  inflammation  of 
the  mucous  membrane  of  the  colon."  We  have  witnessed  this  pecu- 
liar effect  of  cesspool  exhalations,  in  various  degrees,  so  frequently 
among  prison  convicts,  that  we  were  satisfied  as  to  its  true  origin, 
before  the  investigations  had  been  undertaken  to  contradict  the  erro- 
neous hypothesis  of  poisoned  food  or  drink.  An  epidemic  of  diar- 
rhoea and  general  intestinal  irritation,  the  exact  counterpart  of  the 
National  Hotel  disease,  might  at  any  time  be  developed  among  the 
inmates  of  our  prisons  by  a  neglect  of  the  usual  cleansing  of  the 
privy  pans  and  pipes.  See  on  this  subject,  "Am.  Journ.  of  Med. 
Sci."  Jan.  1858,  p.  97  ;  "  Boston  Med.  and  Surg.  Journ."  vol.  lvi. 
1857,  pp.  305,  371,  422 ;  "  New  York  Journ.  of  Med."  July,  1857, 
p.  90  ;  "  Virg.  Med.  and  Surg.  Journ."  vol.  viii.  1857,  pp.  478,  514 ; 
"  Trans.  Coll.  of  Phys.  of  Philad."  New  Series,  vol.  iii.  No.  3,  1857, 
p.  128.— II.] 

Analysis. — The  recognition  of  these  gases  and  vapors  is  a  simple 
operation.  The  odor  which  they  possess  is  sufficient  to  determine 
their  presence,  even  when  they  are  diluted  with  a  large  quantity  of 
atmospheric  air.  The  sutyhuretted  hydrogen  gas  is  at  once  identified 
by  its  action  on  paper  previously  dipped  in  a  solution  of  salt  of  lead  ; 
if  present,  even  in  very  small  proportion  (1-100, 000th  part),  the 
moistened  paper  speedily  acquires  a  brownish-black  stain  from  the 
production  of  sulphide  of  lead.  It  must  not  be  supposed  that  sul- 
phuretted hydrogen,  when  it  has  proved  fatal  in  a  diluted  form,  can 
be  detected  in  the  lungs,  stomach,  or  blood  of  a  dead  body.  When 
the  body  is  recently  removed  from  a  drain  or  sewer,  the  gas  may 
be  found  pervading  the  whole  of  the  tissues ;  but  in  other  cases  it 
will  be  as  useless  to  look  for  it  as  for  carbonic  acid  in  poisoning  by 
this  gas.  Noxious  gases  are  not  long  retained  by  the  tissues ;  a  short 
exposure  will  suffice  to  remove  all  traces  of  them.  The  examina- 
tion of  the  locality  can  alone  throw  a  light  upon  the  cause  of  death. 
The  proportion  of  the  gas  found  in  an  apartment  will,  however, 
rarely  be  a  criterion  of  the  quantity  which  has  destroyed  life.  A 
person  going  into  a  room  where  the  deceased  bodies  are  lying,  may 
notice  only  a  disagreeable  or  stifling  smell,  but  he  may  be  able  to 
breathe  for  a  longer  or  a  shorter  period  with  the  door  or  window 


THEIR    EFFECTS    WHEN"    BREATHED.  401 

open.  It  is  not  the  respiration  of  a  few  minutes,  but  the  breathing 
of  the  diluted  noxious  atmosphere  for  many  hours,  that  really  de- 
stroys life.  The  best  method  of  detecting  sulphuretted  hydrogen 
when  present  in  a  dead  body  (not  putrefied)  is  to  place  a  piece  of 
card,  glazed  with  lead,  in  the  muscles  or  soft  organs ;  it  will  sooner 
or  later  be  tarnished  and  acquire  a  brown  color,  if  the  gas  be  present. 

Sulphuretted  hydrogen  may  be  proved  to  exist  by  the  lead-test  in 
the  vapor  of  hydrosulpkate  of  ammonia  when  mixed  with  air,  and  the 
pressure  of  ammonia  indicated  in  the  compound  by  its  volatile  alka- 
line reaction  on  test-paper ;  also  by  holding,  in  a  vessel  containing 
the  vapor  recently  collected,  a  rod  dipped  in  strong  hydrochloric 
acid ;  the  production  of  dense  white  fumes  announces  the  formation 
of  hydrochlorate  of  ammonia.  The  presence  of  this  compound  va- 
por in  any  mixture  is  at  once  indicated  by  introducing  paper  wetted 
with  a  solution  of  nitroprusside  of  sodium.  The  hyclrosulphate 
produces  with  it  a  rich  crimson  color ;  if  sulphuretted  hydrogen 
alone  is  present,  the  nitroprusside  paper  undergoes  no  change.  It  is 
a  fact  which  cannot  be  too  universally  known  that  a  candle  will 
readily  burn  in  a  mixture  of  either  of  these  gases  with  air  which,  if 
breathed,  would  suffice  to  destroy  life.  ("  Ann.  d'Hyg."  1829,  vol. 
2,  p.  69.)  The  candle-test  should  be  applied  with  caution  in  places 
where  these  effluvia  are  collected  and  confined  in  sewers  or  close 
cesspools.  When  sulphuretted  hydrogen  is  diffused  in  a  proportion 
of  about  7  per  cent,  with  air  it  forms  a  dangerously  explosive  mix- 
ture. 

It  is  worthy  of  remark  that  the  air  of  a  cesspool  may  be  often 
breathed  with  safety  until  the  workmen  commence  removing  the 
soil,  when  a  large  quantity  of  mephitic  vapor  may  suddenly  escape, 
which  will  lead  to  the  immediate  suffocation  of  all  present.  Several 
persons  have  been  killed  by  trusting  to  the  previous  burning  of  a 
candle,  in  ignorance  of  this  fact.  In  descending  in  order  to  render 
assistance  to  those  who  are  lifeless,  the  person  should  on  these  occa- 
sions, whether  sulphuretted  hydrogen  or  carbonic  acid  be  the  cause, 
make  a  moderate  inspiration  of  pure  air  and  hold  his  breath  while 
in  the  noxious  mixture.  In  an  accident  which  occurred  in  White- 
chapel,  in  August,  1857,  three  men  died  speedily  from  breathing  the 
vapor  of  an  old  sewer,  and  two  others  nearly  lost  their  lives  in  at- 
tempting to  assist  them.  The  best  plan  for  getting  rid  of  the  gas  is 
by  a  free  exposure  of  the  locality,  or  by  exciting  active  combustion 
in  it.  According  to  Parent-Duchatelet,  men  can  work  in  an  atmo- 
sphere containing  from  2  to  3  per  cent,  of  sulphuretted  hydrogen. 
The  air  of  one  of  the  principal  sewers  of  Paris  gave  the  following 
results,  on  analysis,  in  100  parts  :  oxygen,  13.79;  nitrogen,  81.21 ; 
carbonic  acid,  2.01  ;  sulphuretted  hydrogen,  2.99. 

Another  gaseous  mixture  in  the  form  of  deoxidized  air  was  found 
by  Thenard  in  the  sewers  of  Paris ;  it  was  composed,  in  100  parts, 
of  nitrogen  94,  of  oxygen  2,  and  of  carbonic  acid  4.  Sometimes  the 
carbonic  acid  is  combined  with  ammonia,  and  then  it  may  be  re- 
garded, chiefly,  as  a  mixture  of  nitrogen  holding  diffused  through  it 
the  vapor  of  carbonate  of  ammonia,  which  is  sufficient  to  render  it 
26 


402  LIGHTNING. 

highly  irritating  to  the  mucous  membrane  of  the  eyes  and  nose.  Its 
action  on  the  human  body  when  respired  will  be  readily  understood 
from  its  chemical  composition.  In  its  operation  it  is  essentially  nega- 
tive, and  destroys  life  by  cutting  off  the  access  of  oxygen.  The 
small  proportion  of  carbonic  acid  or  of  carbonate  of  ammonia  exist- 
ing in  it  cannot  give  rise  to  the  asphyxia  which  so  rapidly  follows 
its  inhalation.  The  chances  of  recovery  are  much  greater  in  persons 
who  become  asphyxiated  from  the  inspiration  of  this  compound  than 
in  those  who  are  exposed  to  the  influence  of  the  preceding.  Com- 
monly the  immediate  removal  to  a  current  of  pure  air  is  sufficient 
to  bring  about  a  recovery.  Should  death  take  place,  it  will  be  found 
on  inspection  that  the  internal  appearances  are  the  same  as  those 
which  are  met  with  in  death  from  suffocation. 

Analysis. — This  compound  has  no  offensive  smell ;  it  extinguishes 
a  taper ;  the  carbonic  acid  contained  in  it  may  be  removed  by  caustic 
potash,  and  then  it  will  be  seen  that  the  great  bulk  of  the  mixture 
is  formed  of  nitrogen  ;  a  gas  which,  by  its  negative  properties,  can- 
not be  easily  confounded  with  any  other.  In  a  mixed  atmosphere 
of  carbonic  acid  and  sulphuretted  hydrogen,  the  two  gases  may 
be  separated  by  agitating  the  mixture  with  a  solution  of  acetate  of 
lead,  and  treating  the  precipitate  with  acetic  acid,  which  dissolves 
the  carbonate  and  leaves  sulphide  of  lead. 


LIGHTNING.    COLD.    HEAT.    STARVATION. 


CHAPTER    XL. 

Effects  of  the  electeic  fluid.  —  post-mortem  appearances, 
cold  ax  occasional  cause  of  death.  —  symptoms. circum- 
stances which  accelerate  death.  —  post-mortem  appear- 
ances.— effect  of  heat. — starvation  a  rare  cause  of  death. 
— symptoms. — appearances  after  death. — legal  relations. 

Lightning. 

Deaths  from  lightning  are  more  common  than  is  generally  sup- 
posed. Although  they  usually  occur  under  circumstances  in  which 
the  facts  are  known,  yet  cases  may  present  themselves  in  which  the 
marks  of  violence  left  upon  the  dead  bodies  may  be  suggestive  of 
homicide.  Eew  or  no  statistics  of  these  deaths  have  been  published 
in  England  ;  but  in  France  the  facts  collected  by  M.  Boudin  show 
the  following  results  :  In  twenty-five  years — from  1835  to  1863 — 
2,238  persons  were  killed  by  lightning.  From  1854  to  1864.  in- 
clusive, 967  persons  were  killed,  698  being  males,  and  269  females. 


CAUSE    OF    DEATH.  403 

In  the  year  186-4  alone  there  were  87  killed,  61  males  and  26  females. 
Of  34  persons  killed  by  lightning  in  the  open  fields  during  the  year 
1853,  15  were  struck  while  taking  shelter  under  trees;  and  of  107 
persons  killed  by  lightning  between  1841  and  1853,  21  are  reported 
to  have  been  killed  under  trees.  Children  appear  to  escape  this 
mode  of  death  more  than  adults.  ("  Chemical  News,"  1865,  July  7 
and  Dec.  8.) 

Cause  of  Death. — The  electric  fluid  appears  to  act  fatally  by  pro- 
ducing a  violent  shock  to  the  brain  and  nervous  system.  In  general 
there  is  no  sense  of  pain ;  the  individual  falls  at  once  into  a  state  of 
unconsciousness.  In  a  case  which  did  not  prove  fatal,  the  person, 
who  was  seen  soon  after  the  accident,  was  found  laboring  under  the 
following  symptoms  :  insensibility  ;  deep,  slow,  and  interrupted  re- 
spiration ;  entire  relaxation  of  the  muscular  system ;  the  pulse  soft 
and  slow  ;  the  pupils  dilated,  but  sensible  to  light.  ("  Med.  Gaz." 
vol.  14,  p.  654.)  It  will  be  seen  that  these  are  the  usual  symptoms 
of  concussion  of  the  brain.  The  effect  of  a  slight  shock  is  that  of 
producing  stunning;  and  when  persons  who  have  been  severely 
struck  recover,  they  suffer  from  noises  in  the  ear,  paralysis,  and 
other  symptoms  of  nervous  disorder.  ("  Med.  Times,"  July  15,  1848.) 
Insanity  has  even  been  known  to  follow  a  stroke  of  lightning. 
(Conolly's  "  Eeport  of  Hanwell,"  1839.)  In  one  case  the  person  re- 
mained delirious  for  three  days,  and  when  he  recovered  he  had  com- 
pletely lost  his  memory.  ("  Lancet,"  August  3,  1839,  p.  582.)  A 
boy,  set.  4,  received  a  severe  shock  on  the  11th  May,  was  seized  with 
tetanus  on  the  13th,  and  died  in  four  hours.  ("  Med.  Times  and  Gaz." 
May  26,  1855.)  In  another  instance  an  old  man  who  took  shelter 
under  a  tree  felt  as  if  a  vivid  flash  had  struck  him  in  the  face ;  he 
did  not  fall,  but  he  became  almost  blind.  He  suffered  for  some  days 
from  frontal  headache,  and  loss  of  sight  supervened.  ("  Med.  Times 
and  Gaz."  July  24,  1858.) 

It  may  be  observed  of  the  effects  of  lightning,  general  by,  that 
death  is  either  immediate,  or  the  individual  recovers.  A  person  may 
however  linger,  and  die  from  the  effects  of  severe  lacerations  or 
burns  indirectly  produced.  In  a  case  which  occurred  in  July, 
1838,  death  was  thus  caused  indirectly  by  the  effects  of  electricity. 
The  following  case  of  recovery  illustrates  further  the  action  of  the 
electric  fluid :  Three  persons  were  struck  by  lightning  at  the  same 
time.  In  one,  a  healthy  man,  get.  26,  the  symptoms  were  severe. 
An  hour  and  a  half  after  the  stroke  he  lay  completely  unconscious, 
as  if  in  a  fit  of  apoplexy ;  his  pulse  was  below  60,  full  and  hard ; 
his  respiration  snoring,  his  pupils  dilated  and  insensible.  There 
were  frequent  twitchings  of  the  arms  and  hands ;  the  thumbs  were 
fixed  and  immovable,  and  the  jaws  firmly  clenched.  Severe  spasms 
then  came  on,  so  that  four  men  could  scarcely  hold  the  patient  in 
his  bed;  and  his  body  was  drawn  to  the  left  side.  When  these 
symptoms  had  abated  he  was  copiously  bled ;  cold  was  applied  to 
the  head,  a  blister  to  the  nape  of  the  neck,  and  mustard-poultices  to 
the  legs.  Stimulating  injections  and  opium  were  also  administered; 
in  the  course  of  twenty-four  hours  consciousness  slowly  returned, 


404  APPEARANCES    AFTER    DEATH. 

and  the  man  soon  completely  recovered.  The  only  external  injury 
discoverable  was  a  red  streak,  as  broad  as  a  finger,  which  extended 
from  the  left  temple  over  the  neck  and  chest ;  this  disappeared  com- 
pletely in  a  few  days.  ("Brit,  and  For.  Med.  Eev."  Oct.  1842.) 
These  red  streaks  or  marks  sometimes  assume  a  remarkable  disposi- 
tion over  the  skin.  (See  case  by  Dr.  Horstmann,  Casper's  "  Yiertel- 
jahrsch."  April,  1863,  p.  308.) 

Appearances  after  Death. — The  suddenness  of  death  is  such  that 
the  body  sometimes  preserves  the  attitude  in  which  it  was  struck. 
("  Med.  Times  and  Gaz.,"  Feb.  18,  1860,  p.  167.)  Generally  speak- 
ing there  are,  externally,  marks  of  contusion  and  laceration  about 
the  spot  where  the  electric  current  has  entered  or  passed  out : — some- 
times a  severe  lacerated  wound  has  existed: — on  other  occasions 
there  has  been  no  wound  or  laceration,  but  an  extensive  ecchymosis, 
which,  according  to  Meyer,  is  most  commonly  found  on  the  skin  of 
the  back.  In  one  instance,  which  occurred  in  London  in  May,  1839, 
there  were  no  marks  of  external  violence ;  and  several  similar  cases 
are  quoted  from  American  journals  in  the  "Medical  Times"  (May  3, 
1845,  p.  82.)  The  clothes  are  in  almost  all  cases  rent  and  torn,  and 
partially  singed,  giving  rise  to  a  peculiar  odor — sometimes  even 
rolled  up  in  shreds  and  carried  to  a  distance.  They  are  occasionally 
found  partially  burnt,  but  this  is  not  a  frequent  occurrence.  Metallic 
substances  about  the  person  present  traces  of  fusion,  and  articles  of 
steel  have  been  observed  to  acquire  magnetic  polarity.  Dr.  West 
has  informed  me,  that  in  a  case  to  which  he  was  called,  in  which  a 
boy,  set.  18,  had  been  instantly  struck  dead  by  lightning,  he  observed 
that  a  knife  in  the  pocket  of  the  deceased  had  acquired  strong  mag- 
netic polarity.  This  case  further  shows  that  which  has  frequently 
been  noticed — namely,  that  while  much  violence  has  been  done  to 
the  dress,  the  parts  of  the  body  covered  by  it  had  escaped  injury. 
The  deceased  wore  at  the  time  of  the  accident  a  pair  of  strong  leather 
boots :  these  were  torn  to  shreds,  probably  owing  to  the  presence  of 
iron  nails  in  the  soles,  but  the  feet  of  the  deceased  presented  no 
mark  of  injury!  An  accident  by  lightning  occurred  in  the  presence 
of  a  friend  of  mine,  by  which  a  healthy  man  was  instantaneously 
killed.  A  cap  which  the  man  wore  had  a  hole  through  it ;  his  hair 
was  singed,  his  shoes  were  burst  open,  and  his  trousers  torn.  The 
woodwork  of  the  building  down  which  the  electric  fluid  passed  was 
merely  split,  and  there  was  no  mark  of  burning.  I  have  examined, 
in  several  instances,  the  wood  of  trees  which  have  been  struck  by 
the  electric  fluid :  in  each  case  it  has  presented  only  the  appearance 
of  rending  by  mechanical  force. 

Wounds  and  burns  are  sometimes  met  with  on  the  body.  The 
wounds  have  commonly  been  lacerated  punctures,  like  stabs  pro- 
duced by  a  blunt  dagger.  In  the  case  of  a  person  who  was  struck 
but  not  killed,  a  deep  wound  was  produced  in  one  thigh,  almost 
laying  bare  the  femoral  artery.  This  person  was  struck,  as  many 
others  have  been,  while  in  the  act  of  opening  an  umbrella  during  a 
storm.     Fractures  of  the  bones  have  not  been  commonly  observed : 


FATAL    EFFECTS    PRODUCED    BY    LIGHTNING.  405 

in  a  case  mentiued  by  Pouillet,  the  skull  was  severely  fractured,  and 
the  bones  were  depressed.  ("  Traite  de  Physique,  Elect.  Atmosph.") 
In  May,  1864,  Dr.  Mackintosh,  of  Littleport,  was  called  to  see 
three  persons  who  had  been  struck  by  lightning  about  twenty  min- 
utes previously.  They  had  taken  shelter  under  a  haystack,  which 
had  been  set  on  fire  by  the  same  flash.  1.  A  boy,  aged  10,  was  then 
able  to  walk,  although  unable  to  move  his  legs  immediately  after 
the  occurrence.  All  that  he  remembered  was — he  saw  the  stack 
on  fire,  and  called  to  his  father ;  he  felt  dizzy  all  over,  and  unable 
to  move.  His  hair  and  clothes  were  not  singed,  and  the  metallic 
buttons  on  his  dress  showed  no  signs  of  fusion.  On  removing  his 
clothes  a  slight  odor  of  singeing  was  perceptible.  He  complained  of 
pain  at  the  lower  part  of  the  abdomen.  There  were  several  red 
streaks,  of  about  a  finger's  breadth,  running  obliquely  downwards 
and  inwards  on  either  side  of  the  chest  to  the  middle  line  in  front  of 
the  abdomen ;  they  then  descended  over  the  pubes,  and  were  lost  in 
the  perineum.  It  does  not  appear  that  there  was  any  abrasion  of 
the  skin.  This  boy  perfectly  recovered ;  the  red  streaks  disappeared 
gradually,  and  could  hardly  be  traced  four  days  after  the  injury.  2. 
Another  boy,  aged  11,  lay  prostrate  and  unconscious,  with  an  expres- 
sion of  grim  terror  and  suffering ;  he  frothed  at  the  mouth,  moaned 
piteously,  and  flung  his  legs  and  arms  about  in  all  directions.  The 
breathing  was  deep,  slow,  and  laborious ;  the  heart  palpitating,  pulse 
weak  and  very  irregular;  the  pupils  were  dilated,  and  insensible  to 
light.  There  were  in  this  case  several  red  streaks  converging  from 
the  neck  and  shoulders  to  the  middle  of  the  chest-bone,  and  passing 
over  the  abdomen  until  they  were  lost  on  the  pubes.  There  were 
similar  streaks  radiating  for  a  few  inches  from  the  tuber  ischii  on 
each  hip  in  different  directions,  until  they  were  lost  in  the  skin.  It 
appears  that  this  boy  was  in  a  sitting  posture  when  struck.  The 
hair  on  the  back  of  his  head  and  neck  was  singed,  and  the  peculiar 
odor  of  singeing  was  perceived,  although  his  clothes  showed  no 
traces  of  burning,  nor  the  metallic  buttons  of  fusion.  The  boy  be- 
came conscious  in  five  hours,  and  rapidly  recovered.  The  red  streaks 
gradually  disappeared,  leaving  streaks  of  a  scaly  glistening  white 
appearance,  which  ultimately  left  no  trace  of  their  existence.  3.  A 
man,  aged  46.  Like  the  two  others,  he  was  in  a  sitting  posture,  and 
he  appeared  to  have  been  killed  on  the  spot :  he  had  not  moved  hand 
or  foot.  The  countenance  was  placid,  and  the  pupils  were  widely 
dilated.  The  electric  fluid  had  produced  a  large  lacerated  wound  of 
the  scalp,  at  the  junction  of  the  occipital  with  the  parietal  bones,  but 
without  producing  any  fracture.  The  electric  fluid  appeared  to  have 
passed  down  each  side  of  the  head,  between  the  soft  parts  and  the 
cranium.  On  the  left  side  it  had  passed  downwards  in  front  to  the 
left  ear,  and  terminated  on  the  side  of  the  neck,  rupturing  bloodves- 
sels and  muscles,  and  causing  swelling  of  the  parts  with  effusion  of 
blood.  It  presented  the  appearance  of  an  extensive  bruise  caused 
by  mechanical  violence.  On  the  right  side  the  current  had  passed 
down  to  the  space  above  the  collar-bone,  causing  lividity  and  swell- 
ing of  the  right  ear  as  well  as  of  the  adjacent  skin;  and  it  termi- 
nated in  a  dark-blue  mangled  patch  of  skin,  in  which  there  were 


406  FATAL    EFFECTS    PRODUCED    BY    LIGHTNING. 

several  free  communications  with  the  surface.  The  hair  on  the  back 
of  the  head  was  slightly  singed,  and  that  in  front  of  the  chest  was 
singed  quite  close  to  the  skin,  but  the  hair  which  covered  the  wound 
in  the  scalp,  where  the  current  had  entered,  was  uninjured.  The 
clothes  were  neither  torn  nor  burnt,  and  the  metallic  buttons  were 
not  fused.  The  clothes  of  all  three  were  very  wet.  The  hat  was 
not  examined.  The  left  side-pocket  of  the  trousers  contained  several 
lucifer-matches  and  a  tin  tobacco-box,  which  were  unaffected  by  the 
electric  discharge.  The  right  pocket  contained  a  knife,  which  had 
acquired  strong  magnetic  polarity.  The  body  was  placed  in  a  warm 
room,  and  it  is  worthy  of  remark  that  cadaveric  rigidity  came  on  in 
fourteen  hours  after  death.  ("Lancet,"  July  30,  1864,  p.  118.)  It 
is  to  be  regretted  that  no  post-mortem  examination  was  allowed.  It 
is  probable  that  the  brain  sustained  severe  injury,  causing  immediate 
death.  These  cases  singlarly  present  the  effects  of  lightning  in  three 
degrees — the  effect  of  a  slight  shock  in  No.  1,  of  a  severe  shock  in 
No.  2,  and  of  a  fatal  shock  in  No.  3.  There  was  but  little  bodily 
injury  in  either  case,  and  no  appearance  of  burning.  The  marks  on 
the  skin  in  Nos.  1  and  2  could  not  have  been  mistaken  for  violence, 
but  the  wound  to  the  scalp  and  the  injuries  to  the  neck  in  No.  3 
might  have  been  ascribed  to  the  violence  of  another,  had  not  the 
circumstances  been  fully  known.  The  clothes  probably  escaped 
burning  or  tearing  by  reason  of  their  being  wet,  and  their  readily 
conducting  the  electric  fluid. 

The  burns  occasionally  found  on  the  bodies  of  persons  who  have 
been  struck  by  lightning  have  been  hitherto  ascribed  to  the  ignition 
of  the  clothes.  It  appears,  however,  from  the  subjoined  cases,  that 
burns  even  of  a  severe  kind  may  be  the  result  of  a  direct  agency  of 
the  electric  fluid  itself  upon  the  body.  Dr.  Geoghegan  met  with  the 
case  of  a  girl  who  had  been  struck  by  lightning ;  there  was  burning 
of  the  thigh  and  buttocks  to  the  first  and  second  degrees,  but  the 
clothes  did  not  show  any  signs  of  combustion.  On  the  16th  of  July, 
1852,  a  man,  set.  23,  while  engaged  in  milking  a  cow  in  a  wooden 
shed,  during  a  severe  thunder  storm,  suddenly  observed  a  vivid  flash 
of  lightning,  which  killed  the  cow  instantly,  and  inflicted  serious 
injuries  upon  himself.  He  was  seen  sixteen  hours  after  the  accident, 
and  a  severe  burn  was  found  upon  his  person,  extending  from  the 
right  hip  to  the  shoulder,  and  covering  a  large  portion  of  the  front 
and  side  of  the  body.  His  mind  was  then  wandering,  and  there 
were  symptoms  of  inflammatory  fever.  The  man  was  confined  to 
his  bed  for  seventeen  days,  at  the  end  of  which  time  the  injuries  had 
not  perfectly  healed.  On  examining  his  dress,  the  right  sleeve  of 
his-  shirt  was  found  burnt  to  shreds,  but  there  was  no  material  burn- 
ing of  any  other  part  of  the  dress.  The  case  is  singular,  inasmuch 
as  it  shows  that  the  dress  may  be  burnt  without  the  surface  of  the 
body  being  simultaneously  injured;  and  further,  that  a  burn  may 
be  produced  on  the  body,  although  the  clothes  covering  the  part 
may  have  escaped  combustion.  Mr.  Fleming  has  described  the  cases 
of  eight  persons  who  were  struck  by  lightning,  and  on  the  bodies  o\' 
some  of  these  there  were  marks  of  severe  burns.     The  dresses  were, 


FATAL    ACCIDENTS    FROM    LIGHTNING.  407 

in  parts,  much  singed.  These  cases  show,  in  a  remarkable  manner, 
the  intense  heat  evolved  in  the  instantaneous  passage  of  the  electric 
fluid  through  the  clothes  and  body.  The  persons  struck  were  be- 
numbed or  paralyzed  in  various  degrees,  but  all  ultimately  recovered ; 
but  the  burns  were  so  severe  that  some  months  elapsed  before  they 
were  entirely  healed.  ("Glasgow  Med.  Journal,"  Oct.  1859,  p.  257.)  A 
man  was  struck  by  lightning  in  July,  1861.  Externally  there  was 
a  burn  upon  the  nape  of  the  neck,  where  the  metallic  watchguard 
rested ;  and  from  the  point  where  the  current  of  electricity  left  the 
chain  the  skin  was  blistered  in  a  straight  line  down  to  the  feet, 
scorching  the  hair  of  the  pubes  in  its  course.  His  intellect  was  con- 
fused, and  his  general  condition  was  that  of  collapse.  With  the  aid 
of  stimulants,  he  became  sufficiently  restored  to  communicate  his 
feelings.  There  was  paralysis  of  the  lower  extremities,  with  loss  of 
sensibility  (anaesthesia),  and  retention  of  urine.  He  was  deaf,  and 
complained  of  a  noise  in  his  ears  like  thunder ;  he  had  some  diffi- 
culty in  articulating  and  pain  in  swallowing,  with  a  peculiar  metallic 
taste  in  his  mouth.  The  anaesthesia  passed  away  in  half  an  hour, 
but  he  did  not  completely  recover  the  use  of  his  limbs  for  four  days; 
the  bladder  was  paralyzed  for  twenty-four  hours,  and  only  relieved 
by  the  use  of  a  catheter,  of  high-colored  urine  with  abundance  of 
phosphates;  the  bowels  were  confined.  All  these  symptoms  gradu- 
ally disappeared,  excepting  slight  deafness,  and  the  man  was  dis- 
charged convalescent. 

The  following  complete  account  of  the  external  and  internal 
appearances  found  in  the  body  of  a  healthy  middle-aged  laborer, 
who  was  killed  by  a  stroke  of  lightning,  has  been  published  by  Dr. 
Schaffer:  The  man  was  working  in  the  fields  with  several  other 
laborers,  just  after  a  thunder  storm  had  passed  over,  and  had  appa- 
rently subsided.  He  was  endeavoring  to  kindle  a  light  with  a  flint 
and  steel,  when  the  lightning  struck  him.  For  a  moment  after  the 
shock  he  stood  still,  and  then  his  body  fell  heavily  to  the  ground. 
The  electric  fluid  entered  at  the  upper  part  of  his  forehead,  perfo- 
rating and  tearing  his  hat  at  that  part ;  it  seemed  then  to  have  become 
divided  into  two  currents,  which  passed  down  the  sides  of  the  body, 
along  the  lower  limbs,  and  out  at  the  feet.  On  the  upper  part  of  the 
forehead  was  found  a  soft  swelling,  of  a  dark-blue  color,  and  about 
the  size  of  the  palm  of  a  hand ;  the  hair  which  covered  it  was 
uninjured.  From  this  spot  two  dark  red  streaks  proceeded  in  dif- 
ferent directions.  One  of  these  passed  to  the  left,  running  over  the 
temple,  in  front  of  the  left  ear,  down  the  neck  to  the  surface  of  the 
chest,  over  which  it  passed  between  the  left  nipple  and  the  armpit; 
and  so  made  its  way  over  the  body  to  the  left  inguinal  region,  where 
it  formed  a  large,  irregular,  scorched-looking  (brandige)  patch  on 
the  skin.  From  this  point,  a  dark-red  streak  again  continued  its 
downward  course,  passing  over  the  great  trochanter,  then  along  the 
outer  surface  of  the  left  leg  to  the  back  of  the  foot,  where  it  termi- 
nated in  several  small  dark-blue  spots.  The  other  streak,  which 
proceeded  from  the  ecchymosed  swelling  on  the  forehead,  passed 
directly  to  the  right  ear,  which  was  considerably  swollen  and 'of  a 


408  MARKS    OF    VIOLENCE    FROM    LIGHTNING. 

dark-blue  color ;  from  the  ear  it  ran  downwards  and  backwards  along 
the  neck,  crossed  the  right  border  of  the  scapula,  and  eventually 
reached  the  right  groin,  where  a  scorched  patch  of  skin  similar  to 
that  in  the  left  groin  was  found.  From  this  part  the  discolored 
streak  continued  down  the  outer  side  of  the  right  leg  to  its  termina- 
tion on  the  back  of  the  foot,  just  as  on  the  left  side.  It  is  remarkable 
that  although  the  hair  on  the  forehead,  as  well  as  that  which  occurred 
in  any  part  of  the  track  taken  by  the  electric  current  down  to  the 
groin,  was  not  burnt,  yet  at  the  groin  itself,  and  at  every  part  hence 
to  the  foot  over  which  the  electric  stream  had  passed,  the  hairs  were 
completely  burnt.  The  cause  of  the  skin  and  hair  in  the  groins 
being  burnt  is  probably  to  be  referred  to  the  buckles  of  a  belt  which 
the  man  wore  round  his  abdomen  at  the  time  of  the  accident ;  the 
belt  was  completely  destroyed.  Nothing  further  worthy  of  notice 
was  observed  on  the  exterior  of  the  body,  with  the  exception  of  the 
face  being  very  red.  The  swelling  of  the  head  was  found  to  be  due 
to  the  presence  of  a  large  quantity  of  extravasated  blood.  The  bone 
beneath  was  not  injured.  Blood  was  effused  in  other  parts  of  the 
scalp  corresponding  to  the  swollen  discolored  patches  outside ;  about 
four  ounces  had  been  effused.  The  vessels  of  the  cerebral  membranes 
were  greatly  congested,  and  the  brain  itself  contained  much  blood, 
especially  observed  in  the  choroid  plexuses.  A  large  quantity  of 
reddish  mucus  was  found  in  the  larynx,  windpipe,  and  air-tubes ;  the 
lungs  were  loaded  with  dark  blood ;  there  was  a  great  deficiency  of 
blood  in  the  cavities  of  the  heart  and  in  the  large  vessels ;  the  blood- 
vessels of  the  stomach  and  intestines  were  more  than  usually  con- 
gested; the  right  lobe  of  the  liver  was  of  a  dark-red  color,  and 
loaded  with  blood,  especially  the  part  which  corresponded  to  the 
burnt  patch  of  skin  at  the  lower  part  of  the  abdomen;  the  spleen 
also  was  large,  and  filled  with  blood.  Much  blood  was  found  accu- 
mulated in  the  substance  of  the  muscles  of  the  abdomen,  at  those  parts 
which  lay  beneath  the  burnt  surfaces  outside.  ("Oesterreich.  Med. 
Wochenschrift,"  6th  June,  1846.)  It  was  formerly  supposed  that 
the  blood  was  never  found  coagulated  in  persons  killed  by  lightning, 
and  that  the  body  did  not  become  rigid  after  death.  Experience  lias 
shown,  however,  that  these  statements  are  not  in  accordance  with 
observed  facts. 

Ecchymoses  resembling  those  produced  by  mechanical  violence 
and  of  great  extent  are  sometimes  met  with.  A  short,  muscular  man 
was  killed  by  lightning.  There  was  a  strong  smell  of  burning  about 
the  body.  The  hair  was  singed  considerably  at  the  back  of  the  head. 
at  the  nape  of  the  neck,  and  slightly  above  the  forehead,  at  each 
corner  of  which  there  was  a  dark  ecchymosis.  The  scalp  was  greatly 
ecchymosed  at  the  top  and  at  the  back  of  the  head.  There  was  a 
large  ecchymosis  at  the  nape  of  the  neck,  and  from  this  a  livid  band 
half  an  inch  broad  curved  round  the  right  side  of  the  neck,  and  ter- 
minated in  a  large  ecchymosis  at  the  sternal  end  of  the  right  clavicle. 
The  left  forearm  was  scorched  in  front,  and  along  the  centre  of  the 
scorched  surface  ran  a  dark  line  about  three  or  four  lines  broad. 
There  was  a  slight  ecchymosis  on  the  right  thigh  and  on  the  right  side 


ACTION    FOR    DAMAGES    BY    LIGHTNING.  409 

of  the  scrotum.  About  half  way  down  the  right  leg  was  an  extensive 
scorch  encircling  the  leg,  and  a  line  of  about  three-quarters  of  an 
inch  in  breadth  ran  down  the  inner  side  of  the  leg  to  the  sole.  The 
soles  of  both  feet  were  extensively  blistered,  and  the  cuticle  charred. 
The  clothing  corresponding  to  the  injured  parts  was  extensively 
scorched,  and  large  holes  were  burnt  in  the  soles  of  the  socks.  The 
boots  were  scorched  inside,  but  not  injured  outside,  although  there 
were  iron  nails  in  the  soles.  Excepting  the  nails  in  the  boots  there 
was  no  metal  about  the  body.  The  pupils  were  widely  dilated. 
Cadaveric  rigidity  was  unusually  marked,  requiring  great  force  to 
overcome  it.  The  inner  surface  of  the  scalp  was  ecchymosed.  The 
brain  appeared  bloodless  and  soft,  and  there  was  but  little  fluid  in 
the  ventricles.  The  veins  and  sinuses  of  the  base  were  filled  with 
dark  fluid  blood.  The  heart  was  flabby ;  the  right  ventricle  con- 
tained a  small  quantity  of  dark  fluid  blood ;  the  great  veins  were 
distended  with  very  dark  blood,  everywhere  perfectly  fluid.  There 
was  no  coagulurn  or  clot  in  any  part,  and  the  blood  showed  no  ten- 
dency to  coagulate  after  its  escape.  The  lungs  were*  much  congested 
posteriorly  and  very  soft.  ("  Med.  Times  and  Gaz."  Oct.  14,  1865, 
p.  118.) 

The  external  injuries  in  these  cases  resemble  those  caused  by 
violence,  but  the  peculiar  form,  extent  and  direction  of  the  ecchy- 
moses,  as  well  as  the  presence  of  marks  of  burning,  either  on  the 
clothes  or  the  body,  were  sufficient  to  distinguish  them  as  injuries 
produced  by  the  electric  fluid. 

Legal  Relations. — Rare  as  the  combination  of  circumstances  must 
be  in  which  a  medico-legal  question  can  arise  in  reference  to  the 
action  of  the  electric  fluid  on  the  body,  a  case  was  tried  in  France, 
in  October,  1845,  in  which  medical  evidence  respecting  the  charac- 
ters of  wounds  caused  by  electricity  was  of  considerable  importance. 
In  August  of  that  year  some  buildings  were  destroyed  at  Malaunay 
near  Rouen,  as  it  was  alleged,  on  the  one  side  by  a  thunderstorm, 
on  the  other  by  a  whirlwind ;  and  as  the  parties  were  insured  against 
lightning,  they  brought  an  action  for  recovering  the  amount  insured. 
The  evidence  in  favor  of  the  accident  having  been  due  to  electricity 
consisted — first,  in  the  alleged  carbonized  appearances  of  the  leaves 
of  some  trees  and  shrubs  growing  near ;  and  secondly,  in  the  charac- 
ters of  the  wounds  on  the  bodies  of  several  persons  who  were 
injured  at  the  time  of  the  occurrence.  M.  Lesauvage  stated  at  the 
trial  that  there  was  an  appearance  of  dark  stains  scattered  over  the 
bodies,  and  that  those  who  survived  suffered  from  torpor,  pains  in 
limbs,  and  a  partial  paralysis  of  motion.  He  observed,  also,  that 
decomposition  took  place  very  speedily  in  the  bodies  of  those  who 
were  killed.  In  one  instance  the  muscles  were  torn  and  lacerated, 
and  some  small  arteries  divided.  This  witness  attributed  most  of  the 
wounds  to  the  effects  of  electricity.  M.  Funel  deposed,  that  in  some 
of  the  dead  bodies  which  he  examined  the  face  and  neck  were 
bloated  and  discolored,  as  if  death  had  taken  place  from  asphyxia. 
It  does  not  appear,  however,  that  there  were  any  circumstances 
decisively  proving  that  the  buildings  had  been  destroyed  by  light- 


410  FATAL    EFFECTS    OF    COLD. 

ning.  M.  Pouillet  lias  given  an  accurate  description  of  the  storm : 
he  believed  that  although,  as  deposed  to  by  some  of  the  witnesses  at 
tin-  trial,  it  may  have  been  attended  with  thunder  and  lightning,  the 
buildings  with  the  surrounding  trees  were  overthrown  by  the  mere 
force  of  the  wind,  and  not  by  the  electric  fluid.  The  description 
given  bears  out  this  view,  but  at  the  same  time  it  is  unusual  that 
trees  when  struck,  unless  old  or  dry  and  withered,  should  present 
any  marks  of  combustion  about  the  leaves  or  trunk.  (See  "  Comptes 
Rendns,"  Sept.  1845;  also  "Med.  Gaz."  vol.  36,  p.  1133.)  The  scien- 
tific evidence  was  of  the  most  conflicting  kind.  The  Eoyal  Court 
of  Eouen  decided  that  the  disaster  was  occasioned  by  the  atmosphere ; 
and,  without  entering  into  the  various  theories  of  storms,  condemned 
the  insurance  companies  to  pay  the  amounts  claimed.  ("Law  Times," 
March  14,  1846,  p.  490.) 

Cold. 

Cause  of  Death. — The  protracted  exposure  of  the  human  body  to 
a  low  temperature  may  destroy  life;  and  although  in  this  country 
cases  but  rarely  occur  in  which  cold  alone  operates  fatally,  it  is  not 
unusual,  during  a  severe  winter,  to  hear  of  persons  in  a  state  of 
misery  and  destitution,  being  found  dead  in  exposed  situations.  On 
these  occasions  we  may  reasonably  suspect  that  the  want  of  proper 
food  and  nourishment  has  accelerated  death.  It  is,  however,  con- 
venient to  make  a  distinction  between  the  effects  of  cold  and  of 
starvation  on  the  system,  as  the  symptoms  preceding  death  and  the 
rapidity  with  which  it  takes  place,  are  different  in  the  two  cases. 

Symptoms. — A  moderate  degree  of  cold  is  well  known  to  have  an 
invigorating  effect  upon  the  body:  but  if  the  cold  be  severe,  and  the 
exposure  to  it  long-continued,  while  the  calorific  function  is  not 
maintained  by  warmth  of  clothing  or  exercise,  the  skin  becomes 
pale,  and  the  muscles  become  gradually  stiff  and  contract  with  diffi- 
culty, especially  those  of  the  face  and  extremities.  Sensibility  is 
lost,  a  state  of  torpor  ensues,  followed  by  profound  sleep  from  which 
the  person  cannot  be  readily  roused :  in  this  state  of  lethargy  the 
vital  functions  gradually  cease,  and  the  person  finally  perishes.  Such 
are  the  general  effects  of  intense  cold  upon  the  body :  its  influence 
on  the  nervous  system  is  seen  in  the  numbness,  torpor,  and  sleepi- 
ness which  have  been  described  as  consequences  of  a  long  exposure 
to  severe  cold.  Giddiness,  dimness  of  sight,  tetanus,  and  paralysis 
have  in  some  cases  preceded  the  fatal  insensibility.  It  has  been 
found  that  temperature  materially  affects  the  amount  of  oxygon 
taken  by  the  blood.  At  a  low  temperature  this  fluid  takes*  less 
oxygen;  hence  it  becomes  less  oxygenated,  and  this  state  of  the 
blood  affects  the  condition  of  the  brain  and  nervous  system.  (Ber- 
nard, op.  cit.  p.  114.)  It  was  observed  during  the  retreat  of  the 
French  from  Moscow,  that  those  who  were  most  severely  affected  by 
cold  often  reeled  about  as  if  in  a  state  of  intoxication  :  they  also 
complained  of  giddiness  and  indistinctness  of  vision,  and  sank  under 
a  feeling  of  lassitude  into  a  state  of  lethargic  stupor,  from  which  it 


COLD,   ACCELERATION    OF    DEATH.  411 

was  found  impossible  to  rouse  them.  Sometimes  the  nervous  system 
was  at  once  affected :  tetanic  convulsions  followed  by  rigidity  of  the 
whole  of  the  voluntary  muscles,  seized  the  individual,  and  he  rapidly 
fell  a  victim.  Symptoms  indicative  of  a  disturbance  of  the  func- 
tions of  the  brain  and  nervous  system  have  also  been  experienced 
by  Arctic  travellers  during  their  residence  within  the  Polar  circle. 
The  late  researches  of  M.  Pouchet  on  the  effects  of  a  freezing  tem- 
perature on  animals  have  led  him  to  the  conclusion  that  death  is 
due  to  a  physical  change  in  the  blood-globules,  and  not  to  any  effect 
on  the  nervous  system.  The  first  phenomenon  produced  by  cold  is 
a  contraction  of  the  capillary  vessels  to  such  an  extent  that  the 
blood-globules  cannot  enter  them  ;  these  vessels,  therefore,  remain 
completely  empty.  The  second  phenomenon  is  an  alteration  of 
these  globules,  amounting  to  their  complete  disorganization.  Under 
these  circumstances  an  animal  cannot  be  restored.  ("Chemical 
News,"  Dec.  1,  1865,  p.  263.)  A  human  being  may,  however,  per- 
ish from  a  degree  of  cold  not  sufficient  to  produce  congelation. 

Circumstances  which  Accelerate  Death. — There  are  certain  conditions 
which  may  accelerate  death  from  cold.  In  all  cases  in  which  there 
is  exhaustion  of  the  nervous  system — as  in  those  who  are  worn  out 
by  disease  or  fatigue,  in  the  aged  and  infirm,  or,  lastly,  in  persons 
who  are  addicted  to  the  use  of  intoxicating  liquors — the  fatal  effects 
of  cold  are  more  rapidly  manifested  than  in  others  who  are  healthy 
and  temperate.  It  has  been  uniformly  remarked  that  whenever  the 
nervous  energy  is  impaired,  either  b}^  intoxication  or  exhaustion 
from  fatigue,  a  man  dies  quickly  from  cold.  The  exposure  of 
drunken  persons,  during  a  severe  winter,  may  therefore  suffice  to 
destroy  life,  although  the  cold  might  not  be  so  intense  as  to  affect 
others  who  were  temperate.  Casualties  of  this  nature  sometimes 
occur  during  the  winter-season  in  this  metropolis ;  and  a  knowledge 
of  the  influence  of  intoxication,  in  accelerating  death  under  such 
circumstances,  may  occasionally  serve  to  remove  a  doubt  in  the 
mind  of  a  practitioner  respecting  the  real  cause.  Infants,  especially 
when  newly  born,  easily  perish  from  exposure  to  cold.  Cold,  when 
accompanied  by  rain  and  sleet,  appears  to  have  a  more  powerfully 
depressing  influence  than  when  the  air  is  dry — probably  from  the 
effects  of  evaporation.  The  following  case  by  Dr.  Currie  shows  the 
fatal  effects  of  cold  winds  accompanied  by  humidity :  "  Of  several 
persons  who  clung  to  a  wreck,  two  sat  on  the  only  part  that  'was 
not  submerged ;  of  the  others,  all  were  constantly  immersed  in  the 
sea,  and  most  of  them  up  to  the  shoulders.  Three  only  perished, 
two  of  whom  were  generally  out  of  the  sea,  but  frequently  over- 
whelmed by  the  surge,  and  at  other  times  exposed  to  heavy  showers 
of  sleet  and  snow,  and  to  a  high  and  piercing  wind.  Of  these  two, 
one  died  after  four  hours'  exposure;  the  second  died  three  hours 
later,  although  a  strong  healthy  adult,  and  inured  to  cold  and  hard- 
ship ;  the  third  that  perished  was  a  weakly  man.  The  remaining 
eleven,  who  had  been  more  or  less  completely  submerged,  were  taken 
from  the  wreck  the  next  day,  after  twenty-three  hours'  exposure, 
and  they  recovered.     The  person  among  the  whole  who  seemed  to 


■il2  COLD.      APPEARANCES    AFTER    DEATH. 

have  suffered  least  was  a  negro:  of  the  other  survivors,  several 
were  by  no  means  strong  men,  and  most  of  them  had  been  inured 
to  the  warm  climate  of  Carolina." 

Appearances  after  Death. — Opportunities  rarely  occur  of  examining 
bodies  when  death  results  purely  from  exposure  to  cold.  The  skin 
is  commonly  pallid,  and  the  viscera  of  the  chest  and  abdomen  as 
well  as  the  brain  are  congested  with  blood.  Dr.  Kellie,  of  Leith, 
found  in  two  cases  which  he  examined,  a  redness  of  the  small  intes- 
tines from  the  congestion  of  the  capillary  vessels,  and  a  great  effusion 
into  the  ventricles  of  the  brain.  A  sufficient  number  of  cases  have 
not  yet  been  inspected,  to  enable  us  to  determine  how  far  these  two 
last-mentioned  appearances  are  to  be  regarded  as  consequences  of 
death  from  cold ;  but  all  observers  have  found  a  general  congestion 
of  the  bloodvessels  and  viscera.  In  consequence  of  the  great  con- 
gestion uniformly  met  with  in  the  vessels  and  sinuses  of  the  brain, 
some  pathologists  have  regarded  death  from  cold  as  resulting  from 
an  attack  of  apoplexy ;  but  the  symptoms  which  precede  death  do 
not  bear  out  this  view.  Effusions  of  blood  have  not  yet  been 
observed,  and  a  mere  fulness  of  the  cerebral  vessels  after  death  is 
not  in  itself  sufficient  to  justify  this  opinion.  It  will  be  observed 
that,  on  the  whole,  these  appearances  are  remarkably  similar  to 
those  which  are  found  in  death  from  severe  burns  and  scalds.  Thus 
then  a  medical  jurist  will  perceive,  that  in  order  to  come  to  a  deci- 
sion whether,  on  the  discovery  of  a  dead  body,  death  has  taken  place 
from  cold  or  not,  is  a  task  of  some  difficulty.  The  season  of  the 
year — the  place  and  circumstances  under  which  the  body  of  the 
deceased  is  found — together  with  the  absence  of  all  other  possible 
causes  of  death  (such  as  from  violent  injuries  or  internal  disease), 
form  the  only  basis  for  a  medical  opinion.  Death  from  cold  is  not 
to  be  determined  except  by  negative  or  presumptive  evidence ;  for 
there  is  no  organic  change,  either  externally  or  internally,  sufficiently 
characteristic  of  it  to  enable  a  medical  man  to  give  a  positive  opinion 
on  the  subject. 

Heat. 

Intense  Heat. — The  effect  of  an  intensely-heated  atmosphere  in 
causing  death  has  been  but  little  studied.  I  have  been  consulted  in 
one  case  in  which  the  captain  of  a  vessel  was  charged  with  man- 
slaughter, for  causing  a  man  to  be  lashed  within  a  short  distance  of 
the  stoke-hole  of  a  steam-furnace  in  the  hold  of  a  vessel.  The  man 
died  apparently  from  the  effects  of  this  exposure.  The  engine-rooms 
of  steamers  in  the  tropics  have  been  observed  to  have  a  temperature 
as  high  as  140°  ;  and  engineers  after  a  time  become  habituated  to 
this  excessive  heat,  without  appearing  to  suffer  materially  in  health. 
In  certain  manufactures  the  body  appears  to  acquire  a  power,  by 
habit,  of  resisting  these  high  temperatures — still  it  has  been  proved 
that  many  suffer  severely.  In  a  Report  on  the  Employment  of 
Children  (1865),  it  is  stated  than  in  a  glass  manufactory  a  thermo- 
meter held  close  to  a  boy's  head  stood  at  130°,  and,  as  the  Inspector 


EFFECTS    OF    STARVATION.  413 

stood  near  to  observe  the  instrument,  bis  hat  actually  melted  out  of 
shape.  Another  boy  had  his  hair  singed  by  the  heat,  and  said  that 
his  clothes  were  sometimes  singed  too ;  while  a  third  worked  in  a 
temperature  of  no  less  than  150°.  Amid  this  tremendous  heat  they 
carry  on  work  which  requires  their  constant  attention :  they  are 
incessantly  in  motion.  In  the  Turkish  bath  higher  temperatures 
than  this  have  been  noted,  but  there  is  reason  to  believe  that  serious 
symptoms  have  been  occasionally  produced  in  persons  unaccustomed 
to  them,  and  that  in  one  or  two  cases  death  has  resulted.  In  attempt- 
ing to  breathe  air  heated  to  temperatures  varying  from  180°  to 
200°,  there  is  a  sense  of  suffocation  with  a  feeling  of  dizziness  and 
other  symptoms  indicative  of  an  effect  on  the  brain :  the  circulation 
is  enormously  quickened. 

In  July,  1861,  an  inquest  was  held  in  London  on  the  body  of  a 
stoker  of  an  Aberdeen  steamship.  He  had  been  by  trade  a  grocer, 
and  was  not  accustomed  to  excessive  heat.  While  occupied  before 
the  engine  furnace  he  was  observed  to  fall  suddenly  on  the  floor  in 
a  state  of  insensibility ;  when  carried  on  deck  it  was  found  that  he 
was  dead.  All  that  was  discovered  on  a  post-mortem  examination 
was  an  effusion  of  serum  into  the  ventricles  of  the  brain ;  death  had 
been  caused  by  sudden  apoplexy.  In  some  cases  a  person  may  sink 
from  exhaustion  as  a  result  of  long  exposure.  Intense  heat  appears 
generally  to  operate  by  inducing  congestion  of  the  ,  brain  (heat- 
apoplexy).  The  death  is  usually  sudden,  as  from  severe  apoplexy. 
During  the  hot  summer  of  1865  several  deaths  from  this  cause  are 
reported  to  have  occurred.  In  India,  also,  many  sudden  deaths 
took  place  from  sun-stroke  or  heat-apoplexy  during  the  hot  season 
of  1865. 

Starvation. 

A  rare  Cause  of  Death. — Death  from  the  mere  privation  of  food  is 
a  rare  event,  although,  if  we  were  to  form  an  opinion  from  the  ver- 
dicts of  coroners'  juries,  its  occurrence  would  not  appear  to  be  un- 
common in  this  and  other  large  cities.  In  one  of  the  Annual 
Registration  Returns  it  is  stated  that  130  persons  died  from  starva- 
tion. Such  cases  must,  however,  be  received  with  some  distrust,  as 
care  is  rarely  taken  to  ascertain  precisely  how  far  bodily  disease 
may  have  been  concerned  in  causing  death.  Still  it  cannot  be  denied 
that  starvation  should  be  classed  among  the  forms  of  violent  death, 
being  sometimes  the  result  of  criminal  neglect  or  inattention  in  the 
treatment  of  children  or  of  infirm  and  decrepit  persons,  and  thus 
constituting  homicide;  or  at  other  times,  although  rarely,  arising 
from  an  obstinate  determination  to  commit  suicide  in  those  from 
whom  all  other  means  of  self-destruction  are  cut  oft*. 

Symptoms. — The  symptoms  which  attend  on  the  privation  of  food, 
or  the  supply  of  improper  food,  have  been  variously  described. 
Referring  to  cases  which  occurred  during  the  Irish  famine  of  1847, 
Dr.  Donovan  states  that  the  persons  who  suffered  described  the  pain 
of  hunger  as  at  first  very   acute,  but  said  that   after  twenty-four 


414  EFFECTS    OF    STARVATION. 

hours  had  been  passed  without  food,  the  pain  subsided,  and  was  suc- 
ceeded by  a  feeling  of  weakness  and  sinking,  experienced  principally 
in  the  region  of  the  stomach;  accompanied  with  insatiable  thirst,  a 
st long  desire  for  cold  water,  and  a  distressing  feeling  of  coldness 
over  the  entire  surface  of  the  body.  In  a  short  time  the  face  and 
limbs  became  frightfully  emaciated;  the  eyes  acquired  a  peculiar 
stare;  the  skin  exhaled  an  offensive  smell;  and  was  covered  with  a 
brownish  filthy-looking  coating,  almost  as  indelible  as  varnish.  This 
he  was  at  first  inclined  to  regard  as  incrusted  filth,  but  further  ex- 
perience convinced  him  that  it  was  a  secretion  poured  out  from  the 
exhalants  on  the  surface  of  the  body.  The  sufferer  tottered  in  walk- 
ing, like  a  drunken  man :  his  voice  was  weak,  like  that  of  a  person 
affected  with  cholera ;  he  whined  like  a  child,  and  burst  into  tears 
on  the  slightest  occasion.  In  respect  to  the  mental  faculties,  their 
prostration  kept  pace  with  the  general  wreck  of  bodily  power ;  in 
many  there  was  a  state  of  imbecility,  in  some  almost  complete 
idiocy ;  but  in  no  instance  was  there  delirium  or  mania,  which  has 
been  described  as  a  symptom  of  protracted  abstinence  among  ship- 
wrecked mariners.     ("Dub.  Med.  Press,"  February,  1848,  p.  67.) 

Among  the  symptoms  there  is  severe  pain  in  the  region  of  the 
stomach,  a  suppression  of  the  fasces,  or,  if  discharged,  they  are  in 
small  quantity,  dry,  and  dark-colored ;  the  urine  is  scanty,  high- 
colored,  and  turbid ;  the  intellect  is  dull.  '  The  person  may  be  ex- 
hausted, and  remain  without  motion  in  one  position,  or  be  seized 
with  a  furious  delirium,  which  may  drive  him  to  acts  of  violence. 
In  the  last  stage  the  body  is  reduced  to  an  extreme  state  of  emacia- 
tion, and  before  death  it  evolves  an  offensive  odor,  like  that  of 
incipient  putrefaction.  The  excretions  have  also  a  putrescent  odor. 
The  surface  of  the  skin  may  be  covered  with  spots  (petechias),  and 
the  person  finally  dies,  in  some  cases  slightly  convulsed.  (Op.  cit. 
p.  415.)  M.  Chassat  found,  in  his  experiments  on  animals,  that  in 
some  instances  the  animal  died  after  having  had  successive  attacks 
of  convulsions.     (Beck's  "  Med.  Jur."  vol.  2,  p.  80.) 

In  a  case  which  fell  under  the  notice  of  Dr.  Sloan,  a  healthy  man, 
set.  65,  was  by  an  accident  shut  up  in  a  coal-mine  for  twenty-three 
days  without  food.  When  found  he  was  conscious,  and  he  recog- 
nized and  named  his  deliverers.  He  was  so  weak  that  he  could 
scarcely  raise  his  hand  to  his  mouth,  and  so  much  emaciated  as  to 
excite  the  surprise  of  his  fellow-workmen  by  the  extreme  lightness 
of  his  body.  Under  careful  treatment  he  so  far  recovered  as  to  give 
an  account  of  his  feelings.  For  the  first  two  days  hunger  was  his 
most  urgent  symptom.  This  passed  off,  and  he  then  began  to  suffer 
from  severe  thirst,  which  he  allayed  by  drinking  some  foul  water. 
After  ten  days  he  became  so  weak  that  he  was  unable  to  move  from 
the  spot  where  he  had  lain  down.  He  slept  but  little,  and  not 
soundly— never  entirely  losing  the  consciousness  of  his  situation. 
His  bowels  acted  only  once,  but  he  passed  urine  freely.  The  mat- 
ter brought  from  his  bowels  by  injections  was  dark-colored,  like 
meconium,  and  very  fetid.  He  died  on  the  third  day  after  his  re- 
moval, in  spite  of  every  effort  to  save  him,  and  on  the  day  of  his 


APPEARANCES    AFTER    DEATH.  415 

death  lie  was  in  the  following  state :  his  features  were  sharp  and 
pale,  his  eyes  sunk ;  the  skin  of  the  abdomen  seemed  to  touch  the 
backbone,  which  could  be  distinctly  felt  through  it ;  his  body  pre- 
sented more  emaciation  than  Dr.  Sloan  had  ever  seen  produced  by 
disease ;  he  had  altogether  a  dried  appearance,  very  much  like  that 
of  natural  mummies  found  in  catacombs ;  his  pulse  was  gone ;  his 
voice  was  in  a  whisper,  like  the  vox  cholerica;  there  was  uneasiness, 
increased  by  pressure,  in  the  region  of  the  stomach ;  his  intellect 
was  sound,  and  remained  so  until  death.  ("  Med.  Gaz."  vol.  17,  p. 
265.)  This  case  confirms  the  observation  of  Dr.  Donovan,  that  deli- 
rium is  not  a  necessary  attendant  on  protracted  abstinence :  and  it 
proves  incontestably  that  a  person  may  die  from  the  effects  of  ab- 
stinence or  starvation,  in  spite  of  the  best-directed  efforts  for  re 
covery.  Mr.  Thornhill  reports,  in  the  same  journal,  the  cases  of 
eight  men  and  a  boy  who  were  shut  up  in  a  coal-mine  for  eight  days 
without  food  ("Med.  Gaz."  vol.  17,  p.  890);  but  the  symptoms  here 
noted  were  rather  those  of  hunger  than  of  long  abstinence.  They 
all  suffered  from  excessive  thirst ;  they  were  all  troubled  with  ocu- 
lar illusions,  showing  cerebral  excitement.  The  occurrence  of  ocular 
spectra,  and  other  symptoms  indicative  of  a  depressed  state  of  the 
nervous  system,  has  also  been  noticed  by  Casper.  ("  Handbuch  der 
Ger.  Med."  1857,  vol.  1,  p.  374.)  According  to  Dr.  Martin,  the 
emaciation  in  starvation  is  characteristic ;  it  is  a  withering  or  shrivel- 
ling up  of  the  skin,  which  has  lost  its  elasticity,  giving  to  youth  the 
aspect  of  age.  Death,  when  not  hastened  by  disease,  is  slow  and 
imperceptible,  or  it  is  precipitated  by  syncope  from  sudden  effort, 
or  by  exposure  to  severe  cold.  Delirium  is  not,  according  to  him, 
a  symptom  of  starvation.  ("Med.  Times  and  Gaz."  March  30,  1861, 
p.  344.)  The  period  which  it  requires  for  an  individual  to  perish 
from  hunger  is  subject  to  variation :  it  will  depend  materially  upon 
the  fact  whether  a  person  has  had  it  in  his  power  or  not  to  take  at 
intervals  a  portion  of  liquid,  to  relieve  the  overpowering  thirst 
which  is  commonly  experienced.  The  smallest  portion  of  liquid, 
thus  taken  occasionally,  is  found  to  be  capable  of  prolonging  life. 
It  is  probable  that  in  a  healthy  person,  under  perfect  abstinence, 
death  would  not  commonly  take  place  in  a  shorter  period  than  a 
week  or  ten  days.  This  opinion  appears  to  derive  support  from  the 
results  of  those  cases  in  which  there  has  been  abstinence  owing  to 
disease  in  the  throat  and  difficulty  of  swallowing  food.  Age,  sex, 
state  of  health,  and  the  effects  of  exposure  to  cold,  may  accelerate 
or  retard  a  fatal  termination. 

Appearances  after  Death. — There  are  but  few  details  of  the  appear- 
ances presented  by  the  bodies  of  those  who  have  died  from  starvation, 
and  the  cases  themselves  are  too  rare  to  enable  us  to  decide  with 
certainty  upon  the  accuracy  of  the  reports  which  have  hitherto  ap- 
peared on  the  subject.  The  body  is  shrunk  and  emaciated,  and 
remarkable  for  its  lightness.  The  skin  is  dry,  shrivelled,  and  free 
from  fat.  The  muscles  are  soft,  deprived  of  fat,  and  much  reduced 
in  size.  The  stomach  and  intestines  are  usually  found  collapsed, 
contracted,  and  empty — the  mucous  membrane  being  thinned  and 


•116  APPEARANCES    AFTER    DEATH. 

sometimes  ulcerated.  The  liver,  lungs,  heart,  kidneys,  and  the  great 
vessels  connected  with  these  organs  are  collapsed  and  destitute  of 
blood;  the  heart  and  kidneys  free  from  any  surrounding  fat — the 
gall-bladder  distended  with  bile — the  omentum  shrunk  and  destitute 
of  fat.  In  Dr.  Sloan's  case  (supra)  the  body  was  observed  to  be  ex- 
tremely emaciated ;  the  intestines  were  collapsed,  the  stomach  was 
distended  with  air,  and  slightly  reddened  at  its  greater  extremity. 
The  omentum  had  almost  disappeared ;  it  was  entirely  destitute  of 
fat.  The  liver  was  small,  and  the  gall-bladder  distended  with  bile. 
The  other  viscera  were  in  their  normal  state.  ("Med.  Gaz."  vol.  17, 
p.  389.)  Mr.  Tomkins,  of  Yeovil,  inspected  the  body  of  a  man  who 
died  from  starvation  in  February,  1838.  The  face  was  much  shrunk 
and  emaciated;  the  eyes  were  open,  and  presented  a  fiery  red  ap- 
pearance, as  intense  as  in  a  case  of  acute  ophthalmia  during  life. 
This  red  appearance  has  been  met  with  by  Dr.  Donovan  in  death 
from  exposure  to  cold.  ("  Dublin  Med.  Press,'-'  Feb.  2,  1848,  p.  66.) 
The  skin  was  tough,  and  there  was  scarcely  any  cellular  membrane 
to  be  seen.  The  tongue,  lips,  and  throat  were  dry  and  rough.  A 
peculiar  odor  was  exhaled  from  the  body.  The  lungs  were  shrunk 
and  contracted ;  the  investing  membrane  was  slightly  inflamed.  The 
stomach  and  intestines  were  empty,  but  quite  healthy ;  the  gall- 
bladder was  nearly  full  of  bile,  and  the  surrounding  parts  were  much 
tinged  by  this  liquid.  The  urinary  bladder  was  empty  and  con- 
tracted. ("Lancet,"  March,  1838.)  In  some  cases  inspected  during 
the  Irish  famine,  Dr.  Donovan  states  that  the  appearances  which  he 
witnessed  were  extreme  emaciation,  total  absorption  of  the  fatty 
matter  on  the  surface  of  the  body,  total  disappearance  of  the  omen- 
tum, and  a  peculiarly  thin  condition  of  the  small  intestines,  which 
in  such  cases  were  so  transparent,  that  if  the  deceased  had  taken  any 
food  immediately  before  death,  the  contents  could  be  seen  through 
the  coats  of  the  bowel;  on  one  occasion  (at  an  inquest)  he  was  able 
to  recognize  a  portion  of  raw  green  cabbage  in  the  duodenum  of  a 
man  who  had  died  from  starvation.  This  thin  condition  of  the  coats 
of  the  intestines  he  looks  upon  as  the  strongest  proof  of  this  mode 
of  death.  The  gall-bladder  was  usually  full,  and  the  parts  in  the 
vicinity  of  it  were  much  tinged  by  the  cadaveric  exudation  of  bile  : 
the  urinary  bladder  was  generally  contracted  and  empty,  and  the 
heart  pale,  soft,  and  flabby ;  there  was  no  abnormal  appearance  in 
the  brain  or  lungs.  Dr.  Martin  assigns  as  a  condition  of  the  intes- 
tines diagnostic  of  starvation,  that  they  are  not  only  contracted  but 
shrunken  and  diminished  in  size,  shortened  in  length  as  well  as  in 
calibre,  and  like  a  mere  cord,  as  if  the  canal  was  obliterated.  (**  Med. 
Times  and  Gazette,"  March  30,  1861.)  He  met  with  this  state  in 
three  cases :  once  in  starvation  from  want  of  food,  and  twice  from 
total  obstruction  to  its  ingestion.  Mr.  Fletcher  found  the  following 
appearances  in  the  case  of  two  children,  named  AsjnnaU,  who  died 
from  starvation— the  elder  aged  one  year  and  ten  months,  the 
younger  four  months.  In  the  body  of  the  elder  there  was  extreme 
emaciation,  without  the  slightest  trace  of  disease  in  any  of  the  vis- 
cera.    Some  dirty  creamy  fluid  and  four  cherry-stones  were  found 


APPEARANCES    AFTER    DEATH.  417 

in  the  small  intestines,  but  no  distinctly  fecal  matter,  a  few  grains 
of  which,  however,  were  found  in  the  large  intestines;  scarcely  a 
trace  of  fat  was  visible. '  In  the  infant  the  same  appearances  were 
presented,  although  the  emaciation  had  not  proceeded  to  the  same 
extent.  The  evidence  produced  on  the  trial  proved  that  the  mother 
spent  in  drink  the  money  given  to  her  for  household  expenses,  and 
that  the  children's  food  and  clothing  were  neglected.  The  prisoners 
were  tried  for  wilful  murder,  in  accordance  with  the  verdict  of  the 
coroner's  jury.  The  judge  ruled  that  the  wife  in  law  was  the  hus- 
band's servant,  and  if  it  were  proved  that  he  had  supplied  her  with 
sufficient  money,  he  must  be  acquitted ;  if  he  had  not,  the  wife  must 
be  acquitted.  The  jury  acquitted  the  man  and  brought  in  a  ver- 
dict of  manslaughter  against  the  woman,  who  was  sentenced  to  two 
years'  imprisonment.  ("Proceedings  of  Liverpool  Medical  Society," 
1855-56.)  In  some  of  these  alleged  deaths  by  starvation,  ulceration 
of  the  bowels  is  met 'with.  This  has  been  considered  to  arise  from 
want  of  food ;  but  Dr.  Donovan  did  not  meet  with  it  in  those  who 
died  of  lingering  starvation.  ("Dublin  Med.  Press,"  Feb.  2,  1848, 
p.  6Q.) 

These  appearances,  in  order  to  throw  any  light  upon  the  cause  of 
death,  should  be  accompanied  by  an  otherwise  healthy  state  of  the 
body;  since,  as  it  is  well  known,  they  may  be  produced  by  many 
organic  diseases,  and  death  may  be  thus  due  to  disease,  and  not  to 
the  mere  privation  of  food.  It  will  not  be  always  easy  to  say  whether 
the  emaciation  depends  on  disease  or  want  of  food,  unless  we  are  put 
in  possession  of  a  complete  history  of  the  case.  On  this  account,  in 
all  charges  of  homicidal  starvation,  the  defence  generally  turns  upon 
the  coexistence  of  disease  in  the  body,  and  the  sufficiency  of  this  to 
account  for  death. 


27 


413  SIGNS    OF    PREGNANCY. 


PREGNANCY. 


CHAPTER    XLI. 

Signs  of  pregnancy. — suppression  of  the  menses. — quickening. 
— SOUNDS  of  the  fcetal  heart. FEIGNED  pregnancy. — CON- 
cealed pregnancy. — pregnancy  in  the  dead. — impregnation 
in  a  state  of  unconsciousness. — legal  relations. 

Signs  of  Pregnancy. 

Suppression  of  the  Menses. — It  is  well  known  that  in  the  greater 
number  of  healthy  females,  so  soon  as  conception  has  taken  place, 
this  secretion  is  arrested.  But  there  are  certain  abnormal  conditions 
which  must  not  be  overlooked.  There  are  some  cases  recorded  which 
show  that  women  in  whom  the  menses  have  never  appeared  may 
become  pregnant.  This,  however,  is  allowed  by  all  accoucheurs  to  be 
rare;  and  when  it  occurs,  which  we  may  readily  learn  from  the 
account  of  the  woman,  it  will  be  necessary  to  search  for  other  signs 
in  order  to  determine  the  question  of  pregnancy.  Irregularity  as  to 
the  period  at  which  the  function  takes  place  is  common  among  females. 
This  irregularity  may  depend  upon  the  age  of  the  person,  or  upon 
disease,  either  of  which  causes  it  will  not  be  difficult  to  recognize. 
Their  continuance  after  conception  may  make  a  pregnancy  appear 
short.  A  case  is  reported  in  which  a  woman  was  married  in  the 
summer  of  1856,  and  the  menses  continued  after  as  before  marriage. 
In  October,  1857,  they  ceased  for  the  first  time,  and  in  the  following- 
December  the  woman  was  delivered  of  a  full-grown  child ;  as  the 
abdomen  was  not  much  enlarged,  she  thought  she  was  only  two 
months  pregnant.  ("  Med.  Times  and  Gaz."  April  30,  1850.)  It  is 
well  known  that  there  are  numerous  disorders  of  the  uterus  under 
which,  irrespective  of  pregnancy,  the  menses  may  become  suppressed. 
The  continuance  of  the  menstrual  discharge,  when  once  set  up,  is  not 
a  necessary  condition  for  impregnation.  Dr.  Murphy  has  reported 
the  case  of  a  woman  who  for  sixteen  years  went  on  bearing  children, 
eight  in  number,  without  having  had  during  that  period  any  appear- 
ance of  the  menses.  The  late  Dr.  Eeid,  who  quotes  this  case,  men- 
tions five  instances  that  fell  within  his  own  knowledge  in  which  females 
became  pregnant  notwithstanding  a  long  previous  cessation  of  the 
discharge.  ("Lancet,"  September  10,  1853,  p.  236.)  The  absence 
of  the  menses  as  a  consequence  of  pregnancy  is  generally  indicated 
by  the  good  health  which  a  female  enjoys";  and  although  disease 


SIGN'S    OF    PREGNANCY.  419 

may  coincide  with  pregnancy,  yet  a  careful  practitioner  will  be  able 
to  estimate  from  the  symptoms  to  which  cause  the  suppression  is  due. 
On  the  other  hand  a  discharge  perfectly  analogous  to  the  menstrual 
sometimes  manifests  itself,  not  merely  for  several  periods  in  a  preg- 
nant woman,  but  during  the  whole  course  of  pregnancy.  (Dr.  Mur- 
phy's "  Obstetric  Report,"  1844,  p.  9  ;  also  Henke's  "  Zeitschrift  der 
S.  A."  1844,  p.  265.)  Mr.  Whitehead  has  collected  seven  well-marked 
instances  of  menstruation  during  pregnancy.  ("  On  Abortion,"  p. 
218.)  These  facts  show  that  we  must  be  cautious  in  forming  an 
opinion;  and  not  assert  that,  because  a  discharge  continues,  preg 
nancy  cannot  possibly  exist,  or  because  there  is  no  discharge  a  female 
must  be  pregnant.  The  retention  of  the  menses  within  the  uterus 
from  any  cause,  may  produce  enlargement  of  the  abdomen,  and  give 
rise  to  some  of  the  external  symptoms  of  pregnancy. 

Feigned  Menstruation. — The  menses  may  be  either  suppressed  or 
retained ;  but  if  there  be  any  strong  motive  for  the  concealment  of 
her  condition,  a  woman  may  feign  menstruation.  Dr.  Montgomery 
detected  a  case  of  this  kind,  by  the  examination  of  the  areolae  of  the 
breasts.  The  woman  had  stained  her  linen  with  blood  in  order  to 
make  it  appear  that  the  menses  continued,  but  she  subsequently  ad- 
mitted that  this  was  an  imposition.  It  has  been  stated  that  there  are 
differences  between  menstrual  and  ordinary  blood,  but  there  are  no 
certain  chemical  means  of  distinguishing  them. 

Prominence  of  the  Abdomen. — A  gradual  and  progressive  enlarge- 
ment of  the  abdomen  is  a  well-marked  character  of  pregnancy :  the 
skin  becomes  stretched,  and  the  navel  almost  obliterated.  This  en- 
largement in  general  begins  to  be  obvious  about  the  third  month, 
although  there  are  some  women  of  peculiar  structure  in  whom  the 
enlargement  may  not  become  perceptible  until  the  fifth  or  sixth 
month,  or  even  later :  still  it  may  be  detected  on  examination.  In 
fact,  this  sign  can  never  be  absent  in  pregnancy,  although  it  may  not 
be  so  apparent  in  some  females  as  it  is  in  others.  The  objection 
which  exists  to  it  is,  that  numerous  morbid  causes  may  give  rise  to 
prominence  of  the  abdomen.  This  is  undoubtedly  the  fact,  as  we 
have  occasion  to  witness  in  the  various  kinds  of  dropsy,  or  in  sup- 
pressed and  retained  menses — diseases  which  in  several  instances,  have 
been  mistaken  for  pregnancy  by  eminent  practitioners.  On  the  other 
hand,  instances  are  not  wanting  in  which,  owing  to  the  persistence  of 
menstruation  and  the  absence  of  quickening,  the  gravid  uterus  has 
been  actually  tapped  by  mistake  for  an  ovarian  tumor :  the  opera- 
tion being  speedily  followed  by  the  birth  of  a  full-grown  child ! 
(Whitehead  "On  Abortion,"  p.  186);  but  the  history  of  a  case  will 
in  general  enable  a  practitioner  to  form  a  correct  opiuion. 

[In  the  Court  of  Oyer  and  Terminer  of  Cumberland  County, 
Pennsylvania,  August,  1859,  in  the  case  of  Commonwealth  v.  M.C- 
Manus,  the  defendant  was  indicted  for  infanticide  and  for  concealment 
of  the  death  of  a  bastard  child.  The  evidence  on  the  part  of  the 
Commonwealth  was,  that  the  prisoner  had  walked  to  the  office  of  a 
physician  residing  some  considerable  distance  from  her  residence, 


420  SIGNS    OF    PREGNANCY. 

and  that  he,  after  an  examination,  declared  that  she  was  far  gone  in 
pregnancy,  so  far  indeed  that  he  had  distinctly  felt  the  sutures  in  the 
head  of  the  child!  A  few  days  afterwards  another  physician  was 
railed  iii  by  defendant's  mother.  He  declared  that  she  was  with 
child,  and  would  very  soon  be  confined;  whereupon  the  mother 
indignantly  ordered  him  from  the  house.  Subsequently,  on  the  same 
day,  an  old  woman,  a  neighbor,  called  at  the  request  of  the  mother. 
She  found  the  prisoner  and  her  mother  in  a  room  together.  The 
prisoner,  who  was  seated  on  a  bucket  apparently  undergoing  the  pains 
of  labor,  seemed  to  pull  from  herself  something  which  she  squeezed 
violently.  The  witness  heard  the  falling  of  a  body  into  the  bucket, 
but  saw  nothing.  This  occurred  on  Friday.  On  the  Monday  fol- 
lowing, the  prisoner  went  in  a  wagon  to  a  house  some  miles  distant, 
carrying  with  her  a  covered  basket.  This  she  placed  in  the  closet 
of  the  room  where  she  was  to  sleep.  While  it  was  there,  the 
woman  who  owned  the  house  having  occasion  to  go  into  the  room, 
perceived  a  most  disagreeable  and  offensive  odor,  which  upon  inves- 
tigation she  discovered  proceeded  from  the  prisoner's  basket  in  the 
closet.  In  the  evening  the  prisoner  took  her  basket  for  the  purpose, 
as  she  said,  of  going  to  the  house  of  an  acquaintance,  who  lived  be- 
yond the  creek  near  by ;  when  she  returned  the  basket  was  empty,  and 
the  odor  had  disappeared.  A  few  days  after,  the  body  of  a  new-born 
infant  was  found  in  the  creek  several  miles  below  where  the  prisoner 
had  crossed.  This,  it  was  alleged  by  the  Commonwealth,  was  the 
prisoner's  child,  which  had  been  strangled  by  her,  and  subsequently 
thrown  into  the  water. 

It  was  proved,  however,  that  the  prisoner  never  had  given  birth 
to  a  child,  or  even  been  pregnant.  That  for  years  she  had  suffered 
from  suppression  of  the  menses.  The  physician  who  orginally  at- 
tended her  proved  that  he  had  recommended  her  to  sit  over  a  bucket 
of  steaming  water  as  a  means  of  obtaining  relief.  What  the  old 
woman  had  heard  fall  into  the  bucket  was  a  clot  of  blood,  loosened 
by  the  effects  of  hot  vapor.  The  odor  in  the  basket  came  from  a 
bottle  containing  a  quack  lotion  of  herbs,  with  which  she  was  in  the 
habit  of  washing  herself,  and  which  had  been  broken  when  she 
jumped  from  the  wagon  upon  reaching  her  destination.  The  defend- 
ant was  acquitted. — P.] 

A  Cltange  in  the  Breasts. — These  organs  in  a  pregnant  woman  are 
full  and  prominent,  and  the  areolae  around  the  nipples  undergo  changes 
of  color  which  Dr.  Montgomery  and  others  regard  as  highly  charac- 
teristic of  the  pregnant  state.  A  mere  fulness  or  pain  in  the  breasts, 
and  even  in  some  rare  instances  the  secretion  of  milk,  may  arise 
from  other  causes  than  pregnancy.  Severe  uterine  or  ovarian  irri- 
tation may  cause  the  breasts  to  become  painful  and  swollen.  The 
fulness  of  the  breasts  from  pregnancy  is  not  commonly  observable 
until  about  the  second  or  third  month.  A  more  or  less  transparent 
fluid  is  secreted  by  the  gland  tissue  of  the  breast,  and  can  be  expressed 
from  the  nipples.  This  secretion  of  milk  may  occur  in  a  non-preg- 
nant female  as  a  result  of  uterine  or  ovarian  disease.  These  cases, 
however,  are  not  very  common  ;  but  after  a  woman  has  once  secreted 


SIGNS    OF    PREGNANCY.  421 

milk,  the  secretion  is  easily  reproduced  in  the  breasts  by  very  slight 
causes,  quite  independently  of  pregnancy. 

The  areola  is  generally  observed  during  pregnancy  to  become  con- 
siderably darker  in  color  and  larger  in  diameter.  The  skin  of  which 
the  areola  is  formed  is  soft,  moist,  and  slightly  tumid.  The  little 
glandular  follicles  about  it  are  prominent,  and  often  bedewed  with 
a  secretion ;  the  change  of  color  has  been  the  most  attended  to. 
The  areolas  are  commonly  well  marked  in  from  the  second  to  the 
fourth  month  of  pregnancy — the  intensity  of  color  being  the  last 
condition  of  the  areola  to  appear.  The  prominence  of  the  glandular 
follicles  does  not  always  exist  in  pregnancy,  and  the  areola  may  be- 
come large  and  dark-colored  from  other  causes :  consequently  these 
signs  are  only  to  be  looked  upon  as  corroborative.  In  females  of 
dark  complexion,  the  areolae  are  naturally  dark  irrespective  of  preg- 
nancy ;  and  in  some  advanced  cases  these  changes  in  the  areolae  are 
entirely  absent.  ("Edin.  Month.  Jour."  March,  1848,  p.  693.)  Dr. 
Montgomery  has  described  as  a  sign  of  pregnancy  the  existence  of 
a  brown  line  extending  from  the  pubes  to  the  navel,  especially  in 
women  of  dark  complexion,  and  a  dark-colored  but  not  raised 
areola  of  about  a  quarter  of  an  inch  in  breadth  around  the  navel ; 
but  this  also  may  be  produced  by  uterine  or  ovarian  disease. 

Quickening. — The  signs  above  given  are  applicable  to  the  early  as 
well  as  to  the  late  stages  of  utero-gestation  ;  but  that  which  we  have 
here  to  consider  is  one  which  is  rarely  manifested  until  about  the 
fourth  or  fifth  month.  Quickening  is  the  name  applied  to  peculiar 
sensations  experienced  by  a  woman  about  this  stage  of  pregnancy. 
The  symptoms  are  popularly  ascribed  to  the  first  perception  of  the 
movements  of  the  foetus,  which  occur  when  the  uterus  begins  to 
rise  out  of  the  pelvis ;  and  to  these  movements,  as  well  as  probably 
to  a  change  of  position  in  the  uterus,  the  sensation  is  perhaps  really 
due.  .  The  movements  of  the  foetus  are  perceptible  to  the  mother 
before  they  are  made  evident  by  an  external  examination.  The 
term  is  derived  from  the  old  Saxon  word  "quick,"  signifying  living; 
as,  at  the  time  when  medical  science  was  in  its  infancy,  it  was  con- 
sidered that  the  foetus  only  received  vitality  when  the  mother  expe- 
rienced the  sensation  of  its  motion!  On  the  occurrence  of  quicken- 
ing there  is  generally  a  great- disturbance  of  the  system,  indicated 
by  syncope,  nausea,  and  other  distressing  symptoms.  After  a  short 
time  the  female  recovers ;  and  if  sickness  has  hitherto  attended  the 
pregnant  state,  it  has  been  frequently  observed  to  disappear  when 
the  period  of  quickening  has  passed. 

No  evidence  but  that  of  the  female  can  satisfactorily  establish  the 
fact  of  quickening,  and  this  it  is  necessary  to  bear  in  mind  ;  since,  in 
some  cases  in  which  pregnancy  is  an  object  of  medico-legal  impor- 
tance, proof  of  quickening  may  be  demanded  by  law.  Dr.  Reid 
remarks  ("Lancet,"  September  10,  1853,  p.  237),  with  respect  to  this 
sign,  that  few  women  can  tell  the  exact  day  on  which  they  first  feel 
it ;  and  a  large  proportion  cannot  place  it  within  a  range  of  fourteen 
days,  which  is  of  little  assistance  in  the  calculation  of  the  probable 


422  SIGNS    OF    PKEGNANCY. 

date  of  delivery.  AVomen  who  profess  to  be  most  exact  in  noting 
the  period  of  quickening  differ  from  each  other  as  to  the  time. 
There  is  much  self-deception  as  to  this  symptom.  The  discovery  of 
the  movements  of  a  child  by  an  examiner  is  really  a  proof  that  the 
usual  period  of  quickening  is  past,  but  their  non-discovery  at  the 
time  of  examination  is  no  proof  whatever  that  the  woman  has  not 
quickened ;  since  the  movements  are  by  no  means  constant,  and  may 
be  accidentally  suspended  even  at  several  successive  examinations. 
Besides,  cases  every  now  and  then  occur  in  which  well-formed  healthy 
women  do  not  experience  the  sensation  of  quickening  during  the 
whole  course  of  pregnancy ;  and,  what  is  of  more  importance,  the 
movements  of  the  child  may  be  at  no  time  perceptible  to  the  exam- 
iner. The  uncertainty  of  quickening  as  a  sign  of  pregnancy  is  too 
well  known  to  require  more  than  adverting  to.  Women  have  been 
known  to  mistake  other  sensations  for  it,  and  in  the  end  it  has  been 
proved  that  they  were  not  pregnant.  A  woman  may  declare  that 
she  has  felt  quickening  when  she  has  not ;  and  unless  the  movements 
of  the  child  are  perceived  by  the  examiner  at  the  time,  how  is  he  to 
confirm  or  disprove  her  statement?  Quickening,  then  (so  far  as  it 
concerns  the  statement  of  the  woman),  cannot  be  relied  on  as  a  proof 
of  pregnancy ;  but  if  the  movements  of  a  child  can  be  felt  by  the 
examiner  through  the  abdomen,  this  is  clear  evidence  not  only  of 
the  woman  being  pregnant  but  of  her  having  passed  the  period  of 
quickening.  Taking  the  general  experience  of  accoucheurs,  quicken- 
ing happens  from  the  tenth  to  the  twenty-fifth  Aveek  of  pregnancy ; 
but  the  greater  number  of  instances  occur  between  the  twelfth  and 
sixteenth  week,  or  between  the  fourteenth  and  eighteenth  week  after 
the  last  menstruation. 

From  these  observations,  it  will  be  seen  that  an  examiner  may 
sometimes  detect  the  movements  of  the  child  about  the  third  or  fourth 
month,  at  others  not  until  the  fixth  or  sixth,  and  in  other  instances 
not  at  all  throughout  pregnancy.  Even  in  those  cases  in  which  the 
movements  of  the  child  have  indisputably  existed,  they  are  not 
always  to  be  perceived  ;•  hence  several  examinations  should  be  re- 
sorted to,  before  any  opinion  can  be  fairly  expressed  from  their 
absence.  The  best  mode  of  examining  the  abdomen  for  foetal  move- 
ment is  to  allow  the  hand  to  remain  at  rest  on  the  abdomen.  If  the 
patient  has  quickened  recently,  the  impulse  is  slight,  and  generally 
at  only  one  spot,  which,  however,  is  seldom  the  same.  Should  she 
have  advanced  further,  then  the  movements  will  be  more  rolling,  and 
the  parts  of  the  child  be  detected  at  the  same  time.  In  making  these 
examinations  a  diagnosis  may  be  facilitated  by  previously  immersing 
the  hand  in  cold  water  and  then  suddenly  applying  it  to  the  abdomen. 
When  the  movements  of  the  child  are  distinctly  perceived  through 
the  skin  of  the  abdomen,  they  constitute  a  certain  sign  of  pregnancy ; 
but  their  non-discovery  at  a  particular  time  is  no  proof  that  a  female 
is  not  pregnant.  The"  jury  of  matrons  probably  trust  to  this  sign  ; 
hence  their  verdicts  commonly  turn  out  to  be  erroneous.  There  is 
another  source  of  fallacy  which  may  present  itself  when  an  artful 
woman  is  desirous  of  making  it  appear  that  she  is  pregnant — namely, 


SIGNS    OF    PREGNANCY.  423 

that  a  woman  may  simulate  the  movements  of  a  child  by  a  peculiar 
action  of  the  abdominal  muscles.  Medical  practitioners  of  repute 
have  been  deceived  for  a  time  by  this  artifice,  but  this  occurred 
before  the  discovery  of  chloroform  or  the  stethoscope.  [For  more 
extended  remarks  on  the  "jury  of  matrons,"  with  illustrations  of 
the  entire  want  of  reliability  of  their  verdicts,  see  former  edition  of 
this  work,  pp.  407-411.— P.] 

Sounds  of  the  Foetal  Heart. — Another  sign  is  that  which  is  derived 
from  auscultation.  By  the  application  of  the  ear  or  a  stethoscope  to 
the  abdomen,  at  or  about  the  fifth  month  of  pregnancy  (rarely  earlier), 
the  pulsations  of  the  foetal  heart  may  be  recognized  and  counted. 
These  pulsations  are  not  synchronous  with  those  in  the  arteries  of 
the  mother ;  they  are  much  more  rapid,  and  thus  it  is  impossible  to 
mistake  them.  Their  frequency,  according  to  Dr.  Hope,  is  in  an 
inverse  ratio  to  the  stage  of  gestation,  being  160  at  the  fifth  and  120 
at  the  ninth  month.  Sometimes,  however,  the  fcetal  pulse  may 
descend  to  80  or  even  60  beats  a  minute.  This  sign,  when  present 
(like  the  foetal  movements),  not  only  establishes  the  fact  of  pregnancy 
beyond  all  dispute,  but  shows  that  the  child  is  living.  The  sound 
of  the  fcetal  heart  is,  however,  not  always  perceptible:  when  the 
child  is  dead,  of  course  it  will  not  be  met  with ;  but  its  absence  is  no 
proof  of  the  death  of  the  child,  because  the  hearing  of  the  pulsations 
by  an  examiner  will  depend  very  much  upon  the  position  of  the 
child's  body,  the  quantity  of  liquor  amnii,  the  presence  of  disease, 
and  other  circumstances.  Thus  the  sounds  may  be  distinctly  heard 
at  one  time,  and  not  at  another ;  they  may  be  absent  for  a  week  or 
fortnight,  and  then  will  reappear ;  so  that,  although  their  presence 
affords  the  strongest  affirmative  evidence,  their  absence  furnishes 
uncertain  negative  evidence ;  and  several  examinations  should  be 
made,  in  the  latter  case,  before  an  opinion  is  formed.  The  earliest 
time  at  which  the  pulsations  may  be  heard  has  been  stated  to  be 
about  the  fourth  month,  but  they  will  be  best  heard  after  the  sixth 
month.  The  reason  why  the  sounds  of  the  foetal  heart  are  not  al- 
ways perceived,  is  owing  not  only  to  changes  in  the  positions  of  the 
child,  but  to  the  vibrations  having  to  traverse  the  liquor  amnii  and 
the  soft  layers  of  the  skin  of  the  abdomen.  The  presence  of  much 
fat  in  these  layers  intercepts  them.  The  point  where  the  sounds 
can  be  most  readily  perceived  is  in  the  centre  of  a  line  drawn  from 
the  navel  to  the  anterior  inferior  spinous  process  of  the  ilium  on 
either  side — perhaps  most  commonly  on  the  right.  When  clearly 
detected  they  furnish  an  unequivocal  sign  of  the  pregnant  state. 
Besides  the  sounds  of  the  foetal  heart,  there  are  other  sounds  to 
which  the  name  of  "  placental  murmur,"  or  uterine  sounds,  has  been 
given.  These  are  heard  from  an  earlier  date,  i.  e.,  at  any  time  after 
the  third  month.  As  they  may  occur  in  connection  with  fibroid 
tumors  of  the  uterus,  they  do  not  necessarily  indicate  pregnancy. 
(See  a  paper  on  this  subject  by  Dr.  Druitt,  "  Med.  Times  and  Gaz.," 
Jan.  21,  1860.) 

In  reference  to  these  signs  of  the  pregnant  state  it  may  be  observd 
that  if  the  motions  of  the  child  or  sounds  of  the  heart  be  perceptible, 


424  SIGNS    OF    PREGNANCY. 

no  other  evidence  of  pregnancy  need  be  sougdit  for.  The  mere  sup- 
pression of  the  menses,  prominence  of  the  abdomen,  and  fulness  of 
the  breasts,  cannot  alone  establish  the  facts;  but  unless  the  morbid 
causes  of  these  abnormal  states  of  the  system  be  clearly  and  satisfac- 
torily obvious  to  the  examiner,  it  is  a  fair  presumption  from  these 
symptoms  that  the  woman  is  pregnant.  In  any  case  in  which  a 
doubt  exists  we  should  require  sufficient  time  to  form  a  correct 
opinion. 

Cha  les  in  the  Mouth  and  Neck  of  the  Uteri/.s. — The  signs  heretofore 
mentioned  are  chiefly  relied  on  in  medical  practice ;  but  it  must  be 
remembered  that  no  case  can  possibly  occur  in  civil  or  criminal  juris- 
prudence in  which  it  will  not  be  in  the  power  of  a  medical  witness 
to  make  an  examination  of  the  woman.  He  may  then  form  a  safe 
judgment  from  the  changes  which  take  place  in  the  neck  of  the 
uterus,  and  from  the  sensation  imparted  to  the  fingers  by  the  presence 
of  a  rounded  body  (like  the  foetus)  floating  in  a  liquid,  when  an  im- 
pulse is  given  to  the  uterus  from  below.  Up  to  the  fifth  or  sixth 
month  of  pregnancy,  the  neck  of  the  uterus  may  be  commonly  felt 
projecting  into  the  vagina ;  it  is  of  its  usual  length,  hard  and  firm. 
After  that  period,  the  uterus  rises  into  the  pelvis,  and  the  neck  is 
spread  out,  shorter  and  shorter,  the  aperture  increasing  in  size  and 
becoming  rounded.  Towards  the  end  of  gestation,  the  neck  of  the 
uterus  appears  to  be  lost,  becoming  like  a  thin  membrane,  and  some- 
times no  aperture  can  be  felt. 

A  well-marked  test  of  pregnancy  is  the  motion  perceptible  to  the 
finger  on  giving  a  sudden  impulse  to  the  child  through  the  neck  of 
the  uterus.  Capuron  calls  this  the  touchstone  in  the  distinction  of 
the  pregnant  state:  without  it  he  considers  a  medical  jurist  may  be 
easily  deceived.  To  this  passive  motion  of  a  child,  the  name  of  bal- 
-  at  is  given.  It  cannot  be  easily  determined  before  the  fifth  or 
sixth  month;  but  after  the  latter  period,  especially  as  pregnancy 
becomes  advanced,  it  is  always  available.  In  the  French  schools, 
the  method  of  applying  the  toucher  and  ballotternent  to  pregnant 
females  is  systematically  taught,  and  by  a  little  practice  it  may  be 
easily  acquired.  This  motion  to  the  child  can  also  be  given  through 
the  abdomen,  by  external  ballotternent,  in  two  ways:  either  by  the 
patient  lying  on  her  side,  the  hands  placed  on  the  most  depending 
part  of  the  uterus,  or  by  placing  the  patient  on  her  elbows  and  knees; 
the  uterus  will  then  fall  forwards,  the  child  also  will  fall  in  contact 
with  the  front  wall  of  the  uterus,  and  its  presence  thus  be  made  more 
perceptible.  This  latter  mode  is  best  adapted  for  the  early  stages  of 
pregnancy. 

If  we  find  amenorrhcea  or  suppressed  menses  and  a  tumor  distended 
to  the  size  to  be  expected  from  the  duration  of  the  amenorrhcea — if 
the  tumor  be  more  or  less  central,  alternately  relaxing  and  contract- 
ing, containing  an  irregular-shaped  body,  which  is  freely  moved 
within,  and  also  self-moving,  we  have  the  clear  indications  of  a  living 
foetus;  and  if  we  add  to  these  the  foetal  heart-sounds  with  the  other 
minor  symptoms,  we  have  a  condition  which,  if  clearly  made  out, 
must  be  considered  complete  proof  of  pregnancy.     Of  course  we  may 


FEIGNED    PREGNANCY.  425 

have  certainty  with  the  foetal  heart- sounds  and  movements,  if  well- 
marked,  and  a  strong  suspicion  from  the  other  symptoms. 

As  most  of  these  signs  refer  to  an  advanced  stage,  a  witness  may 
be  asked  what  are  the  unequivocal  indications  of  pregnancy  be/on 
the  fifth  and  sixth  month?  The  answer  to  this  question  is  of  little 
moment  to  a  medical  jurist,  since  he  is  rarely  required  to  give  an 
opinion  under  these  circumstances.  In  all  legal  cases,  when  preg- 
nancy is  alleged  or  suspected,  it  is  the  practice  for  a  judge  or  magis- 
trate, on  a  representation  being  made  by  a  medical  witness,  to  post- 
pone the  decision,  one,  two,  or  three  months,  according  to  the  time 
required  for  obtaining  certain  evidence.  The  evidence  will  consist  in 
plainly  distinguishing — 1.  A  rounded  body  floating  freely  in  a  tumor, 
which  alternately  relaxes  and  contracts.  2.  The  movements  of  a 
foetus ;  and  3.  The  sounds  of  the  foetal  heart.  The  most  experienced 
men  agree,  that  before  the  sixth  month  the  changes  in  the  neck  and 
mouth  of  the  uterus  are  of  themselves  too  uncertain  to  enable  an 
examiner  to  form  a  safe  opinion ;  and,  a  fortiori,  it  is  impossible  to 
trust  to  external  signs  alone.  Mr.  Whitehead  dissents  from  this  view, 
and  considers  that  a  specular  examination  of  the  mouth  of  the  uterus 
is  not  only  more  satisfactory  than  any  other  mode  of  exploration, 
but  that  it  will  enable  a  person  to  determine  with  certainty  the  exist- 
ence of  pregnancy  during  its  earlier  stages — from  a  few  days  after 
conception  to  the  middle  or  end  of  the  fourth  month,  when  ausculta- 
tion first  becomes  available.  In  the  fourth  week  the  lips  of  the  mouth 
of  the  uterus  at  the  centre  of  their  margins  are  permanently  separated 
to  the  extent  of  one  or  two  lines ;  and  the  os  tineas  (the  aperture) 
itself,  which  was  before  a  mere  chink  with  parallel  boundaries,  forms 
an  elliptical  or  sometimes  rounded  aperture,  which  is  occupied  by  a 
deposit  of  transparent  gelatinous  mucus.  At  six  or  eight  weeks,  it  is 
decidedly  oval  or  irregularly  circular,  with  a  puckered  or  indented 
boundary  having  a  relaxed  and  lobulated  character.  The  whole 
circumference  of  the  neck  is  enlarged,  and  the  commissures  or  angles 
of  the  mouth  are  obliterated.  The  mouth  continues  of  this  irregular 
form  throughout  the  whole  period  of  gestation :  but  from  the  time  of 
quickening  to  the  end  of  the  seventh  month,  the  progressive  changes 
are  not  so  marked  as  to  form  a  guide  for  determining  the  period  of 
pregnancy.  ("  On  Abortion,"  p.  204.)  This  condition  of  the  mouth 
of  the  uterus  must  not  be  confounded  with  its  menstrual  state  in  the 
early  stages,  nor  with  a  diseased  state  in  the  latter  stage  of  gestation. 

Feigned  Pregnancy. — Pregnancy  has  been  sometimes  feigned  or 
simulated  for  the  purpose  of  extorting  charity,  of  obtaining  a  settle- 
ment in  a  parish,  or  of  compelling  marriage ;  but  it  is  scarcely  neces- 
sary to  observe  that  an  impostor  may  be  easily  detected  by  a  well- 
informed  practitioner,  since  a  woman  always  feigns  an  advanced 
stage  of  pregnancy.  Although  she  may  state  that  she  has  some  of 
the  symptoms  depending  upon  pregnancy  (and,  unless  she  has  already 
borne  children,  she  will  not  be  able  to  sustain  a  cross-examination 
even  respecting  these),  yet  it  is  not  possible  for  her  to  simulate  with- 
out detection  a  distension  of  the  abdomen  or  the  state  of  the  breasts. 
If  she  submits  to  an  examination,  the  imposition  must  be  detected; 


426       PKEGNANCY    IN    A    STATE    OF    UNCONSCIOUSNESS. 

if  she  refuses,  the  inference  will  be  that  she  is  an  impostor.  Females 
haw  been  known  to  possess  the  power  of  giving  apparent  promi- 
nence to  the  abdomen,  and  even  of  simulating  the  movements  of  a 
child  by  the  aid  of  the  abdominal  muscles.  By  placing  them  under 
the  influence  of  chloroform,  the  abdomen  at  once  collapses,  and  the 
imposture  is  detected.  These  cases  of  spurious  pregnancy  are  some- 
times met  with  in  hysteric  females. 

Concealed  Pregnancy. — By  the  law  of  Scotland,  if  a  woman  con- 
ceals her  pregnancy  during  the  whole  period  thereof,  and  if  the 
child  of  which  she  was  pregnant  be  found  dead,  or  is  amissing,  she 
is  guilty  of  an  offence,  and  is  liable  to  prosecution.  Evidence  is 
sometimes  given  as  to  outward  appearances  indicative  of  pregnancy  ; 
but  the  main  proof  of  a  woman  having  been  pregnant,  and  that 
which  is  relied  on  for  conviction,  is  clear  and  distinct  evidence  of 
the  actual  delivery  of  a  child.  This  is  generally  furnished  by  medi- 
cal witnesses.  The  Scotch  law,  by  making  the  concealment  of 
pregnancy,  under  the  circumstances  above  mentioned,  an  offence, 
proceeds  on  the  principle  that  every  pregnant  female  is  bound  to 
make  preparations  for  the  safe  delivery  of  a  child  ;  and  it  is  therefore 
assumed  that  if  a  child  be  born  clandestinely,  without  preparation, 
and  is  found  dead  or  is  amissing,  its  death  is  owing  to  the  want  of 
such  preparation. 

Impregnation  in  a  State  of  Unconsciousness. — It  was  formerly  a 
questiou  whether  a  woman  could  become  pregnant  without  her 
knowledge.  This  may  undoubtedly  happen,  when  intercourse  has 
taken  place  during  profound  sleep  (lethargy),  or  when  a  woman  has 
been  thrown  into  this  state  by  narcotic  drugs  or  vapors.  But  it  is 
difficult  to  admit  that  any  woman  should  remain  pregnant  up  to  the 
time  of  her  delivery,  without  being  conscious  of  her  condition,  if  the 
intercourse  took  place  during  the  waking  state.  A  woman  endowed 
writh  odinary  intellect  could  not  avoid  suspecting  her  condition  after 
the  fourth  or  fifth  month  :  and  this  alone  would  be  sufficient  to 
induce  her  to  seek  advice  whereby  the  fact  would  become  known  to 
her.  When  a  woman  is  impregnated  in  a  lethargic  state,  it  is  un- 
likely that  she  should  go  beyond  the  sixth  month  without  being 
fully  aware  of  her  pregnancy ;  and  if  her  motives  were  innocent,  she 
would  undoubtedly  make  some  communication  to  her  friends.  Capu- 
ron  mentions  a  case  of  this  kind,  in  which  the  fact  of  pregnancy  was 
first  ascertained  at  the  end  of  the  fourth  month,  by  the  woman 
having  complained  to  one  of  her  sisters  of  a  strange  sensation  which 
she  experienced  in  the  lower  part  of  her  abdomen.  ("  Med.  Leg.  des 
Accouchemens,"  p.  86.)  In  a  case  related  by  Mr.  Skey,  a  young 
woman  who  had  had  intercourse  knowingly,  was  supposed  not  to 
have  been  aware  of  her  pregnancy  until  the  seventh  month ;  but 
there  is  reason  to  believe  that  this  woman  was  guilty  of  deception. 
("Med.  Gaz."  vol.  39,  p.  212.)  There  are  generally,  in  these  cases, 
strong  motives  for  falsehood;  hence  such  stories  require  close  inves- 
tigation before  they  are  allowed  to  influence  the  opinion  of  a  prac- 
titioner. A  case  occurred  in  September,  1857,  in  which  a  woman, 
set.  22,  described   as  modest  and   decorous  in   her   behavior,  then 


UNCONSCIOUS    PREGNANCY.  427 

advanced  to  the  sixth  month  of  pregnancy,  asserted  that  she  had 
not  consciously  had  connection  with  any  one,  although  she  specified 
a  date  at  which  she  remembered  she  had  lost  her  consciousness — at 
which  date  intercourse  might  have  been  had !  On  being  questioned, 
she  denied  that  she  had  had  at  any  time  any  soreness  or  pain  in  her 
private  parts.  Although  there  may  be  unconscious  intercourse  and 
pregnancy,  it  is  not  probable  that  in  the  case  of  a  virgin  there  should 
be  such  intercourse  without  the  production  of  pain,  soreness,  or 
laceration ;  and  these  symptoms,  if  not  perceived  at  the  time,  should 
be  felt  subsequently  and  create  a  suspicion,  if  not  an  actual  know- 
ledge, of  what  had  happened.  This  rendered  the  account  which  the 
woman  gave  wholly  improbable.  The  fact  that  she  was  able  to  fix 
a  date  for  her  unconsciousness,  with  an  accuracy  in  accordance  with 
her  condition,  was  also  a  suspicious  circumstance. 

Unconscious  Pregnancy. — It  is  quite  probable  that  women  who  are 
living  in  connubial  intercourse  may  become  pregnant  without  being 
conscious  of  it.  Dr.  Eiittel  mentions  the  case  of  a  woman,  aet.  41, 
who  had  been  married  upwards  of  sixteen  years,  and  who,  while 
returning  from  a  neighboring  village,  was  suddenly  delivered  of  her 
first  child,  when  only  a  few  days  before  she  had  been  complaining 
that  she  was  not  likely  to  have  any  children.  The  child  was  born 
living  and  mature.  (Henke,  "Zeitschrift  der  S.  A."  1844,  p.  264.) 
Mr.  Long  met  with  a  case  in  which  a  married  woman,  aet.  24,  subject 
to  irregular  menstruation,  consulted  him  for  an  attack  of  spasms. 
On  his  arrival,  he  found  that  she  had  suddenly  given  birth  to  a 
seven-months'  child.  Neither  her  husband  nor  herself  had  the 
slightest  idea  that  she  was  pregnant.  She  had  noticed  that  she  had 
become  somewhat  stout,  and  that  her  breasts  were  more  full  than 
natural.  She  attributed  her  condition  to  improved  health,  and  the 
cessation  of  the  menstrual  discharge  was  set  down  to  some  accidental 
cause.  ("Med.  Times  and  Gazette,"  June  13,  1857,  p.  592.  See  also 
a  case  at  full  term  by  Dr.  Tanner,  "Obstet.  Trans."  vol.  4,  p.  113.) 
I  am  indebted  to  a  distinguished  judge  for  the  following  fact  in 
reference  to  unconscious  pregnancy  :  A  married  lady,  who  had  not 
had  a  child  for  a  period  of  nineteen  years,  found  herself,  as  she 
thought,  getting  unusually  stout.  She  was  moving  about  with  her 
family  to  different  places.  At  last  her  size  alarmed  her,  and  she 
thought  she  was  suffering  from  dropsy ;  she  consulted  a  physician, 
who  informed  her  that  she  was  in  an  advanced  state  of  pregnancy. 
She  treated  this  opinion  with  great  contempt.  In  travelling  with 
her  daughter,  they  arrived  at  a  miserable  inn:  on  the  night  of  their 
arrival,  this  lady  was  seized  with  the  pains  of  labor,  and  was  de- 
livered of  a  child.  She  had  made  no  preparation  for  the  birth,  and, 
up  to  the  moment  when  she  was  seized  with  labor-pains,  she  had 
not,  with  all  her  former  experience,  the  slightest  idea  that  she  was 
pregnant.  (For  other  cases  in  which  married  women  have  had  no 
consciousness  of  pregnancy,  see  "Lancet,"  June  16,  1860,  p.  609,  and 
June  30,  1860,  p.  643.)  Instances  of  this  kind  are  important  in  re- 
ference to  alleged  unconscious  delivery  in  females  charged  with 
infanticide.     At  the  same  time,  all  cases  in  which  there  are  motives 


428  EVIDENCE    OF    PREGNANCY    IN    THE    DEAD. 

foi  pleading  unconscious  intercourse  or  pregnancy  require  close 
examination;  they  will  frequently  be  found  to  be  quite  unworthy 
of  beli> -I'. 

Pregnancy  in  /he  Dead. — There  is  no  special  case  in  law  wherein 
the  fact  of  pregnancy  requires  to  be  verified  after  the  death  of  a 
woman;  but  an  examination  may  be  necessary  in  order  to  determine 
ihe  identity  of  a  body,  or  to  rescue  the  reputation  of  a  woman  from 
a  charge  of  unchastity.  The  discovery  of  an  embryo  or  foetus  with 
its  membranes  in  the  uterus  would  of  course  at  once  solve  the  ques- 
tion, when  the  necessity  for  an  examination  occurred;  and  the  prac- 
titioner will  remember  that,  even  supposing  many  years  to  have 
elapsed  since  interment,  and  the  body  to  have  been  reduced  to  a 
skeleton,  still,  if  the  foetus  had  reached  the  period  at  which  ossifica- 
tion takes  place,  traces  of  its  bones  will  be  found  amidst  the  bones 
of  the  woman.  In  examining  the  body  of  a  female  long  after  death, 
for  the  purpose  of  determining  whether  she  was  or  was  not  pregnant 
at  the  time  of  death,  it  may  be  proper  to  bear  in  mind  that  the  un- 
impregnated  uterus  undergoes  decomposition  much  more  slowly  than 
other  soft  organs.  In  the  case  of  a  female  who  had  been  missing 
for  a  period  of  nine  months — whose  body  was  found  in  the  soil  of  a 
privy,  so  decomposed  that  the  bones  separated  from  the  soft  parts — 
the  uterus  was  of  a  reddish  color,  hard  when  felt,  and  its  substance 
was  firm  when  cut.  The  fact  was  of  importance.  It  was  alleged 
that  the  deceased  was  pregnant  by  a  young  man,  and  that  in  order 
to  conceal  her  condition  he  had  murdered  her.  From  the  state  of 
the  uterus,  Casper  was  able  to  affirm  that  this  organ  was  in  its  virgin 
condition,  and  that  the  deceased  was  not  pregnant  at  the  time  of  her 
death.  On  this  representation  the  accused  was  liberated.  ("  Ger. 
Leich.  Oeffn."  vol.  1,  p.  93.)  In  examining  bodies  many  months 
after  interment,  and  in  one  case  upwards  of  a  year,  I  have  been  sur- 
prised to  find,  that  while  other  soft  organs  were  decomposed,  the 
uterus  had  scarcely  undergone  any  change:  its  substance  was  still 
firm  and  hard. 

It  may  happen  that  the  appearances  in  the  uterus  are  sufficient  to 
create  a  strong  suspicion  that  a  woman  has  been  pregnant,  but  the 
ovum,  embryo,  or  foetus  may  have  been  expelled;  in  this  case  several 
medico-legal  questions  will  arise  in  reference  to  delivery. 

Legal  Relations. — There  are  two  cases  in  English  jurisprudence  in 
which  proof  of  the  pregnancy  of  a  woman  may  be  required.  One 
of  them  relates  to  the  civil,  and  the  other  to  the  criminal  law.  1. 
Under  a  writ  de  ventre  inspicendo.  When  a  woman  asserts  that  she 
is  pregnant,  and  is  likely  to  give  birth  to  a  posthumous  child,  the 
heir-at-law  to  the  estate  may  claim  a  right  to  have  her  statement 
verified  and  proof  given  that  she  is  really  pregnant.  The  object  of 
this  proceeding  is  to  prevent  the  possibility  of  the  heir  being  de- 
feated of  his  rights,  by  the  fraudulent  substitution  of  the  child  of 
another  person.  Formerly,  the  proof  of  pregnancy  in  such  cases 
was  intrusted  to  matrons  nominated  by  the  sheriff,  but  now  the 
matter  is  more  considerately  left  to  skilled  medical  practitioners. 
There  will  be  no  difficulty  in  such  a  case,  provided  the  pregnancy 


LEGAL    RELATIONS    OF    PREGNANCY.  429 

is  at  all  advanced.  Examinations  may  be  made  at  intervals,  until 
the  motions  of  a  foetus  are  clearly  perceived,  with  the  other  con- 
comitant signs  above  described.  An  examination  of  this  kind  should 
be  made  completely.  No  woman  should  be  able  so  to  feign  preg- 
nancy as  to  deceive  a  skilled  medical  man.  2.  The  other  case,  re- 
ferring to  criminal  law,  is  where  a  woman,  after  a  capital  conviction, 
pleads  her  pregnancy  in  bar  of  execution.  If  she  is  pregnant,  the 
execution  of  the  sentence  is  postponed  until  after  her  delivery.  The 
strict  letter  of  the  law  requires  that  married  women  taken  from  any 
who  may  be  in  court,  should  be  impanelled  to  examine  the  convict 
and  report  on  her  condition.  They  are  required  to  decide  whether 
she  has  or  has  not  passed  the  stage  of  quickening.  It  is  however 
the  practice  with  some  learned  judges  to  direct  the  examination  to 
be  made  by  medical  men,  for  the  purpose  of  avoiding  those  mistakes 
into  which  an  ignorant  jury  of  matrons  has  frequently  fallen. 

These  are,  I  believe,  the  only  cases  in  which  pregnancy  has  any 
direct  relation  to  medical  jurisprudence  ;  and  it  is  remarkable  that, 
with  respect  to  them,  the  law  of  England  has  expressly  provided 
that  they  should  be  left  to  the  decision  of  non-medical  persons  !  The 
following  conclusions  may  therefore  be  drawn:  1.  That  the  cases  in 
which  the  signs  of  pregnancy  become  a  subject  of  legal  inquiry  in 
England  are  rare.  2.  That  there  is  no  case,  in  English  law,  in 
which  a  medical  man  will  not  have  an  opportunity  of  performing 
an  examination  per  vaginam.  3.  That  a  medical  opinion  is  never 
required  by  English  law  authorities,  until  the  pregnancy  is  so  far 
advanced  as  to  render  its  detection  certain.  Hence  discussions  con- 
cerning areolee,  the  condition  of  the  breasts,  the  presence  of  kiestein 
in  the  urine,  &c,  are,  in  a  practical  point  of  view,  unnecessary  to  a 
medical  jurist.  By  these  remarks  I  do  not  intend  to  undervalue  the 
importance  of  an  accurate  knowledge  of  the  signs  of  pregnancy  to 
a  medical  practitioner.  Cases  which  may  never  come  before  a  court 
of  law  will  be  referred  to  him,  and  the  serious  moral  injury  which 
lie  may  inflict  on  an  innocent  woman  by  inaccuracy,  should  make 
him  cautious  in  conducting  an  examination  and  in  expressing  his 
opinion. 


•±30  CONCEALED    DELIVERY. 


DELIVERY. 


CHAPTEE   XLII. 

Delivery  in  the  living. — concealed  delivery. — signs  of  abor- 
tion IN  THE  EARLY  STAGES  OF  PREGNANCY. — SIGNS  OF  RECENT 
AND  REMOTE  DELIVERY. — FEIGNED  DELIVERY. — DELIVERY  IN  A 
STATE  OF  UNCONSCIOUSNESS. — SIGNS  OF  DELIVERY  IN  THE  DEAD. — 
TRUE  AND  FALSE  CORPORA  LUTEA. — CHARACTERS  OF  THE  OVUM  OR 
EMBRYO. — MOLES. — CONCEALMENT  OF  BIRTH. 

Delivery  is  a  subject  which  much  more  frequently  requires  med- 
ico-legal intervention  than  pregnancy.  It  will  be  sufficient  to  state 
that  the  concealment  of  birth,  the  crimes  of  abortion  and  infanticide, 
with  questions  relative  to  supposititious  children,  are  closely  depend- 
ent on  the  proof  of  parturition.  This  subject  will  admit  of  being 
considered  under  two  heads  :  1.  As  it  relates  to  delivery  in  the  liv- 
ing. 2.  As  it  relates  to  delivery  in  the  dead.  In  undertaking  the 
investigation,  we  ought,  if  possible,  to  ascertain,  either  from  the 
female  herself  or  from  those  around  her,  whether  there  was  reason 
to  suspect  that  she  had  been  pregnant.  If  we  can  acquire  any 
knowledge  on  this  point  it  will  materially  facilitate  our  inquiry  :  but 
this  is  not  always  possible.  It  has  generally  happened,  that  previ- 
ous pregnancy  has  been  so  concealed  that  few  who  saw  the  woman 
suspected  her  condition  ;  then  again,  as  the  admission  of  her  delivery 
may  be  the  strongest  proof  of  her  criminality,  she  will  perhaps 
resolutely  deny  it ;  and  a  medical  practitioner  has  no  right  to  extort 
this  admission  from  her.  From  this  it  will  be  seen  that  a  medical 
witness  must  often  be  prepared  to  prove  the  fact  of  delivery,  against 
the  woman  who  is  criminally  charged. 

Delivery  in  the  Living.  Concealed  Delivery. — The  signs  of  delivery 
in  a  living  woman  vary  materially,  according  to  the  time  at  which 
this  event  has  taken  place.  In  common  language,  if  the  contents  of 
the  uterus  are  expelled  before  the  sixth  month,  the  woman  is  said 
to  miscarry,  or  to  have  an  abortion  :  if  after  the  sixth  month,  she  is 
said  to  have  a  premature  labor.  The  law  does  not  admit  any  such 
distinction:  the  expulsion  of  the  ovum,  foetus,  or  child  by  criminal 
violence,  at  any  period  of  utero-gestation,  is  regarded  as  a  miscar- 
riage or  abortion.  It  has  been  well  observed  that  the  signs  of  delivery 
are  indistinct  in  proportion  to  the  immaturity  of  the  ovum.  Thus, 
when  it  takes  place  at  the  second  or  third  month,  there  are  scarcely 
any  proofs  which  can  be  derived  from  an  examination  of  the  woman. 


EVIDENCE    OF    DELIVERY    IN    THE    LIVING.  431 

All  the  ordinary  signs  of  delivery  at  the  full  period  will  be  absent — 
the  development  of  the  embryo  not  having  been  sufficient  to  cause 
any  prominence  in  the  abdomen,  or  to  give  rise  to  those  changes  in 
the  system  which  take  place  previously  to  the  birth  of  a  mature 
child :  e.  g.  enlargement  of  the  breasts  and  dilatation  of  the  mouth  of 
the  uterus.  Abortion  at  this  period  (the  second  or  third  month)  is 
generally  accompanied  by  loss  of  blood,  which  may  manifest  itself 
by  its  effects  on  the  body.  This,  however,  can  only  give  rise  to  a 
suspicion.  At  a  later  period  of  gestation  there  may'be  a  discharge 
resembling  the  lochia,  and  the  mouth  of  the  uterus  may  be  found 
enlarged  and  soft ;  but  from  the  small  size  of  the  foetus  the  outlet 
will  present  no  positive  evidence  of  delivery.  The  quantity  of  blood 
lost  may  be  greater,  and  may  have  a  more  decided  effect  on  the  sys- 
tem. Of  course,  if  the  ovum,  foetus,  or  any  of  its  membranes  be 
found,  then  the  presumption  of  abortion  will  be  strongly  supported : 
but  women  who  designedly  conceal  their  condition,  will  commonly 
take  effectual  means  to  prevent  the  examiner  from  obtaining  evidence 
of  this  kind. 

Signs  of  Recent  Delivery  in  the  Living. — The  female  is  weak,  the 
countenance  pale,  the  eyes  are  surrounded  by  livid  areola?,  and  there 
is  an  appearance  of  general  indisposition.  Any  severe  illness  may, 
however,  give  rise  to  similar  symptoms.  Their  sudden  occurrence, 
from  a  state  of  previous  good  health,  especially  when  pregnancy  is 
known  or  suspected,  will  create  a  strong  suspicion.  The  breasts  are 
large  and  full,  especially  about  the  third  or  fourth  day  after  delivery ; 
the  nipples  are  enlarged,  and  the  areolae  around  them  present  all  the 
characters  of  advanced  pregnancy. 

1.  The  skin  of  the  abdomen  is  relaxed,  sometimes  thrown  into 
folds :  the  cuticle  interrupted  by  light-colored  broken  streaks,  pass- 
ing especially  from  the  groins  and  pubes  towards  the  navel,  which 
is  more  or  less  stretched  and  altered  in  appearance.  Any  disease 
which  has  caused  enlargement  of  the  abdomen  may  give  rise  to  a 
similar  appearance  in  the  skin,  so  that  when  taken  alone  much  con- 
fidence cannot  be  placed  in  these  lines  or  streaks  as  proofs  of  delivery. 
The  round  form  of  the  enlarged  and  semi  contracted  uterus  may  be 
felt  at  the  lower  part  of  the  abdomen,  generally  lying  towards  one 
or  the  other  side.  The  apparent  size  of  this  organ  will  depend  upon 
the  degree  to  which  it  has  contracted,  and  therefore  greatly  upon  the 
time  at  which  an  examination  is  made.  Dr.  Montgomery  has  pointed 
out  the  existence  of  a  dark  line  extending  from  the  pubes  to  the 
navel,  with  a  dark  areola  around  the  latter,  in  cases  of  recent  de- 
livery ;  but  he  has  found  this  line  to  exist  independently  of  pregnancy 
and  delivery — in  one  case  in  a  girl  aged  10,  and  in  another  instance 
in,  a  lady  laboring  under  an  ovarian  tumor. 

2.  The  organs  of  generation  will  be  found  externally  swollen,  con- 
tused, or  even  lacerated,  with  clots  of  blood  about  them.  The  outlet 
is  much  dilated,  the  vagina  relaxed,  the  mouth  of  the  uterus  con- 
siderably open,  and  its  margin  completely  relaxed.  The  neck  of  the 
uterus  is  shortened,  and  scarcely  perceptible;  and  the  body  of  this 
organ  is  from  two  to  four  times  the  size  which  it  has  in  the  unim- 


432  SIGNS    OF    RECENT    DELIVERY. 

pregnated  state.  It  occasionally  happens  that  the  neck  of  the  uterus 
is  lacerated  on  one  side  during  the  passage  of  the  head  in  primiparae; 
should  this  be  found,  or  a  cicatrix,  it  will  much  assist  in  proving 
delivery. 

8.  The  Presence  of  the  Lochia. — This  is  a  discharge,  at  first  of  a 
sero-sanguineous  liquid,  but  which  afterwards  appears  as  a  brown 
or  green-colored  serum.  It  commences  soon  after  delivery,  and 
continues  from  a  week  to  a  fortnight,  or  even  longer ;  it  may  be 
absent  after  the  third  day.  The  discharge  has  so  peculiar  an  odor 
that  some  have  regarded  this  alone  as  furnishing  strong  evidence  of 
recent  delivery. 

The  signs  which  have  been  here  enumerated  are  found  only  when 
no  delay  has  taken  place  in  making  the  examination,  and  the  woman 
has  been  recently  delivered.  In  some  strong  and  vigorous  females 
the  body  resumes  its  natural  state  within  a  few  days,  and  the  traces 
of  parturition  may  have  wholly  disappeared  or  have  become  so 
ambiguous  as  to  furnish  no  satisfactory  evidence.  In  others,  again, 
proofs  of  delivery  will  be  obtainable  for  a  fortnight  or  three  weeks 
afterwards.  In  most  cases,  however,  it  is  difficult,  if  not  impossible, 
to  say,  after  the  lapse  of  eight  or  ten  days,  that  delivery  has  certainly 
taken  place,  the  signs  having  commonly  by  that  time  disappeared. 
In  all  cases  the  earlier  the  period  at  which  an  examination  is  made 
the  more  satisfactory  will  be  the  evidence  obtained.  Dr.  Montgomery 
once  examined  a  female  five  days  after  delivery  at  the  full  time,  and 
he  was  particularly  struck  with  the  degree  to  which  the  parts  had 
become  restored  to  their  ordinary  condition,  especially  the  mouth 
and  neck  of  the  uterus,  which  hardly  differed  from  their  natural  and 
unimpregnated  form.  ("  Cyc.  Pr.  Med."  loc.  cit.)  This  inquiry  be- 
comes of  considerable  importance  in  a  case  of  alleged  child-murder. 
When  the  body  of  a  child  is  not  found  until  after  two  or  three  weeks 
from  the  time  of  its  birth,  and  the  suspected  woman  denies  that  she 
has  been  delivered  of  a  child,  she  will  probably  not  deny  her  preg- 
nancy, but  may  assert  that  she  has  had  an  abortion  at  an  early  period. 
(See  a  case  by  Dr.  Walther,  of  Labiau,  in  Casper's  "  Vierteljahr- 
schrift,"  Oct.  1863,  p.  275.)  In  cases  of  abortion  at  an  early  period 
the  placenta  is  not  always  discharged  at  the  time.  ("Med.  Times 
and  Graz.,"  March  12,  1859.)  A  microscopical  examination  of  the 
discharges  might  reveal  placental  or  chorionic  structures.  In  a  case 
which  occurred  to  Dr.  Paxton,  of  Kilmarnock,  all  the  usual  signs  of 
delivery  were  present  in  a  woman  ast.  20 :  she  had  evidently  lost 
much  blood,  and  was  much  reduced.  From  the  state  of  the  organs, 
Dr.  Paxton  considered  that  she  had  been  delivered  of  a  child  within 
three  days.  There  was  no  lochial  discharge  at  the  date  of  examina- 
tion. The  woman  had  previously  denied  her  pregnancy  when  charged 
with  concealment  of  it,  but  after  the  medical  examination  she  altered 
her  statement,  and  said  that  she  had  not  only  been  pregnant,  but  was 
so  at  that  time.  On  a  further  examination,  the  uterus  was  found  to 
contain  a  foetus  advanced  to  about  the  sixth  month,  and  in  three 
months  more  she  was  delivered  of  a  child.  What  caused  the  ap- 
pearances of  delivery,  the  condition  of  the  breasts,  &c?     Either  she 


DELIVERY    AT    A    REMOTE    PERIOD.  433 

had  shortly  before  been  delivered  of  a  child,  or  of  a  blighted  ovum 
or  foetus.  Neither  foetus  nor  placenta  was  ever  seen  or  could  be  found, 
but  the  woman  had  had  ample  opportunity  to  dispose  of  them.  This 
may  have  been  a  case  of  twin  conception  or  of  superfoetation.  It 
shows  that  in  charges  of  concealment  of  pregnancy  or  delivery,  it 
must  not  be  inferred  when  the  appearances  of  delivery  clearly  exist, 
that  the  uterus  is  empty.  The  organs  should  always  be  examined 
in  order  to  determine  whether  it  does  not  contain  another  foetus. 

Signs  of  Delivery  at  a  Remote  Period. — A  question  may  arise 
whether  it  is  in  the  power  of  a  medical  practitioner  to  determine  the 
period  at  which  delivery  took  place,  i.  e.,  how  long  a  time  has  elapsed. 
This  becomes  necessary  when,  in  cases  of  concealed  birth,  abortion, 
or  infanticide  (some  time  after  suspected  parturition),  a  child  is  found, 
and  it  is  required  to  determine  whether  the  time  which  has  elapsed 
since  the  birth  of  the  child,  either  dead  or  living,  corresponds  with 
the  supposed  delivery  of  a  suspected  woman.  An  opinion  may  be 
given  within  eight  or  ten  days  after  delivery,  from  the  state  of  the 
breasts  ;  of  the  discharges  (lochia),  and  of  the  mouth  of  the  uterus  ; 
but  it  becomes  difficult  after  the  sixth  day ;  and  when  the  tenth  or 
twelfth  day  has  passed  it  is  still  more  difficult.  After  two  or  three 
months  it  may  be  regarded  as  impossible  to  assign  the  period  of  de- 
livery with  any  degree  of  precision.  (See  Devergie,  "Med.  Leg." 
vol.  1,  p.  446.) 

In  a  case  of  pretended  delivery,  contested  legitimacy,  or  disputed 
chastity,  a  medical  jurist  may  be  required  to  say  whether  a  woman 
has,  at  any  antecedent  period  of  her  life,  been  delivered  of  a  child. 
This  question,  it  must  be  remarked,  can  be  raised  only  in  respect  to 
delivery  at  the  full  period,  since  there  is  no  doubt  that  abortion  in 
the  early  stages  of  pregnancy  may  take  place,  and  leave  no  traces  of 
such  an  event  discoverable  in  after-life.  Indeed,  a  few  days  or  weeks 
are  sometimes  sufficient  to  obliterate  all  evidence  of  the  fact.  With 
respect  to  delivery  at  the  full  term,  certain  signs  have  been  men- 
tioned, which  by  some  are  considered  indelible.  These  are :  shining 
streaks  on  the  skin  of  the  abdomen,  a  brown  mark  reaching  from 
the  navel  to  the  pubes,  and  the  state  of  the  mouth  of  the  uterus, 
which  is  said  never  to  close  so  effectually  as  in  the  virgin.  In  regard 
to  the  appearance  of  the  skin  of  the  abdomen,  it  may  be  remarked, 
that  any  morbid  causes  giving  rise  to  a  distension  of  the  cavity — as 
ovarian  enlargement  or  dropsy — will  produce  the  same  effect ;  so, 
also,  to  a  certain  extent,  extreme  emaciation  from  a  state  of  obesity. 
(See  "  Med.  Times  and  Gaz."  April  17,  1861,  p.  450,  on  False  Cica- 
trices.) Then,  again,  these  marks  on  the  skin  are  not  always  persist- 
ent throughout  life.  Besides,  a  woman,  according  to  the  statements 
of  good  observers,  may  lie  not  only  once  but  repeatedly  delivered, 
without  having  these  marks  produced.  ("Med.  Times  and  Gaz." 
June  9,  1860,  p.  583.) 

With  regard  to  the  state  of  the  mouth  of  the  uterus,  it  is  liable 
to  vary  in  different  women,  and  to  be  affected  by  disease,  so  that  a 
certain  judgment  cannot  always  be  formed  from  its  condition.  In  a 
28 


434:  FEIGNED    DELIVERY. 

woman  who  has  not  borne  children  the  mouth  of  the  uterus  is  in  the 
form  of  a  slit,  the  angles  being  bent  down,  and  giving-  to  it  the  ap- 
pearance  of  the  os  tineas  (tench's  mouth.)  Mr.  Whitehead  has 
observed  that,  in  a  woman  who  has  borne  children,  the  mouth  be- 
comes elongated,  and  loses  the  slight  bend  at  each  of  its  extremities; 
the  labia  are  thickened,  and  more  nearly  of  equal  size;  the  cornmis- 
sures  are  less  clearly  defined,  and  the  whole  of  the  neck  is  enlarged, 
and  not  so  compact  in  texture.  ("On  Abortion,"  p.  195.)  It  must 
be  remembered,  however,  that  the  condition  of  the  mouth  of  the 
uterus,  even  in  the  virgin,  varies  at  each  menstrual  period.  Should 
there  be  congenital  occlusion  of  the  vagina,  or  the  hymen  be  found 
imperforate,  this  will  at  once  negative  a  previous  delivery ;  but  the 
latter  condition  will  not  negative  a  previous  pregnancy,  since  a 
woman  may  have  been  impregnated,  and  have  had  an  abortion  in 
an  early  stage  of  pregnancy,  without  a  necessary  destruction  of  the 
hymen.  This  sort  of  negative  evidence  may  however  be  sometimes 
of  great  value.  There  is  a  total  want  of  good  affirmative  evidence 
of  delivery  at  a  remote  period  in  the  living,  if  we  except  that  which 
is  furnished  by  the  presence  of  cicatrices  in  the  vagina  or  of  a  cica- 
trix as  a  result  of  lacerated  perineum.  It  is  rare,  however,  that  any 
decision  on  this  subject  is  required  in  medical  jurisprudence.  It 
might  be  demanded,  either  in  a  case  of  infanticide,  when  a  woman 
was  accused  of  having  destroyed  her  alleged  offspring  some  months 
or  years  before ;  or  in  a  case  of  contested  legitimacy,  when  a  female 
is  accused  of  having  substituted  a  child  of  which  she  pretends  she 
has  been  delivered  at  some  remote  period  of  time. 

Feigned  Delivery. — Delivery  has  often  been  feigned  by  women  for 
the  purpose  of  extorting  charity,  compelling  marriage,  or  disinherit- 
ing parties  who  have  claims  to  an  estate,  and  in  other  cases  without 
any  assignable  motive.  Of  course,  an  imposition  of  this  kind  could 
not  be  sustained  before  a  medical  practitioner;  and  detection  is  ren- 
dered easy,  because  it  is  recent  and  not  remote  delivery  which  is  as- 
sumed. The  latter  would,  if  pretended,  be  generally  cleared  up  by 
an  examination,  as  well  as  by  circumstantial  evidence.  (See  case, 
"  Med.  Gaz."  vol.  19,  p.  231 ;  also  another  by  Capuron,  "  Med.  Leg. 
des  Accouchemens,"  p.  110.)  [The  case  of  Mrs.  Cunningham,  in 
New  York,  will  suggest  itself  to  the  mind  of  the  American  reader. 

Can  a  Female  be  Delivered  Unconsciously  f — Another  important 
question  relative  to  delivery  in  the  living,  is  whether  a  woman  can 
be  delivered  without  being  conscious  of  it.  The  signs  of  delivery 
may  be  discovered  by  a  practitioner;  the  offspring  may  also  be 
found.  The  woman  may  admit  the  fact  of  her  delivery,  but  allege 
that  she  was  totally  unconscious  of  it.  The  only  medico-legal  ease 
in  which  this  plea  is  occasionally  raised  is  in  infanticide:  and  as  the 
I  m  .-.-ability  of  the  occurrence  may  be  questioned,  the  practitioner  must 
be  provided  with  a  knowledge  of  those  facts  which  medico-legal 
writers  have  accumulated  respecting  it.  There  is  no  doubt  that  a 
woman  may  be  delivered  unconsciously  during  profound  sleep,  while 


UNCONSCIOUS    DELIVERY.  435 

laboring  under  coma,  apoplexy,  asphyxia,  or  syncope ;  or  Avhen  suf- 
fering from  the  effects  of  narcotic  poisons — e.  g.  the  vapors  of  chlo- 
roform and  ether,  or  intoxicating  liquors.  It  is  said,  also,  that 
delivery  has  taken  place  spontaneously  while  a  female  was  in  the  act 
of  dying.  This,  however,  has  no  bearing  on  the  present  question. 
It  is  in  those  cases  where  a  female,  after  her  recovery,  pleads  uncon- 
sciousness of  delivery  that  medical  practitioners  are  chiefly  con- 
sulted. Besides  the  cases  enumerated,  hysteria,  when  accompanied 
by  loss  of  sense  and  motion,  has  been  mentioned  as  a  state  in  which 
parturition  is  liable  to  occur  unconsciously.  We  need  not  be  sur- 
prised at  delivery  taking  place  under  these  circumstances,  when  we 
consider  that  the  contractile  power  of  the  uterus  is  altogether  inde- 
pendent of  volition :  but,  unless  the  morbid  states  already  mentioned 
are  accompanied  by  the  most  profound  lethargy  and  entire  loss  of 
sensation,  it  can  rarely  happen  that  the  contractions  of  this  organ  in 
its  efforts  to  expel  the  child,  should  not  at  once  rouse  a  woman  into 
consciousness.  We  ought  particularly  to  expect  this  in  primiparse, 
i.  e.  in  those  who  have  never  borne  children.  At  the  same  time  it 
must  be  remembered  that  parturition  in  some  women,  especially 
when  the  pelvis  is  wide  and  the  child  small,  may  take  place  with 
such  rapidity  and  ease  as  scarcely  to  be  accompanied  by  pain. 

It  has  been  observed  that,  when  a  woman  has  frequently  borne 
children,  delivery  sometimes  takes  place  without  effort,  and  without 
any  consciousness  on  her  part.  On  other  occasions  a  woman  may 
lie  in  a  kind  of  torpor  or  stupor,  or  suffer  from  eclampsia  (puerperal 
convulsions),  and  have  no  recollection  of  her  delivery.  The  follow- 
ing case  is  possible :  A  woman  may  be  delivered  while  under  the 
influence  of  eclampsia,  which  might  have  attacked  her  before  labor 
set  in ;  and  after  delivery,  but  before  complete  recovery,  she  might 
become  maniacal — a  not  unfrequent  condition — during  which  interval 
she  may  have  killed  or  injured  her  child:  or  the  child  may  have  been 
born  dead,  or  suffering  from  some  accidental  injury.  She  would 
with  truth  assert  her  entire  ignorance  of  it.  Pier  statement  would 
be  verified  by  a  bitten  tongue,  a  congested  conjunctiva  or  face. 
Should  albumen  be  found  in  the  urine  this  fact  would  be  still  more 
confirmative.  Of  course  eclampsia  might  occur  without  these  results. 
The  statement  might  be  disproved  by  finding  her  actions  had  shown 
care  and  design  in  other  circumstances  at  the  time  she  said  she  was 
unconscious.  Mr.  King  has  described  the  case  of  a  woman,  aged  36, 
the  mother  of  nine  children.  She  received  his  assistance  in  her  tenth 
labor :  when  summoned  she  was  lying  calmly  and  placidly  in  bed, 
and  was  perfectly  insensible.  He  found  that  the  child  had  been  ex- 
pelled with  the  placenta.  The  woman  did  not  recover  her  sensi- 
bility for  ten  or  twelve  hours,  and  then  stated  that  she  had  no 
recollection  of  the  birth  of  the  child,  or  of  any  circumstances  con- 
nected with  that  event :  she  suffered  no  pain  or  uneasiness.  Another 
case  is  mentioned  by  this  gentleman,  in  which  sensation  appeared  to 
be  entirely  paralyzed  during  labor.  ("Med.  Times,"  May  15,  1847, 
p.  234.)  It  is  beyond  doubt  that  profound  lethargy  occasionally 
makes  its  appearance  about  the  time  of  delivery.     L»r.  Schulze  met 


436  unconscious  delivery. 

with  a  case  in  which  a  woman  remained  in  a  state  of  sleep  for  three 
days,  and  was  delivered  while  in  this  unconscious  condition:  on 
awaking,  she  had  no  recollection  of  having  suffered  anv  pain  during 
delivery.  ("Ann.  d'Hyg.,"  1845,  vol.  1,  p.  216;  "  Med.  Gaz.,"  vol. 
86,  p.  40.)  Dr.  Montgomery  relates  the  case  of  a  lady,  the  mother 
of  several  children,  who,  on  one  occasion,  was  unconsciously  delivered 
during  sleep.  ("  Cvc.  Pr.  Med." ;  see  also  case  in  "  Brit,  and  For.  Med. 
Rev.,"  No.  9,  p.  256.)  Dr.  Palfrey  describes  a  case  in  which  labor 
commenced  and  progressed  in  a  woman  to  the  second  stage  during 
sleep.     ("Lancet,"  1854,  vol.  1,  p.  36.) 

The  results  obtained  by  the  use  of  the  vapors  of  chloroform  and 
ether  show  that  the  expulsive  efforts  of  the  uterus  are  often  as  ener- 
getic in  the  unconscious  as  in  the  conscious  state.  It  may  appear 
extraordinary,  however,  that  a  primiparous  woman,  unless  rendered 
unconscious  by  narcotic  substances,  should  be  delivered  without  suf- 
fering pain :  nevertheless,  a  case  of  this  kind  is  recorded  by  Dr. 
Wharrie.  The  woman's  age  was  21 ;  she  had  been  in  labor  about 
six  hours;  she  complained  of  no  pain,  and  the  child  was  born  with- 
out effort  or  consciousness.  The  child  was  healthy  but  small,  weigh- 
ing rather  more  than  four  pounds.  ("Cormack's  Journal,"  January, 
1846,  p.  12.)  Notwithstanding  this  case,  it  is  in  the  highest  degree 
improbable  that  any  primiparous  female  should  be  delivered  during 
ordinary  sleep  without  being  roused  and  brought  to  a  sense  of  her 
condition. 

There  is  another  condition  in  which  a  woman  may  state  that  her 
delivery  took  place  unconsciously;  and  this,  from  its  being  one  of 
the  most  common  species  of  defence  set  up  by  a  female  charged  with 
child-murder,  must  here  claim  our  attention.  Thus  she  will  allege 
that,  while  suffering  from  pain,  she  felt  a  strong  desire  to  relieve  her 
bowels:  that  she  went  to  the  water-closet  for  that  purpose,  and  was 
there  delivered  without  knowing  anything  of  the  occurrence  until  it 
was  too  late  to  save  the  child.  This  kind  of  desire  is  a  very  com- 
mon symptom  of  the  parturient  state ;  and  in  private  practice  it  is 
often  difficult  to  restrain  a  woman  from  yielding  to  the  feeling,  when 
it  certainly  would  be  attended  witli  hazard  to  the  child.  ("Med. 
Times  and  Gaz.,"  April  4,  1857,  p.  347.)  We  must  therefore  admit 
that  an  accident  of  this  kind  can  occur;  although  here,  as  in  every 
other  instance  in  which  unconscious  delivery  is  pleaded,  a  medical 
witness  ought  to  inform  himself,  or  be  informed,  of  all  the  particu- 
lars which  are  stated  to  have  attended  delivery,  before  he  gives  an 
answer  applicable  to  the  case.  As  a  general  rule,  it  cannot  be  denied 
that  delivery  may  take  place  under  these  circumstances,  and  a  woman 
not  be  conscious  of  it;  but  before  we  make  this  admission  in  regard 
to  any  particular  instance,  we  ought  to  have  a  statement  of  all  the 
facts  from  the  female  herself.  It  is  thus  that  we  shall  avoid  the  risk 
•of  seeing  a  premature  medical  opinion  set  aside  by  the  subsequent 
production  of  circumstantial  evidence.  Besides,  it  has  been  properly 
observed  that,  after  an  accident  of  this  kind,  a  woman  cannot  be 
ignorant  of  her  having  been  delivered.  Women  who  have  raised 
this  plea  in  cases  of  child-murder  have  often  been  known  to  maintain 


PROOFS  OF  DELIVERY  IN"  THE  DEAD.        437 

that  they  were  unconscious  of  their  pregnancy,  and  thus  have  at- 
tempted to  excuse  themselves  for  not  having  prepared  the  articles 
necessary  for  childbirth.  It  is  possible  that  a  woman,  especially  one 
who  is  pregnant  for  the  first  time,  may  not  be  aware  of  her  preg- 
nancy in  the  earlier  stage;  but  it  is  rare  for  one  to  advance  to  the 
full  term  without  being  conscious  of  it.  Women  who  have  borne 
children  have  not  unfrequently  consulted  medical  men;  and  although 
nearly  at  full  term  they  have  been  unconscious  of  their  state.  In 
the  majority  of  instances,  it  may  be  presumed  that  a  woman  thus 
situated  must  have  had  some  reason  to  suspect  her  condition ;  and  if 
only  a  suspicion  existed  in  the  mind  of  one  who  did  not  contemplate 
the  destruction  of  her  offspring,  there  would  assuredly  be  many  cir- 
cumstances forthcoming  which  would  at  once  establish  her  inno- 
cence. If  this  remark  applies  to  married  women,  it  applies  with 
still  greater  force  to  those  who  are  unmarried,  since  the  fact  of  illicit 
connection,  and  the  fear  of  its  consequences,  must  render  them  pecu- 
liarly alive  to  all  those  changes  which,  by  common  repute,  take 
place  in  the  female  system  during  pregnancy. 

Signs  of  Delivery  in  the  Dead. — It  will  now  be  proper  to  examine 
the  signs  of  delivery  which  are  derivable  from  an  examination  of 
the  body  of  a  woman  after  death.  Occasionally  we  may  obtain  some 
history  of  the  case  during  life,  by  which  our  labor  will  be  much 
facilitated;  but,  on  the  other  hand,  every  fact  may  be  studiously 
concealed  from  us,  and  then  we  may  be  required  to  prove  not  only 
the  delivery  but  the  previous  pregnancy.  These  investigations  rela- 
tive to  pregnancy  and  delivery  in  the  dead  body  are  almost  exclu- 
sively confined  to  cases  of  criminal  abortion,  where  the  contents  of 
the  uterus  have  been  expelled  at  the  sacrifice  of  the  life  of  the  wo- 
man. Death  commonly  ensues  in  these  cases  within  two  or  three 
days  after  delivery,  and  then  satisfactory  proofs  are  obtainable  by  a 
post-mortem  examination ;  but  if  the  woman  has  survived  three  or 
lour  weeks,  it  will  be  as  difficult  to  determine  delivery  in  the  dead 
as  in  the  living  subject.  This  remark  applies  to  delivery  at  the  full 
period;  for  if  the  uterus  have  expelled  its  contents  in  the  first 
months  of  pregnancy,  the  traces  of  this  expulsion  will  have  generally 
disappeared  in  the  course  of  a  few  days. 

The  following  may  be  taken  as  the  chief  appearances  when  the 
body  of  a  woman  is  examined  soon  after  delivery  at  the  full  period. 
The  uterus  is  like  a  large  flattened  pouch  from  nine  to  twelve  inches 
long,  its  mouth  being  wide  open.  The  cavity  contains  coagula  of 
blood  or  a  sanguineous  fluid :  and  its  surface  is  covered  with  the 
remains  of  a  decidua — the  outermost  membrane  of  the  embryo  or 
foetus.  In  the  part  to  which  the  placenta  has  been  attached,  the 
substance  of  the  organ  appears  exposed,  presenting  several  large 
semilunar  or  valvular  openings.  This  portion  of  the  uterus  has 
been  found  of  a  very  dark  color,  which  has  given  rise  to  a  suspicion 
that  the  organ  was  gangrenous.  The  vessels  are  extremely  large 
and  numerous.  The  Fallopian  tubes,  round  ligaments,  and  ovaria 
are  so  vascular  (full  of  blood)  that  they  have  a  purple  color.     The 


433   MEDICAL  PEOOFS  OF  DELIVERY  IX  THE  DEAD  BODY. 

spot  whence  the  ovum  has  escaped  is  more  congested  than  the  rest 
of  the  ovarian  surface.  Obstetric  writers  differ  greatly  in  their  state- 
incuts  respecting  the  size  of  the  uterus  at  different  periods  after  par- 
turition :  and  these  differences  may  be  explained,  partly  by  the  fact 
that  the  uterus  contracts  more  rapidly  in  some  women  than  in  others, 
and  partly,  perhaps,  by  the  circumstance  of  the  birth  having  been, 
in  some  instances,  premature.  Dr.  Montgomery  states  that,  after 
delivery  at  the  full  period,  and  under  perfect  contraction  of  the 
uterus,  if  the  body  be  examined  within  a  day  or  two,  the  uterus  will 
be  found  seven  inches  long  and  four  broad.  Its  substance,  on  mak- 
ing a  section,  will  be  from  an  inch  to  an  inch  and  a  half  in  thick- 
ness, and  will  present  the  orifices  ot  a  great  number  of  large  vessels. 
At  the  end  of  a  week  the  uterus  is  between  five  and  six  inches,  and 
at  the  end  of  a  fortnight  about  five  inches  in  length ;  the  density  of 
its  structure  has  during  this  period  increased,  and  its  substance  has 
considerably  diminished.  The  inner  surface  is  still  bloody,  and 
covered  partially  with  a  pulpy  membrane  resembling  the  decidua. 
The  orbicular  direction  of  the  fibres  around  the  internal  orifices  of 
the  Fallopian  tubes  is  at  this  time  very  distinct.  In  about  a  month 
the  uterus  will  have  become  fully  contracted ;  but  the  mouth  rarely, 
if  ever,  closes  so  completely  as  in  the  virgin  state.  In  a  case  exa- 
mined by  Dr.  Barnes,  in  which  a  primiparous  woman,  aged  26,  died 
from  puerperal  fever  on  the  sixth  day  after  delivery,  the  following 
appearances  were  met  with  in  the  uterus.  The  internal  surface  was 
blackened  and  congested,  especially  in  those  parts  to  which  the 
placenta  had  been  attached.  There  was  the  appearance  of  suppurative 
action  in  this  part.  The  substance  of  the  uterus  was  healthy ;  there 
was  no  pus  in  the  sinuses.  The  os  uteri  showed  considerable  ecchy- 
mosis.  The  vagina  was  healthy:  the  iliac  veins  contained  nothing 
but  loosely  coagulated  blood.  There  was  in  the  left  ovary  a  small  well- 
marked  corpus  luteum,  having  a  central  cavity.  ("  Med.  Gaz.,"  vol.  41, 
p.  294.)  This  condition  of  the  uterus  must  not  be  confounded  with 
the  appearances  which  are  observed  when  death  takes  place  during 
menstruation.  Dr.  Judee  found  in  the  bodies  of  three  women  who 
died  during  menstruation  that  the  uterus  was  somewhat  enlarged — 
its  walls  being  thickened  and  its  interior  lined  by  a  reddish  gelatin- 
ous layer  about  l-12th  of  an  inch  thick  consisting  of  a  capillary  net- 
work of  vessels,  inclosed  in  a  mucous-like  membrane.  When  this 
was  removed  the  uterus  below  was  found  to  be  white  and  firm.  The 
interior  of  the  neck  was  of  a  grayish  color:  the  lips  were  swollen, 
of  a  dull-red,  bluish,  or  even  black  color.  On  compressing  this  part 
small  drops  of  blood  issued.  This  was  not  observed  either  in  the 
neck  or  body  of  the  vagina.  A  section  of  the  uterus  presented  only 
the  normal  fibrous  tissue :  but  at  the  level  of  the  mouth  (os  uteri)  • 
there  was  a  mass  of  tissue  resembling  a  portion  of  apoplectic  lung. 
The  blood  during  menstruation,  according  to  this  gentleman,  issues 
entirely  from  the  highly  congested  mouth  of  the  uterus.  ("  Gaz.  des 
Hopitaux,"  No.  39,  and  "Med.  Times  and  Gaz.,"  June  23,  1855.) 
An  ecchymosed  condition  of  the  neck  of  the  uterus  is  very  com- 
monly found  as  the  result  of  an  easy  labor,  and  therefore  forms  a 


EVIDENCE  FROM  CORPORA  LUTEA.  439 

good  guide  where  present.  This  point  must  he  home  in  mind  in 
reference  to  criminal  abortion,  inasmuch  as  the  neck  has  the  appear- 
ance as  if  violence  had  been  employed. 

From  the  statement  of  appearances  given  above,  it  will  be  seen 
that  there  must  be  considerable  difficulty  in  determining  the  period 
prior  to  death  at  which  delivery  took  place.  The  difficulty  is  in- 
creased when  a  woman  has  been  prematurely  delivered,  or  when 
death  has  not  taken  place  until  some  time  after  delivery.  A  medical 
opinion  may  be  then  in  some  degree  strengthened  by  searching  for 
those  signs  which  have  been  described  as  characteristic  of  delivery 
in  the  living.  These,  if  present,  will  always  furnish  strong  corro- 
borative evidence,  not  only  of  the  fact  of  delivery,  but  of  the  period 
at  which  it  had  probably  occurred. 

Corpora  Lutea. — The  condition  of  the  ovaries  has  been  considered 
to  furnish  strong  evidence,  not  so  much  of  delivery  as  of  previous 
pregnancy.  These  organs,  as  it  has  been  already  stated,  when  exa- 
mined soon  after  delivery,  are  found  of  a  deep  purple  color  owing 
to  their  extreme  vascularity.  If  the  woman  has  really  been  preg- 
nant, we  may  expect  to  find,  on  one  of  the  ovaries,  the  appearance 
which  is  denominated  a  corpus  luteum.  The  accounts  given  by  ob- 
stetric writers  of  the  characters  of  corpora  lutea,  and  the  evidence 
which  they  are  capable  of  furnishing  in  legal  medicine,  are  very 
conflicting.  According  to  Dr.  Montgomery,  in  a  true  corpus  luteum 
(i.  e.,  of  pregnancy)  the  ovary  presents  a  protuberance  with  a  dis- 
tinct cicatrix  on  the  part  whence  the  ovum  has  escaped.  The  pro- 
tuberant portion  will  be  found  on  section  to  have  an  oval  form  and 
to  be  of  a  dull  yellow  color — hence  the  name  corpus  luteum.  It  is 
full  of  blood,  and  in  texture  resembles  the  section  of  a  kidney.  It 
is  of  its  greatest  size  in  the  early  stage  of  pregnancy,  and  gradually 
diminishes  as  gestation  advances.  In  the  centre  of  this  section 
there  may  be  either  a  cavity  or  a  radiated  white  cicatrix  (scar),  ac- 
cording to  the  period  at  which  the  examination  is  made.  The  cavity 
remains  for  about  three  or  four  months  after  conception,  and  is  sur- 
rounded by  a  strong  white  cyst :  as  gestation  advances  the  opposite 
sides  approximate,  and  a  radiated  white  cicatrix  results.  The  size 
and  vascularity  of  the  corpus  luteum  are  considerably  diminished 
by  the  time  gestation  is  completed,  and  in  about  five  or  six  months 
afterwards — i.  e.,  fourteen  months  after  its  first  formation — it  dis- 
appears altogether  from  the  ovary ;  so  that  the  corpus  luteum  of 
one  conception  is  not  found  with  that  of  another,  unless  a  premature 
expulsion  of  the  contents  of  the  uterus  has  taken  place.  ("  Cyc. 
Pr.  Med.  Pregnancy,"  p.  496;  see  also  "Edinburgh  Monthly  Jour- 
nal," Jan.  1845,  p.  58.)  The  presence  of  a  corpus  luteum,  as  it  is 
here  described,  does  not  prove  that  a  woman  has  borne  a  child.  In 
the  opinion  of  some  obstetric  authorities,  it  establishes  that  concep- 
tion lias  taken  place;  but  the  embryo  may  have  been  converted  into 
a  mole  or  a  blighted  foetus,  and  expelled  at  an  early  period. 

The  late  Drs.  Baly  and  Kirkes,  who  investigated  the  subject  of 
true  and  false  corpora  lutea,  concluded  from  their  researches,  thai 
cases  seldom  occur  in  which  the  mere  presence  of  a  corpus  luteum 


•A40  CHARACTERS    OF    THE    OVUM    OR    EMBRYO. 

can  be  taken  as  a  proof  of  previous  impregnation;  and  they  con- 
sider the  following  rules  to  be  deducible  from  the  facts  which  they 
have  collected  :  1.  A  corpus  luteum  in  its  early  stage  (that  is.  a  large 
vesicle  tilled  with  coagulated  blood,  having  a  ruptured  orifice,  and 
a  thin  layer  of  yellow  matter  within  its  walls)  affords  no  proof  of 
impregnation  having  taken  place.  2.  From  the  presence  of  a  corpus 
luteum,  the  opening  of  which  is  closed,  and  the  cavity  reduced  or 
obliterated  (only  a  stellate  cicatrix  remaining),  no  conclusion  as  to 
pregnancy  having  existed  can  be  drawn,  if  the  corpus  luteum  he  of 
small  size,  and  does  not  contain  so  much  yellow  substance  as  would 
form  a  mass  the  size  of  a  small  pea.  3.  A  similar  corpus  luteum  of 
larger  size  than  a  common  pea,  would  furnish  strong  presumptive 
evidence,  not  only  of  impregnation,  having  taken  place,  but  of 
pregnancy  having  existed  during  several  weeks  at  least ;  and  the 
evidence  would  approximate  more  and  more  to  complete  proof,  in 
proportion  as  the  size  of  the  corpus  luteum  was  greater.  (Op.  cit. 
p.  57.) 

From  these  considerations,  therefore,  it  appears  to  me  that  the  only 
conclusion  to  which  we  can  come  is,  that  medical  evidence  respect- 
ing the  nature  of  a  corpus  luteum,  in  an  unknown  case,  if  received 
by  a  court  of  law  at  all,  should  be  received  with  the  greatest  caution, 
and  only  from  a  witness  of  great  experience.  The  old  doctrine  on 
this  subject,  that  the  presence  of  such  a  body  on  the  ovary  affords 
certain  and  undeniable  evidence  of  impregnation,  may  be  regarded 
as  completely  subverted. 

Characters  of  the  Ovum  or  Embryo  to  the  Sixth  Month. — Hitherto 
the  examination  has  been  confined  to  the  woman,  but  it  is  now 
necessary  to  describe  the  characters  of  the  ovum  or  embryo  and  its 
enveloping  membranes  at  the  early  stages  of  pregnancy,  since,  when 
this  can  be  procured,  it  may  furnish  good  medical  evidence.  The 
"ovum"  signifies  the  embryo  and  its  membranous  coverings;  the 
"  embryo"  is  the  body  which  is  afterwards  converted  into  the  fcetus  ; 
the  term  "fcetus"  is  applied  to  the  embryo  after  the  third  or  fourth 
month  of  gestation.  If  the  ovum  be  expelled  within  a  month  after 
conception,  it  is  scarcely  possible  to  detect  it,  owing  to  its  small  size, 
and  its  being  enveloped  in  coagula  of  blood.  Burns  examined  three 
uteri  within  the  first  month,  where  no  expulsion  had  taken  place, 
but  even  under  these  favorable  circumstances  he  failed  in  discovering 
the  ovum.  At  first  the  ovum  contains  no  visible  embryo,  but  it 
appears  to  consist  merely  of  vesicular  membranous  coverings.  Ac- 
cording to  this  authority,  when  first  distinctly  seen  through  its 
membranes,  it  is  of  an  oblong  form,  and  about  a  line  (the  twelfth  of 
an  inch)  in  length.  At  the  sixth  week  it  is  slightly  curved,  resembling, 
as  it  floats,  a  split  pea.  In  the  seventh  iveek  it  is  equal  in  size  to  a 
small  bee ;  and  by  the  end  of  the  second  month  it  is  bent,  and  as  long 
as  a  kidney  bean.  After  the  second  month,  development  goes  on 
rapidly;  the  features  are  in  part  well  marked,  and  the  limbs  are 
gradually  well  formed.  At  the  third  month,  the  foetus  Aveighs  from 
one  to  two  ounces;  when  stretched  out,  it  measures  about  three 
inches,  and  the  genital  organs,  although  the  sex  is  not  then  distin- 


PKODUCTION    OF    MOLES.  441 

guishable,  are  large  in  proportion  to  the  rest  of  the  body.  r  The 
membranes  are  larger  than  a  goose's  egg.  At  the  fourth  month  the 
foetus  is  from  five  to  six  inches  long,  and  weighs  from  two  to  three 
ounces;  at  the  fifth  month  it  measures  from  six  to  seven  inches,  and 
weighs  from  five  to  seven  ounces ;  and  at  the  sixth  month  its  length 
is  from  eight  to  ten  inches,  and  its  weight  about  a  pound.  (For  the 
characters  of  the  child  beyond  this  period  see  "  Infanticide.") 
The  great  difficulty  will  consist  in  determining  the  nature  of  the 
supposed  ovum  or  embryo  between  the  second  and  third  month.  In 
making  the  examination,  it  should  be  placed  in  water,  and  all  coagula 
gently  washed  away  from  the  membranous  coverings  or  removed  by 
some  blunt  instrument.  Alcohol  may  be  used  as  a  substitute  for 
water,  after  the  blood  has  been  removed.  If  the  embryo  cannot  be 
found,  the  decidua  and  chorion,  or  portions  of  them,  may  be  recog- 
nized ;  the  former  by  its  forming  the  outer  investment  with  its 
smooth  internal  and  rough  external  or  uterine  surface ;  the  latter  by 
the  villous  or  shaggy  appearance  of  that  portion  of  it  which  should 
have  become  the  placenta.  Between  the  third  and  fourth  month  the 
foetus  may  be  commonly  identified  without  much  difficulty.  The 
ovum  in  many  instances  escapes  first,  leaving  the  decidua  behind. 
This  comes  away  after  a  time,  but  it  is  important  to  remember  that 
in  some  states  of  the  virgin,  decidua-like  structures  are  thrown  off 
from  the  uterine  mucous  membrane,  which,  when  examined  by  the 
microscope,  resembles  the  true  decidua.  Both  are  constituted  of 
the  innermost  portion  of  the  uterine  mucous  membrane,  and  contain 
all  its  elements.  Dr.  Keiller  ("Ed.  Med.  Jour.,"  July,  1865,  p.  82) 
and  Dr.  C.  Bell  in  the  same  journal  (Aug.  1865,  p.  120)  have  called 
attention  to  the  fact  that  an  erroneous  medical  opinion  on  the  date 
of  pregnancy  may  be  formed  by  trusting  too  much  to  the  appearance 
of  the  ovular  membranes.  The  ovum  or  foetus  may  die  and  the 
membranes  afterwards  continue  to  grow,  thus  giving  the  apj^earance 
of  a  longer  date  to  pregnancy.  The  embryo  alone  can  give  any 
satisfactory  result  on  this  point.  The  membranes  may  be  also  en- 
larged as  the  result  of  dropsical  accumulation,  and  this  may  be  set 
down  to  pregnancy  of  some  duration  when  it  may  not  have  extended 
beyond  the  second  or  third  month. 

A  mole  is  the  result  of  conception,  the  foetus  of  which  has  died 
in  consequence  of  the  effusion  of  blood  into  the  decidua  and  the 
various  membranes;  and,  should  a  placenta  exist,  into  its  structure. 
The  symptoms  accompanying  a  mole  resemble  those  of  pregnancy ; 
and  the  appearances  produced  by  its  expulsion  are  not  to  be  distin- 
guished from  those  attending  the  abortion  of  a  foetus  at  an  early 
period  of  gestation.  The  only  means  of  distinction  would  be  derived 
from  an  examination  of  the  expelled  matters.  The  local  injury 
produced  by  the  expulsion  of  these  bodies  on  the  organs  of  genera- 
tion is  by  no  means  so  great  as  that  caused  by  delivery  at  the  full 
period. 

When  from  some  accident  the  foetus  dies  at  any  time  before  the 
complete  formation  of  the  placenta,  the  villi  of  the  chorion,  instead 
of  completely  dying,  retain  a  certain  amount  of  vital  force;    the 


■±12  CONCEALMENT    OF    BIRTH. 

consequence  of  which  is  that  in  some  parts  growth  goes  on  imper- 
fect 1  v.  serous  fluid  is  effused  within,  and  the  part  is  distended  into  a 
globular  form.  This  is  called  a  vesicular  mole.  In  the  early  state  of 
pregnancy  a  decidual  covering  will  always  be  found  more  or  less 
complete  around  this  mole,  but  if  the  size  of  the  mass  be  great,  then, 
although  present,  it  will  be  less  observable,  being  spread  over  a 
large  surface.  A  corpus  luteum  will  also  be  found,  but  not  so  per- 
fectly formed  as  in  normal  pregnancy.  The  ordinary  symptoms  of 
pregnancy  accompany  this  state,  although  in  all  forms  of  mole- 
pregnancy  it  is  imperfectly  marked,  or  only  proceeds  to  a  certain 
point.  (See  case,  "  Obstetric  Eecord,"  vol.  i.  p.  21.)  It  is  also  to  be 
remembered  that  the  effects  produced  by  the  expulsion  of  a  mole 
are  very  similar  to  those  of  abortion.  These  facts  may  have  an 
important  bearing  on  medico-legal  practice. 

Concealment  of  Birth. — [For  the  law  in  England  previous  to  the 
statute  of  Victoria,  see  the  last  American  edition  of  this  work,  p. 
127,  &c.  For  the  Pennsylvania  law  upon  the  subject  of  concealment 
in  such  cases,  see  Eevisecl  Criminal  Code,  March  31,  1860,  §  89. 
Concealment  of  birth  of  child  is  not  punishable  under  the  Penn- 
sylvania  Revised  Code. — P.]  Medical  evidence  respecting  delivery 
is  required  in  two  cases:  1st,  when  the  birth  of  a  child  is  wilfully 
concealed ;  and  2dly,  when  the  contents  of  the  uterus  have  been 
prematurely  expelled  by  criminal  means.  The  concealment  of  preg- 
nancy is  no  offence  in  the  English  law ;  but  the  concealment  of 
d  livery  or  of  the  birth  of  a  child  is  a  misdemeanor  by  the  21  &  25 
Tic.  c.  100,  sec.  60,  the  words  of  which  are  to  the  following  effect : 
"  If  any  woman  shall  be  delivered  of  a  child,  every  person  who 
shall  by  any  secret  disposition  of  the  dead  body  of  the  said  child, 
whether  such  child  died  before,  at,  or  after  its  birth,  endeavor  to 
conceal  the  birth  thereof,  shall  be  guilty  of  a  misdemeanor,  and  be- 
ing convicted  thereof  shall  be  liable  at  the  discretion  of  the  court 
to  be  imprisoned  for  any  term  not  exceeding  two  years,  with  or 
without  hard  labor."'  A  proviso  is  added  to  the  effect  that  any  per- 
son tried  for  the  murder  of  any  child,  and  acquitted  thereof,  may  be 
found  guilty  of  concealment  of  birth,  if  it  shall  appear  in  evidence 
that  the  child  had  recently  been  born,  and  that  such  person  did  by 
some  secret  disposition  of  the  dead  body  endeavor  to  conceal  the 
birth.  Various  interpretations  have  been  put  upon  the  terms  "  con- 
cealment" or  "  secret  disposition"  of  the  bodj^.  This  part  of  the 
evidence  does  not  affect  a  medical  witness,  unless  he  himself  has 
found  the  dead  body  or  was  present  when  it  was  found.  It  will  rest 
with  the  judge  to  determine  whether  the  body  has  been  so  disposed 
of  as  to  constitute  legally  a  misdemeanor.  (Beg.  v.  Clarke,  Chelms- 
ford Summer  Assizes,  1861.) 

This  is  an  offence  of  which  women  charged  with  child-murder 
are  commonly  convicted  in  England:  while  the  Scotch  law  punishes 
women  for  the  concealment  of  pregnancy  if  the  child  be  dead  or 
missing.  (Alison's  "  Criminal  Law,"  p.  153.)  The  medical  evidence 
on  trials  for  this  misdemeanor  is  exclusively  derived  from  an  exami- 
nation of  the  mother;   and  thus,  much  will  depend  upon  the  time  at 


LEGAL    DEFINITION    OF    A    CHILD.  443 

which  this  is  made.  With  respect  to  the  child,  its  body  need  not  even 
be  produced,  provided  there  be  satisfactory  evidence  of  its  death : 
the  body  may  have  been  secretly  buried  or  burnt,  and  in  the  latter 
case  it  may  be  necessary  to  examine  the  bones  or  ashes. 

According  to  the  statute,  the  child  must  be  dead — the  concealment 
of  the  birth  of  a  living  child  not  being  any  offence,  unless  it  should 
happen  to  die  before  its  birth  was  made  known.  In  the  case  of 
the  Queen  v.  Woodman  (Kingston  Lent  Ass.  1844),  the  woman  was 
acquitted  because  the  child  was  living  when  concealed.  Mr.  Chitty 
says,  that  in  order  to  constitute  the  offence,  the  child  must  have  ad- 
vanced to  the  end  of  the  seventh  month  ("  Med.  Jur.,"  p.  412) ;  but 
it  is  to  be  presumed  that  the  concealment  of  the  birth  of  a  dead 
child  at  the  sixth  or  under  the  seventh  month,  would  be  as  much  an 
infringement  of  the  statute  as  if  it  were  more  advanced.  The  con- 
cealment of  the  aborted  but  undeveloped  ovum  or  embryo — of  a 
monster,  i.  e.  a  child  without  human  shape,  a  mole  or  other  morbid 
growth — would  not  probably  be  considered  a  contravention  of  the 
statute.  From  some  observations  made  by  the  Recorder  of  London 
at  the  Central  Criminal  Court,  October,  1865,  there  appears  to  be 
great  uncertainty  on  this  point.  It  is  difficult  to  suggest  a  proper 
legal  definition  of  a  "child."  In  reference  to  the  case  of  Beg.  v. 
Knight,  a  woman  charged  with  concealment  of  birth,  the  prisoner 
admitted  to  a  policeman  that  she  had  been  delivered  of  a  "  some- 
thing" (not  forthcoming).  "  Now,  was  she  delivered  of  a  child,  and 
had  she  disposed  of  the  body  in  such  a  way  as  to  conceal  the  fact  of 
her  having  been  so  delivered?  Then,  what  was  'a  child?'  for  those 
were  the  words  used  in  the  Act  of  Parliament.  He  felt  himself  a 
little  debarred  from  expressing  his  own  opinion  in  reply  to  this 
question,  because  two  of  the  learned  judges  had  given  decisions  di- 
rectly contrary  the  one  to  the  other  upon  this  subject.  One  of  them 
said  it  was  not  a  child  unless  it  had  attained  that  state  in  which  it 
could  live,  supposing  it  had  been  born  alive.  If  it  had  attained 
that  state,  then  he  was  of  opinion  that  it  was  a  child.  The  other 
judge  said  that  this  was  not  his  idea  of  a  child  ;  but  that  if  it  had 
the  outward  form  of  a  child,  it  was  a  child  according  to  the  Act  of 
Parliament.  The  one  contended  that  it  ought  to  have  attained  to  a 
state  in  which  it  could  live ;  and  the  other  that,  at  any  rate,  it  should 
have  the  outward  form  of  a  child.  Was  there  any  proof  of  that 
sort  here  ?  The  prisoner  herself  said  she  did  not  know  whether  she 
had  been  in  the  family  way  for  three  months.  Taking  the  widest 
view  of  the  learned  judges,  had  what  was  born  in  this  state  the  out- 
ward form  of  a  child?  If  it  had  not,  then  the  prisoner  was  not 
guilty  of  the  offence  charged  against  her." 

It  is  not  material  here,  as  in  the  case  of  alleged  infanticide,  to 
prove  token  the  child  died—  whether  before,  during,  or  after  its  birth; 
iind  thus  those  subtleties  and  technicalities  which  are  met  with  in 
eases  of  child-murder  are  avoided.  In  regard  to  proof  of  conceal- 
ment, and  what  constitutes  it,  these  are  essentially  legal  points;  hut 
a  medical  practitioner  may  sometimes  benefit  an  accused  person,  if 
he  can  prove  that  the  woman  had  made  application  to  him  on  the 


■i-U  CRIMINAL    ABORTION. 

subject  of  her  pregnancy  and  delivery.  The  law  is  especially  lenient 
under  such  circumstances.  Questions  connected  with  concealment 
of  birth  do  not  fall  under  the  jurisdiction  of  the  coroner ;  the  med- 
ical evidence  is  therefore  required  by  a  magistrate. 


CRIMINAL  ABORTION. 


CHAPTEE  XLIII. 

Abortion  from  natural  causes. — criminal  causes. — mechani- 
cal   MEANS. — MEDICINAL     SUBSTANCES. SIGNS    OF     ABORTION. — 

SPECIFIC  ABORTIVES. — LOCAL  APPLICATIONS. — FEIGNED  ABORTION. 
— MEANING  OF  THE  WORD  NOXIOUS  AS  APPLIED  TO  DRUGS. — ON 
INDUCING  PREMATURE  LABOR. — PROOF  OF  PREGNANCY  NOT  NECES- 
SARY.— ABORTION  OF  MONSTERS. — MOLES  AND  HYDATIDS. 

By  abortion  is  commonly  understood,  in  medicine,  the  expulsion 
of  the  contents  of  the  uterus  before  the  sixth  month  of  gestation.  If  the 
expulsion  take  place  between  the  sixth  and  ninth  month,  the  woman 
is  said  to  have  a  premature  labor.  The  law  makes  no  distinction  of 
this  kind,  but  the  term  abortion  is  applied  to  the  expulsion  of  the  foetus 
at  any  period  of  pregnancy  before  the  term  of  gestation  is  completed; 
and  in  this  sense  it  is  synonymous  with  the  popular  term  miscarriagt . 
Criminal  abortion  is  rarely  attempted  before  the  third  month  ;  it  is 
perhaps  most  common  between  the  fourth  and  fifth  month ;  because 
then  a  female  begins  for  the  first  time  to  acquire  a  certainty  of  her 
pregnancy.  The  causes  of  abortion  may  be  either  natural  or  violent. 
The  latter  only  fall  under  the  cognizance  of  the  law ;  but  a  medical 
witness  should  be  well  acquainted  with  the  causes  which  are  called 
natural,  in  contradistinction  to  others  which  depend  on  the  applica- 
tion of  violence.  These  natural  causes  are  sometimes  very  obscure, 
and  the  real  cause  is  often  overlooked.  They  are  so  frequent,  that, 
according  to  Mr.  Whitehead's  observation,  of  2000  pregnancies,  one 
in  seven  terminated  in  abortion.  These  causes  are  commonly  ascrib- 
able  to  peculiarities  in  the  female  system,  to  the  presence  of  uterine 
or  other  diseases,  or  to  some  moral  shock  sustained  by  a  woman 
during  pregnancy.  Any  diseases  which  strongly  affect  the  uterus  or 
general  system  of  a  woman  may  give  rise  to  abortion.  An  attack  of 
smallpox  has  been  known  to  produce  it ;  and  it  has  been  suggested 
by  Mr.  Acton,  that  the  presence  of  constitutional  syphilis  in  the 
father  is  not  only  a  cause  of  infection  in  the  offspring,  but  of  repeated 
abortion  in  the  female.  ("Med.  Gaz."  vol.  36,  p.  164;  Kamsbotham's 
'_'  Obstetric  Medicine,"  p.  655.)  These  facts  deserve  attention,  when 
it  is  proved  that  a  woman  has  really  aborted,  and  an  attempt  is  un- 


ABOKTION    BY    MECHANICAL    MEANS.  445 

justly  made  to  fix  an  alleged  act  of  criminality  on  another.  For 
further  information  on  the  numerous  natural  and  accidental  causes 
which  may  give  rise  to  abortion,  the  reader  may  consult  the  work  of 
Mr.  Whitehead  ("On  Abortion  and  Sterility,"  p.  252;  also,  for  the 
effects  of  undue  laceration  and  disease  of  the  placenta,  in  causing 
abortion,  see  "  Med.  Times  and  Gaz."  Dec.  4,  1852,  p.  580,  and  March 
19,  1853,  p.  302.)  In  considering  the  operation  of  these  causes,  it  is 
proper  to  bear  in  mind  that  during  pregnancy  the  uterus  is  subject 
to  a  natural  periodical  excitement,  corresponding  to  what  would  have 
been  the  menstrual  period  dating  from  the  last  cessation.  Hence 
comparatively  trivial  causes  operating  at  these  periods  may  lead  to 
an  expulsion  of  the  foetus. 

The  violent  causes  of  abortion  may  be  of  an  accidental  or  criminal 
nature.  In  general  the  distinction  will  not  be  difficult;  the  kind  of 
violence,  and  the  adequacy  of  the  alleged  cause  to  produce  abortion 
will  be  apparent  from  the  evidence.  In  reference  to  criminal  cases, 
the  causes  may  be  referred  either,  1st,  to  the  use  of  mechanical  means, 
or  2dly,  of  irritating  medicinal  substances  acting  upon  the  uterus  or 
bowels.  They  operate  with  greater  certainty  just  in  proportion  as 
the  pregnancy  is  advanced. 

Mechanical  Means. — Among  the  mechanical  causes  may  be  men- 
tioned— severe  exercise,  the  violent  agitation  of  the  body,  as  by  riding 
or  driving  over  a  rough  pavement,  in  which  case  no  marks  of  violence 
would  be  apparent.  Any  physical  shock,  sustained  by  the  body,  may 
operate  indirectly  on  the  uterus.  Violent  pressure  or  blows  on  the 
abdomen  are  sometimes  resorted  to ;  but  in  these  cases  the  marks  of 
violence  will  be  commonly  perceptible.  Instruments  have  been 
devised  for  the  purpose  of  piercing  the  membranes,  destroying  the 
child,  and  thereby  leading  to  its  expulsion.  Devergie  speaks  of  such 
instruments  being  well  known  in  England,  and  of  English  midwives 
deriving  a  living  from  the  practice  of  this  crime.  (Op.  cit.  vol.  1,  p. 
285.)  Although  this  must  be  regarded  as  an  exaggerated  statement, 
it  cannot  be  denied  that  cases  have  transpired  which  show  that  the 
crime  is  frequently  perpetrated  by  persons  who  basely  derive  a  profit 
from  the  practice;  and  for  one  case  that  comes  to  light  probably  a 
dozen  are  effectually  concealed.  In  the  evidence  given  on  four  trials 
within  a  recent  period,  the  case  presented  no  feature  of  novelty  or 
interest.  Instruments  were  employed,  and  drugs  in  large  doses  were 
proved  to  have  been  administered. 

Mechanical  means  are  undoubtedly  more  effectual  in  producing 
abortion  than  medicinal  substances ;  yet,  from  the  fact  of  such  attempts 
being  made  by  ignorant  persons,  the  woman  generally  dies  from  in- 
flammation of  the  womb  or  peritoneum,  or  other  serious  after-conse- 
quences. A  case  was  tried  some  years  since,  in  which  the  evidence 
showed  that  the  prisoner  had  attempted  to  produce  abortion  in  the 
deceased  by  thrusting  wooden  skewers  in  the  substance  of  the  uterus. 
Inflammation  and  gangrene  took  place,  and  the  woman  died.  The 
prisoner  was  convicted  and  executed  for  murder.  (For  a  similar 
case  by  Mr.  M'Pherson,  see  "Med.  Gaz."  vol.  36,  p.  102;  see  also 
another  case  in  the  same  journal,  vol.  45,  p.  693.)     This  kind  of  in- 


446      ABORTION    FROM    RUPTURE    OF    THE    MEMBRANES. 

jury  to  the  uterus  always  implies  the  interference  of  some  other 
person  in  the  perpetration  of  the  crime.  Mechanical  means  can 
seldom  be  applied  to  the  uterus  without  leaving  marks  of  violence 
on  the  organ,  as  well  as  on  the  body  of  the  child.  If  the  mother 
should  die,  a  result  which  generally  takes  place,  an  inspection  will 
at  once  settle  the  point.  (''Ann.  cl'Hyg."  1834,  191;  1838,  vol.  1, 
p.  425 ;  1839,  vol.  2,  p.  109.)  An  important  case  of  this  kind  was  the 
subject  of  a  criminal  trial  in  Scotland  in  1858  (case  of  Reid,  "Medi- 
cal Gazette,"  December  11,  1858.)  The  uterus  near  its  mouth  pre- 
sented two  openings  in  its  substance,  described  as  punctured  wounds 
by  the  medical  witnesses  for  the  prosecution  who  made  the  exami- 
nation— and  as  the  openings  of  torn  bloodvessels  by  others  who  wrere 
called  for  the  defence.  There  was  also  a  rupture  of  one  ovary.  The 
prisoner  was  convicted ;  but  the  medical  man  who  was  supposed  to 
have  been  the  principal  agent  in  the  crime  committed  suicide.  The 
case  is  chiefly  important  in  showing  that  any  apparent  mechanical 
injury  to  the  uterus  should  be  minutely  examinee!,  so  that  no  doubt 
of  the  cause  may  afterwards  be  entertained.  If,  in  a  case  of  this 
kiud,  the  mother  survives  and  the  child  be  expelled,  then  marks  of 
violence  wTill  be  found  on  its  body.  These  marks  may  not  be  suffi- 
cient to  account  for  its  death;  but  this  is  not  here  the  question.  If 
it  can  be  proved  that  they  have  not  resulted  from  accidental  causes 
during  gestation  or  subsequently  to  delivery,  then  their  presence 
may  furnish  strong  corroborative  evidence  of  the  actual  means  by 
which  abortion  was  attempted.  It  is  said  that  abortion  has  been 
in  some  instances  accomplished  by  frequent  bleeding  from  the  arm. 
This  effect  may  follow  as  a  result  of  shock  produced  by  the  loss  of 
blood.  An  examination  of  the  veins  of  the  arms  would  show 
whether  any  such  attempt  had  been  made. 

There  can  be  no  doubt  that  of  all  the  exciting  causes  of  abortion, 
the  most  effectual,  and  that  which  most  certainly  brings  on  the  ex- 
pulsive action  of  the  uterus,  is  the  destruction  of  the  ovum  or  em- 
bryo. If  by  accident  or  design  the  ovular  membranes  should  become 
ruptured,  gestation  is  arrested,  and  abortion  necessarily  ensues.  At 
any  period  of  pregnancy,  therefore,  a  puncture  through  the  mem- 
branes will  sooner  or  later  occasion  the  evacuation  of  the  uterus. 
(Ramsbotham's  "  Obstetric  Medicine,"  p.  655.)  This  author  remarks 
that  the  performance  of  the  operation  demands  a  most  accurate 
knowledge  of  the  anatomy  of  the  ovum  and  the  maternal  structures, 
as  well  as  of  the  state  of  development  which  the  neck  of  the  uterus 
assumes  at  different  periods  of  pregnancy.  In  medical  practice,  for 
the  induction  of  premature  labor,  the  membranes  are  ruptured  either 
by  the  use  of  a  female  catheter,  or  by  an  instrument  of  this  shape, 
but  including  a  blade  like  a  tonsil-lancet.  Unless  the  inner  membrane 
or  amnion  be  opened,  gestation  may  still  proceed,  and  abortion  will 
not  take  place.  When  the  membranes  are  completelv  penetrated 
and  the  waters  are  discharged,  uterine  action  is  invariably  induced, 
but  the  time  which  elapses  from  the  performance  of  the  operation 
to  the  commencement  of  labor,  is  subject  to  great  variation.  Dr. 
Eamsbotham  states  that  he  has  known  the  uterus  beuin  to  act  in  ten 


ABORTION  FROM  RUPTURE  OF  THE  MEMBRANES.   447 

hours  after  the  rapture,  but  in  another  case  a  week  elapsed  before  its 
action  commenced.  As  a  general  rule,  uterine  action  is  fully  estab- 
lished in  fifty  or  sixty  hours.  It  must  not  be  supposed,  however, 
that  where  a  criminal  intention  exists,  so  long  a  period  is  required 
for  removing  the  contents  of  the  uterus.  The  cases  above  referred 
to  were  cases  of  obstetric  practice,  in  which  there  was  no  desire  to 
expose  the  female  to  the  slightest  risk,  and  premature  labor  was 
openly  induced.  In  a  criminal  attempt  by  a  medical  practitioner,  in 
which  the  woman  would  be  a  consenting  party  to  the  act,  the  re- 
moval of  the  embryo  or  foetus  might  be  effected  in  a  much  shorter 
period  of  time.  At  any  rate,  the  time  for  the  completion  of  abor- 
tion could  not  be  measured  by  cases  in  which  the  uterus  has  been 
left  to  undergo  spontaneous  contraction  after  the  membranes  had 
been  punctured,  and  the  waters  had  escaped.  There  would,  however, 
be  great  danger  to  a  woman  in  the  necessary  manipulations  required. 
The  reader  will  find  reports,  by  M.  Tardieu,  of  numerous  cases  of 
abortion  as  a  result  of  mechanical  means  applied  to  the  uterus,  in 
the  "  Annales  d'Hygiene,"  1855,  vol.  1,  p.  406 ;  and  some  good  prac- 
tical remarks  by  the  same  writer,  on  the  mode  in  which  these  inqui- 
ries should  be  conducted,  in  the  "Annales  d'Hygiene,"  1856,  vol.  1, 
p.  141. 

It  is  obvious  that  this  mode  of  perpetrating  abortion  is  only  likely 
to  succeed  in  the  hands  of  persons  who  have  a  complete  anatomical 
knowledge  of  the  parts.  The  certain  death  of  the  woman  will  con- 
vert the  crime  to  murder,  when  instruments  are  introduced  into  her 
body  by  persons  who  are  ignorant  of  anatomy.  It  is  to  be  regretted 
that  members  of  the  medical  profession  have  on  several  occasions 
misused  their  professional  knowledge,  and  have  exposed  themselves 
to  prosecutions  for  this  crime.  Sometimes  it  is  probable  the  charge 
has  been  raised  falsely,  or  through  misapprehension  on  the  part  of 
the  woman ;  at  others,  the  evidence  has  left  it  very  clear  that  the 
charge  was  well-founded.  Of  late  years  medical  men  have  rather 
freely  used  the  speculum.  When  this  instrument  has  been  impro- 
perly or  unnecessarily  used  on  a  pregnant  woman,  a  charge  of  at- 
tempted abortion  by  instruments  may  be  easily  raised  against  a 
medical  practitioner.  A  trial  took  place  at  the  Exeter  Lent  Assizes, 
1854  {Keg.  v.  Griffin  and  Venn),  in  which  it  was  charged  that  the 
accused,  Venn  (a  surgeon),  had  feloniously  used  an  instrument  with 
the  intent  to  procure  the  miscarriage  of  the  prosecutrix.  Accord- 
ing to  the  evidence,  Venn  had  on  several  occasions  passed  a  round 
polished  instrument  into  the  body  of  the  woman,  once  in  a  coppice 
and  at  another  time  in  a  field.  The  defence  was,  that  the  surgeon 
had  merely  used  a  speculum  to  ascertain  whether  the  girl  was  preg- 
nant, in  order  to  know  how  to  prescribe  for  her;  and  that  it  was 
absurd  to  suppose  that  he  had  ever  intended  to  procure  abortion,  for 
this  had  not  followed,  and  it  might  have  been  easily  produced  by 
him  at  any  period  of  pregnancy  if  the  medical  man  had  wished  it. 
The  prisoners  were  acquitted.  Admitting  the  statements  of  the 
prosecutrix  and  the  prisoner  to  be  correct,  it  may  be  remarked  that 
medical  practitioners,  in  the  lawful  exercise  of  their  profession,  do 


448  FROM    MEDICINAL    SUBSTANCES. 

not  commonly  use  a  speculum  in  open  fields  or  coppices  to  deter- 
mine whether  a  female  is  pregnant  or  not;  and  it  is  a  well-known 
fact  that  a  speculum  is  not  required  for  determining  the  question  of 
pregnancy  at  all.  This  case  conveys  a  serious  caution  to  members 
of  the  medical  profession. 

Medicinal  Substances. — These  are,  perhaps,  more  frequently  re- 
sorted to  for  inducing  criminal  abortion  than  other  means ;  but  they 
rarety  answer  the  intended  purpose,  and  when  this  result  is  obtained, 
it  is  generally  at  the  expense  of  the  life  of  the  woman.  Mineral 
poisons  have  been  ignorantly  employed  for  this  nefarious  object — 
such  as  arsenic,  corrosive  sublimate,  sulphate  of  copper,  muriate  of 
iron  {Reg,  v.  Wright,  Abingdon  Autumn  Assizes,  1855),  and  other 
irritants.  Croton-oil,  gamboge,  colocynth,  aloes  (Henke,  "Zeit- 
schrift,"  1844,  vol.  2,  p.  203),  hiera  picra,  a  mixture  of  aloes  and 
canella,  elaterium,  and  other  drastic  purgatives,  have  also  been  used 
for  a  similar  purpose.  Purgatives  which  produce  much  straining, 
and  powerful  emetics  or  diuretics,  will  readily  excite  abortion  in  the 
advanced  stages  of  pregnancy ;  but  these  violent  medicines  fail  in 
their  effect  at  the  earlier  stages.  A  decoction  of  fern  or  of  broom- 
tops  has  been  sometimes  used.  The  decoction  of  broom  acts  as  a 
strong  diuretic.  In  the  case  of  Reg.  v.  Morris  (Reading  Lent  Assi- 
zes, 1858),  a  decoction  of  fern  was  given  to  cause  abortion,  but  it 
merely  produced  sickness.  The  substances  just  mentioned  exert  an 
indirect  action  on  the  uterus  by  producing  a  shock  to  the  general 
system :  but  there  is  a  certain  class  of  bodies,  called  emmenagogues, 
which  have  a  specific  action  on  the  uterus  itself.  Among  these,  the 
ergot  of  rye,  or  secale  cornutum,  may  be  particularly  noticed. 
Other  vegetable,  animal,  and  mineral  substances,  which  may  be 
enumerated  as  having  acquired  popular  repute  for  procuring  abor- 
tion are  savin,  cantharides  (see  p.  151),  rue,  iron  filings,  squills, 
grains  of  paradise  {Reg.  v.  Rushforth,  York  Autumn  Assizes,  1857), 
pennyroyal,  black  hellebore,  and  tansy.  M.  Tardieu  relates  three 
cases  in  which  a  strong  decoction  of  rue  produced  abortion  at  the 
fourth,  fifth,  and  beyond  the  sixth  month  respectively,  and  the  woman 
recovered.  ("  Ann.  cVHyg."  1855,  vol.  1,  p.  403.)  Its  operation  as 
an  abortive  was  generally  preceded  by  well-marked  nervous  symp- 
toms— e.  g.  giddiness  and  stupor,  depression  of  the  action  of  the 
heart,  with  nausea  and  severe  pain  in  the  stomach.  ("  Ann.  d'Hyg." 
1856,  vol.  1,  p.  135.)  In  April,  1856,  a  medical  man  was  convicted 
before  the  Central  Criminal  Court  of  Sydney,  of  administering  ex- 
tract of  belladonna  in  a  suppository,  with  a  view  to  procure  abor- 
tion. In  a  case  which  occurred  in  France  iodide  of  potassium  was 
pronounced  by  three  medical  men  to  be  an  abortive  ("  Med.  Times 
and  Gazette,"  Jan.  29,  1859),  but  the  grounds  for  this  opinion  are  not 
given.  ^  None  of  these  substances  have  any  influence  on  the  uterus, 
except  in  affecting  it  indirectly  by  their  irritant  action  on  the  system. 
In  the  Coroners'  return  for  1837-8,  there  were  four  cases  of  the 
administration  of  savin  and  other  drugs,  with  the  view  of  procuring 


SPECIFIC    ABORTIVES.  449 

abortion.     In  three  of  these  cases,  the  mother  died  undelivered ;  in 
the  fourth,  the  child  perished. 

Specific  Abortives.  Ergot  of  JRye,  or  Secale  Comjitum. — This  sub- 
stance has  been  found,  in  many  instances,  to  bring  on  violent  action 
of  the  uterus  at  an  advanced  stage  of  gestation,  or  when  efforts  at 
parturition  had  already  commenced.  There  is,  however,  consider- 
able difference  of  opinion  respecting  its  alleged  specific  properties. 
According  to  Dr.  Lee,  it  has  no  effect,  at  least  in  the  early  stages  of 
gestation,  although  given  in  very  large  doses.  ("  Med.  Gaz."  vol. 
25,  p.  10  ;  see  also  "  Edin.  Med.  and  Surg.  Jour."  vol.  53,  p.  27.)  Dr. 
Kluge,  of  Berlin,  found  that  its  properties  varied  according  to 
whether  it  was  gathered  before  or  after  harvest ;  in  the  former  case 
it  had  an  energetic  action,  while  in  the  latter  it  was  powerless.  The 
properties  of  the  secale  are  but  little  known  to  the  vulgar  in  this 
country ;  and  this  may  account  for  the  fact  of  our  rarely  hearing  of 
cases  in  which  it  has  been  criminally  administered  by  midwives  to 
pregnant  women.  Dr.  Beatty  states  that  when  used  in  obstetric 
practice,  it  is  liable,  by  absorption  into  the  system  of  the  mother, 
which  may  take  place  within  two  hours,  to  endanger  the  life  of  the 
child.  ("  Dub.  Med.  Jour."  May,  1844,  p.  202.)  This  question  was 
actually  referred  by  the  French  Government  to  the  Academy  of 
Medicine  in  1845,  as  there  was  reason  to  think  that,  under  its  employ- 
ment in  the  practice  of  midwifery,  children  were  frequently  born 
dead.  ("Ann.  d'Hyg."  184(3,  vol.  1,  p.  204;  see  also  "Med.  Gaz." 
vol.  46,  p.  680.)  In  confirmation  of  Dr.  Beatty's  statement,  Drs. 
M'Clintock  and  Hardy  report,  that,  out  of  thirty  cases  in  which  it 
was  administered,  twenty  children  were  born  dead.  ("  Practical 
Observations,"  p.  95.)  Dr.  Ramsbotham  considers  that  the  drug- 
may  operate  fatally  on  a  child  according  to  the  circumstances  under 
which  it  is  administered ;  but  that,  unless  it  excites  the  expulsive 
action  of  the  uterus,  it  has  no  effect  on  the  child's  system.  (Op.  cit. 
p.  319 ;  also  cases  by  Mr.  Paterson,  "  Edin.  Med.  and  Surg.  Jour." 
vol.  53,  p.  142.)  According  to  M.  Millet,  in  commenced  or  imminent 
abortion,  ergot  procures  a  safe  and  prompt  termination ;  and  he 
never  met  with  a  case  in  which  it  injured  the  child.  ("  Med.  Chir. 
Rev."  July,  1855,  p.  41.) 

On  trial  for  criminal  abortion,  perpetrated  or  attempted,  a  medical 
witness  must  be  prepared  for  a  close  examination  on  the  specific 
emmenagogue  properties  of  the  ergot  of  rye  on  the  uterus,  as  well 
as  its  general  action  as  a  poison  on  the  woman  and  child.  A  case, 
which  occurred  a  few  years  since  {Beg.  v.  Calder,  Exeter  Lent  Assizes, 
1844),  has  been  reported,  with  comments  on  this  subject,  by  Dr. 
Shapter  ("Prov.  Med.  Journ.,"  April  10,1844).  It  was  alleged  on 
this  occasion,  that  savin,  cantharides,  and  ergot  had  been  respec- 
tively given  by  the  prisoner,  a  medical  man,  for  the  purpose  of 
pr<  icuring  miscarriage.  The  prosecutrix  was  a  woman  of  notoriously 
bad  character,  and  the  prisoner  was  acquitted.  There  were  three 
medical  witnesses,  who  agreed  that  savin  and  cantharides  were  only 
likely  to  occasion  abortion  indirectly,  i.  e.  by  powerfully  affecting 
29 


450  SPECIFIC    ABORTIVES.      ACTION 

ilic  system — the  view  commonly  entertained  by  professional  men. 
Sonic  difference  of  opinion  existed  with  regard  to  ergot.  Dr.  Shapter 
stated,  in  his  evidence,  that  he  did  not  think  the  ergot  would  act 
mi  less  the  natural  action  of  the  uterus  had  already  commenced- — a 
statement  supported  by  a  number  of  authorities.  Subsequently  to 
the  trial,  he  collected  the  observations  of  many  obstetric  writers,  and 
so  far  modified  his  opinion  as  to  admit  that  the  ergot  might  occasion- 
al'///  exert  a  specific  action  on  the  uterus,  in  cases  of  advanced  preg- 
nancy, even  when  uterine  action  had  not  already  commenced.  His 
summary  on  this  subject  is  one  of  the  best  which  has  been  published. 
Dr.  Iiamsbotham  has  reported  three  cases  from  which  it  would 
appear  that  the  ergot  may  in  some  instances  exert  a  direct  action  on 
the  impregnated  and  quiescent  uterus.  In  these  instances,  the  women 
were  in  or  about  the  eighth  month  of  pregnancy.  ("Med.  Gaz.,"  vol. 
14,  p.  484.)  This  observation  has  been  fully  confirmed  by  further 
experience  on  the  use  of  the  drug.  ("Med.  Times  and  Gaz.,"  Jan. 
7,  1854,  p.  8  ;  see  also  his  "Obstetric  Medicine  and  Surgery,"  p.  198.) 
Dr.  J.  H.  Davis  believes  that  it  is  a  specific  excitant  of  uterine  action, 
and  points  out  the  cases  in  which,  in  his  opinion,  it  may  be  safely 
emploj^ed.  ("  Lancet,"  Oct.  11,  1845,  p.  393.)  In  one  instance  in 
which,  owing  to  distortion  of  the  pelvis,  it  was  necessary  to  bring 
on  labor  six  weeks  before  the  full  period,  Mr.  Raynes  found  that 
ergot  in  the  form  of  infusion  in  repeated  doses  excited  the  action  of 
the  uterus,  and  delivery  was  accomplished  within  fifty-eight  hours 
of  the  taking  of  the  first  dose.  The  uterus  was  in  a  quiescent  state 
before  the  medicine  was  given  to  the  patient.  ("Med.  Times  and 
Gaz.,"  March  14,  1857,  p.  260.)  Mr.  Whitehead,  who  has  had  con- 
siderable experience  on  this  subject, -has  found  that  its  action  is  very 
uncertain.  In  a  case  under  his  care,  that  of  a  woman  with  deformed 
pelvis,  it  was  considered  advisable  to  procure  abortion  in  the  fifth 
month  of  pregnancy ;  the  ergot  alone  was  employed,  and  at  first 
with  the  desired  effect.  It  was  given  in  three  successive  pregnancies ; 
and  in  each  instance  labor-pains  came  on  after  eight  or  ten  doses  had 
been  administered,  and  expulsion  was  effected  by  the  end  of  the 
third  day.  It  was  perseveringly  tried  in  a  fourth  pregnancy  in  the 
same  woman,  and  failed  completely.  ("  On  Abortion,"  p.  254.)  It 
also  failed  in  a  case  in  the  hands  of  Dr.  Oldham.  ("  Med.  Gaz.,"  vol. 
44,  p.  49.)  Nevertheless,  the  balance  of  evidence  is  decidedly  in 
favor  of  its  specific  action,  as  a  direct  uterine  excitant ;  and  accord- 
ing to  Dr.  Griffiths,  this  is  so  well  known  to  the  inhabitants  of  the 
United  States,  that  it  is  there  in  frequent  use  as  a  popular  abortive. 
Perhaps  the  differences  which  have  been  observed  in  its  action  may 
have  depended  on  the  quality  of  the  drug,  as  well  as  on  the  period 
at  which  it  was  administered.  Admitting  that  the  uterus  is  subject 
to  periodical  excitement,  corresponding  to  the  menstrual  periods,  it 
is  probable  that  the  action  of  ergot  may  be  more  powerfully  abortive 
at  these  than  at  other  times.  In  a  case  in  which  I  was  consulted  in 
1860,  an  attempt  had  been  made  to  administer  secretly  the  ethereal 
tincture  of  ergot. 

A  case  occurred  at  Brighton,  in  October,  1864,  in  which  a  ques- 


OF    THE    ERGOT    OF    RYE.  451 

tion  arose  respecting  the  fatal  effects  of  this  drug  on  a  woman  who 
had  taken  it  for  a  long  period,  obviously  with  a  view  to  procure 
abortion.  She  died,  however,  without  abortion  having  taken  place; 
and  the  question  at  issue  was,  whether  this  drug  had  or  had  not 
caused  her  death.  The  dose  taken  was,  I  am  informed,  about  a  tea- 
spoonful  of  the  tincture  of  ergot  three  times  a  day,  for  a  period  of 
eleven  weeks.  On  inspection,  patches  of  inflammation  were  found 
on  the  mucous  membrane  of  the  stomach  after  death.  No  other 
cause  for  death  was  apparent,  and  one  medical  witness  assigned  it  to 
the  poisonous  irritant  action  of  the  ergot,  as,  at  the  early  stage  of 
pregnancy  which  she  had  reached  (the  third  month),  this  substance 
would  not  be  likely  to  act  as  an  abortive.  Another  medical  gentle- 
man who  gave  evidence  at  the  inquest,  asserted  that  death  could 
never  be  primarily  caused  by  ergot  of  rye.  The  qualification  intro- 
duced into  this  medical  opinion  is  of  small  importance.  The  deceased 
woman  is  reported  to  have  taken  a  large  quantity  of  the  tincture, 
and  it  is  immaterial  whether  the  drug  killed  her  by  a  primary  or 
secondary  operation.  M.  Tardieu  describes  the  case  of  a  woman, 
aet.  24,  who  aborted  in  the  fourth  month  of  pregnancy,  as  a  result  of 
the  administration  of  ergot  in  powder  ;  she  died  from  peritonitis  in 
about  twenty-four  hours.  The  ergot  was  found  in  fragments  in  the 
lower  third  of  the  bowels.  ("Ann.  d'Hyg.,"  1855,  vol.  1,  p.  404.) 
At  the  same  time  this  medical  jurist  states  that,  in  his  opinion,  ergot 
of  rye  has  no  direct  action  as  an  abortive.  ("Ann.  d'Hyg.,"  1865, 
vol.  1,  p.  139.)  In  respect  to  its  operation,  it  may  be  observed  that 
the  effects  produced  by  its  administration  are  not  such  as  readily  to 
excite  suspicion.  It  does  not  cause  the  decided  symptoms  of  irrita- 
tion observed  in  the  action  of  savin,  nor  the  nervous  symptoms  which 
are  usually  produced  by  rue.  In  medicinal  doses,  given  at  proper  in- 
tervals, the  only  marked  effect  which  it  produces  on  a  pregnant  woman 
is  a  lowering  of  the  pulse.  Sometimes  other  symptoms  of  a  severe 
character  have  presented  themselves.  ("  Ann.  d'Hyg."  1856,  vol.  1, 
p.  140.)  If  a  person  dies  from  the  effects  of  the  drug,  the  results 
are  legally  the  same  whether  its  operation  as  a  noxious  substance  is 
of  a  primary  or  secondary  kind. 

Action  of  Ergot. — In  doses  of  from  half  a  drachm  to  two  drachms 
ergot  in  powder  has  caused  nausea,  vomiting,  dryness  of  the  throat, 
great  thirst,  aversion  to  food,  pain  in  the  abdomen,  slight  purging, 
pain  in  the  head,  stupor,  and  dilatation  of  the  pupils.  (Pereira, 
"  Mat.  Med."  vol.  2,  pt.  1,  p.  111.)  Paralysis  is  said  to  have  been 
observed  among  the  symptoms.  (See  paper  by  Mr.  Wright,  "  Edin. 
Med.  and  Surg.  Jour."  vol.  58,  p.  14.)  The  medicinal  dose  of  the 
powder  in  uterine  diseases  is  from  5  to  15  grains.  It  is  employed  in 
a  larger  dose  (from  20  to  60  grains  at  intervals  of  half  an  hour)  to 
excite  uterine  action  either  for  abortion  or  parturition.  The  dose  of 
the  tincture  is  one  drachm  (a  teaspoonful) ;  this  is  considered  to  be 
equivalent  to  20  grains  of  the  powder.  The  dose  of  the  ethereal 
tincture,  according  to  Pereira,  when  employed  for  the  purpose  of 
exciting  uterine  action,  is  one  drachm  every  half  hour  for  three  or 
four  doses.     (Op.  cit.  p.  119.)     Ergot  must  be  regarded  as  a  noxious 


452 


SPECIFIC    ABORTIVES.      ERGOT    OF    RYE. 


substance,  and  by  some  authorities  it  is  ranked  among  narcotico-irri- 
tant  poisons.  It  does  not  easily  cause  death  iu  one  large  dose,  but 
its  fatal  operation  appears  to  be  more  strikingly  developed  by  its 
long-continued  use  in  small  or  medicinal  doses.  Its  active  proper- 
tics  are  considered  to  be  due  to  the  presence  of  an  oil  which  is  so- 
luble in  ether.  It  also  contains  a  solid  principle,  ergolin,  which 
exerts  a  poisonous  action  on  animals.  The  reader  will  find  a  large 
collection  of  cases,  illustrating  the  properties  of  this  drug,  in  Wib- 
mer  ("  Arzneimittel  und  Gifte,"  vol.  2,  p.  80 — Sijhacelia  segetum  ; 
see  also  Pereira,  "  Mat.  Med."  vol.  2,  pt.  1,  102.) 

Analysis. — The  form  and  characters  of  the  ergot  in  mass  are  well 
known  to  professional  men.  In  the  annexed  illustrations,  1  repre- 
sents the  ergot  of  rye  of  its  usual  form  and  size.  The  outer  coat  is 
dark-colored,  almost  black,  and  it  is  more  or  less  grooved  or  fluted 
longitudinally,  and  pointed  at  each  end.     It  is  brittle,  and  breaks 


Fig.  42. 


m 


The  Ergot  of  Rye. 

with  a  spongy  or  soft  rough  fracture.  2  2  represent  transverse 
sections  of  the  ergot  of  rye.  The  otiter  coat  here  forms  a  dark  out- 
line with  depressions.  The  substance  is  of  a  pale  reddish-white 
color.  If  a  thin  slice  is  wetted  with  a  weak  solution  of  potash,  and 
is  examined  under  a  low  power  of  the  microscope,  the  outer  dark 
coat  gradually  assumes  a  crimson  or  purple  tint.  Small  fragments 
may  be  thus  identified.  3  represents  a  transverse  section  of  the  er- 
got magnified  thirty  diameters.  The  spongy  character  of  this  sub- 
stance  a  with  its  dark  coat  />,  is  here  more  distinctly  delineated. 

When  the  powder  of  ergot  is  rubbed  with  a  solution  of  potash  it 
evolves  a  fishy  odor,  and  the  solution  acquires  a  dingy-red  color. 
In  the  form  of  tincture,  alcoholic  or  ethereal,  one  test  is  the  pe- 
culiar odor  of  the  extract  when  treated  with  potash.  This  may, 
however,  be  concealed  by  other  odors.  Sometimes  small  particles 
of  ergot,  presenting  a  pink-red  color  and  a  dark  external  coat,  may 
be  detected  in  the  sediment  by  the  microscope.  When  ergot  has 
been  taken  in  powder,  fragments  of  it  may  be  found  scattered  over 
the  lining-membrane  of  the  stomach  or  bowels  ;  these  may  be  iden- 
tified by  the  characters  described.     The  ethereal  tincture  evaporated 


SAVIN.      OIL    OF    SAVIN.  453 

to  an  extract  leaves  an  oily-looking  residue,  which,  when  treated 
with  a  solution  of  potash,  acquires  a  light  or  pinkish-red  color. 

Savin.  Oil  of  Savin. — This  vegetable  substance  possesses  great 
popular  repute  as  an  abortive.  In  a  case  which  I  was  required  to 
investigate  in  1845,  it  was  a  question  whether  savin,  which  had  been 
taken  in  the  state  of  powdered  leaves,  and  had  caused  the  death  of 
a  woman,  exerted  any  specific  action  on  the  uterus  to  induce  labor. 
The  reply  was  given,  that  in  large  doses  it  acted  only  indirectly  as 
an  abortive  by  its  irritant  properties.  (See  "  Med.  Gaz."  vol.  36,  p. 
646.)  It  is  proper  to  remember  that  the  infusion  is  more  powerful 
than  the  decoction ;  since  the  poison,  being  a  volatile  oil,  is  dissi- 
pated by  long  boiling.  Savin  is,  however,  commonly  taken  or  ad- 
ministered in  the  form  of  powdered  leaves.  The  irritant  action  of 
this  powder  has  been  elsewhere  considered  (p.  147).  Any  portion  of 
the  leaves  dried  and  rubbed,  will  emit  the  peculiar  odor  of  savin,  by 
which  it  may  be  identified.  Unless  some  traces  of  the  leaves  are 
found  in  the  sediment  there  are  no  tests  for  detecting  the  decoction 
or  infusion.  For  the  microscopical  appearance  of  the  tips  of  the 
leaves  see  illustration  at  p.  148. 

In  a  case  tried  at  the  Cornwall  Lent  Assizes,  1852  {Reg.  v.  Pascoe), 
the  accused,  a  medical  man,  was  convicted  and  sentenced  to  trans- 
portation for  administering  oil  of  savin  to  a  woman,  with  intent  to 
procure  miscarriage.  The  proof  of  intent  rested  partly  on  medical 
and  partly  on  moral  circumstances.  It  appeared  that  the  prisoner 
had  given  fourteen  drops  of  the  oil,  divided  into  three  doses,  daily — 
a  quantity  which,  according  to  the  medical  evidence  at  the  trial,  was 
greater  than  should  have  been  prescribed  for  any  lawful  purpose. 
The  medical  dose,  as  an  emmenagogue,  on  the  authority  of  Christi- 
son,  is  from  two  to  five  minims,  and  according  to  Pereira  from  two 
to  six  drops.  The  quantity  given  by  the  prisoner,  although  a  full 
dose,  was  not,  therefore,  greater  than  these  authorities  recommend; 
and  his  criminality  appears  to  have  rested  not  so  much  on  the  dose 
given,  as  on  the  question  whether  he  knew,,  or,  as  a  medical  man, 
had  reason  to  suspect  that  the  female  for  whom  he  prescribed  it  was 
pregnant.  No  medical  authority  would  recommend  oil  of  savin  in 
full  doses  for  pregnant  females ;  and  with  regard  to  the  existence  or 
non-existence  of  pregnancy  in  a  special  case,  medical  men  are  reason- 
ably presumed  to  have  better  means  of  satisfying  themselves  than 
non-professional  persons.  The  prisoner's  innocence  therefore  rested 
on  the  presumption  that  he  implicitly  believed  what  the  prosecutrix 
told  him  regarding  her  condition — that  he  had  no  reason  to  suspect 
her  pregnancy,  and  therefore  did  not  hesitate  to  select  and  prescribe 
a  medicine  which  certainly  has  an  evil  reputation,  and  is  rarely  used 
by  regular  practitioners.  According  to  the  evidence  of  the  prose- 
cutrix, she  informed  the  prisoner  that  she  had  disease  of  the  heart 
and  liver,  and  that  nothing  more  was  the  matter  with  her.  It  is 
absurd  to  suppose  that  oil  of  savin  would  be  prescribed  by  a  medical 
man  for  such  a  disease  as  this.  The  prisoner,  on  the  hypothesis  of 
innocence,  must  have  intended  the  medicine  to  act  on  the  uterus,  and 
must  have  inferred  the  existence  of  an  obstruction  of  menstruation 


454  SPECIFIC    ABORTIVES.      OIL    OF    TANSY. 

from  natural  causes  irrespective  of  pregnancy.  The  jury  do  not 
appear  to  have  uiven  him  credit  for  such  ignorance  of  his  profession, 
and  this  probably  led  to  his  conviction.  There  can,  it  appears  to 
me,  be  no  doubt  that  the  oil  was  administered  with  a  guilty  inten- 
tion. Every  qualified  practitioner,  acting  bona  fide,  would  un- 
doubtedly satisfy  himself  that  a  young  woman  whose  menses  were 
obstructed  was  not  pregnant,  before  he  prescribed  full  doses  of  this 
oil  three  times  a  day,  or  he  would  fairly  lay  himself  open  to  a  sus- 
picion of  criminality.  If  pregnancy — a  frequent  cause  of  obstructed 
menstruation — were  only  suspected,  this  would  be  sufficient  to  deter 
a  practitioner  of  common  prudence  from  prescribing,  in  any  dose,  a 
drug  which  may  exert  a  serious  action  on  the  uterine  system.  (A 
report  of  the  case  of  Mr.  Pascoe  will  be  found  in  the  "  Med.  Times 
and  Gazette,"  April  17,  1852,  p.  404.) 

The  oil  of  savin  is  obtained  by  the  distillation  of  the  tops  in  the 
proportion  of  about  3  per  cent,  by  weight.  It  has  a  yellowish  color, 
and  the  peculiar  terebinthinate  odor  of  the  plant,  by  which  alone  it 
may  be  recognized.  It  may  be  separated  from  the  contents  of  the 
stomach  by  agitating  them  in  a  bottle  with  its  volume  of  ether,  in 
which  the  oil  is  very  soluble.  The  ether  may  be  afterwards  removed 
by  distillation.  The  oil  of  savin  forms  a  turbid  mixture  with  alcohol 
(.826).  When  treated  with  its  volume  of  sulphuric  acid,  it  acquires 
a  dark-brown  color,  and  when  this  mixture  is  added  to  distilled 
water,  a  dense  white  precipitate  is  separated.  The  odor  is  the  best 
test. 

Oil  of  Tansy. — Dr.  Hartshorne,  an  American  physician,  states  that 
in  the  United  States  the  oil  of  tansy  (Tanacetum  vulgare)  has  acquired 
the  character  of  a  popular  abortive,  and  caused  death  in  several  in- 
stances. In  England  this  oil  and  the  herb  have  been  chiefly  em- 
ployed for  the  purpose  of  expelling  worms.  Dr.  Pereira  quotes  a 
case  in  which  half  an  ounce  of  the  oil  proved  fatal.  The  symptoms 
were  spasms,  with  convulsive  movements  and  impeded  respiration ; 
no  inflammation  of  the  stomach  or  bowels  was  discovered  upon 
dissection.  ("Mat.  Med."  vol.  2,  pt.  2,  p.  26.)  The  cases  referred 
to  by  Dr.  Hartshorne  are — -1.  A  teaspoonful  of  the  volatile  oil  was 
taken  by  a  girl  in  mistake  for  the  essence.  She  complained  of 
giddiness,  and  became  insensible  in  ten  minutes :  convulsions  came 
on,  with  frothing  at  the  mouth,  difficult  respiration,  and  irregular 
pulse,  and  she  died  in  one  hour  after  taking  the  oil.  ("  Amer.  Jour. 
Med.  Sci."  July,  1852,  p.  279.)  2.  The  second  case  occurred  to  Dr. 
Dalton,  and  is  reported  by  him  in  the  same  journal  for  January,  1852, 
p.  186.  A  healthy-looking  girl,  ast.  21,  took  eleven  drachms  of  oil 
of  tansy  about  six  hours  after  a  hearty  dinner.  She  was  found 
insensible^  and  in  convulsions  soon  after  she  had  taken  the  drug. 
She  died  in  three  hours  and  a  half.  A  strong  odor  of  tansy  was 
observed  in  the  breath  before  death,  and  on  inspection  in  the  perito- 
neal cavity,  stomach,  and  even  the  interior  of  the  heart.  The  uterus 
contained  a  well-formed  foetus  about  four  mouths  old,  which  did  not, 
either  in  itself  or  its  membranes,  present  any  evidence  of  having 
been  disturbed.     3.  In  a  third  case  (reported  in  "Amer.  Jour.  Mod. 


SAFFRON.      MINERAL    IRRITANTS.  455 

Sci."  for  May,  1835)  a  woman  but  a  few  weeks  pregnant,  took  half 
an  ounce  of  the  oil ;  she  did  not  entirely  lose  her  consciousness 
until  three-quarters  of  an  hour  had  elapsed,  although  she  was  con- 
vulsed at  intervals  before  that  time.  She  died,  without  abortion 
being  produced,  within  two  hours  after  taking  the  poison.  (For 
another  case  see  "  Med.  Times  and  Gazette,"  April  13,  1861.)  These 
facts  show,  that  while  oil  of  tansy  possesses  no  specific  action  on  the 
uterus  as  an  abortive,  and  does  not  even  affect  this  organ  or  its  con- 
tents by  sympathy,  it  is  capable  of  acting  as  a  powerful  poison  on 
the  brain  and  nervous  system,  and  of  destroying  life  rapidly.  The 
oil  would  be  easily  recognized,  either  before  or  after  distillation  of 
the  contents  of  the  stomach,  by  its  peculiar  and  penetrating  odor. 
It  is  very  soluble  in  ether,  and  this  may  be  employed  for  its  sepa- 
ration. 

Saffron,  a  decoction  of  the  dried  stigmas  of  saffron  {Crocus  sativus), 
has  been  employed  as  a  popular  abortive.  Dr.  Thomsen  of  Schles- 
wig  has  reported  a  case  in  which  abortion  occurred  in  a  woman  who 
had  taken  repeated  doses  of  a  decoction  of  saffron  with  starch. 
There  was  reason  to  believe,  however,  that  manipulations  per  vagi- 
nam  had  also  been  resorted  to,  and  these  may  have  had  the  principal 
share  in  bringing  about  the  result.  (Horn's  "  Vierteljahrschrift," 
Oct.  1864,  p.  315.)  According  to  Pereira,  although  saffron  was 
formerly  used  as  an  emmenagogue  and  to  promote  uterine  contrac- 
tions, it  is  not  established  by  any  trustworthy  observations  that  it 
possesses  any  medicinal  properties.  ("Mat.  Med."  vol.  2,  pt.  1,  p. 
219.)  In  modern  medicine  its  chief  use  is  to  give  color  and  flavor 
to  liquids.  It  has  been  observed,  that  when  administered  to  preg- 
nant women,  the  yellow  coloring-matter  has  been  absorbed,  and  the 
foetus  in  utero  has  been  stained  by  it.  This  appearance  in  the  body 
of  the  foetus  might  lead  to  a  suspicion  of  its  use,  although  no  injury 
to  the  woman  may  have  resulted. 

It  is  remarkable  that  the  action  of  the  most  powerful  mineral 
irritant  poisons  has  sometimes  failed  to  affect  the  gravid  uterus.  In 
July,  1845,  a  case  was  referred  to  me  for  examination  by  Mr.  T. 
Carter,  of  Newbury,  in  which  a  female,  aged  22  years,  who  had 
passed  the  fifth  month  of  pregnancy,  took  a  large  dose  of  arsenic, 
and  died  in  less  than  seven  hours,  having  suffered  from  severe 
vomiting  and  purging  during  that  time :  yet  abortion  did  not  take 
place !  The  effects  of  mineral  substances  upon  the  body  have  been 
fully  described  in  the  section  on  Poisoning.  Among  them,  atten- 
tion may  be  especially  directed  to  the  action  of  muriate  of  iron. 
(See  p.  146.)  In  a  case  tried  at  the  Lincoln  Summer  Assizes,  1863, 
{Beg.  v.  Rumble),  the  prisoner,  a  druggist,  was  convicted  of  supply- 
ing this  compound  for  the  purpose  of  procuring  the  abortion  of  a 
pregnant  woman.  It  had  not  that  effect,  but  it  very  seriously  in- 
jured her  health:  the  prisoner  also  gave  cantharides  in  pills.  In 
reference  to  the  medicinal  use  of  mercury,  it  may  be  proper  to  state 
that  Dr.  Solomon  has  reported  two  cases,  in  which  premature  deliv- 
ery appeared  to  follow  the  mercurialization  of  the  system.  (Casper's 
"  \\rochenschrift,"  June,  1845  ;  "  Med.  Gaz."  vol.  36,  p.  ^.) 


456  ABORTION    FROM    LOCAL    APPLICATIONS. 

Local  Applications.  Injections. — In  a  case  which  occurred  in  France, 
it  was  proved  that  abortion  had  been  caused  by  the  injection  of  some 
corrosive  or  irritating  substance  into  the  vagina.  The  female  geni- 
tals, as  well  as  the  abdominal  viscera,  were  found  in  a  high  state  of 
inflammation.  ("  Med.  Gaz."  vol.  37,  p.  171.)  This  is  an  unusual 
mode  of  perpetrating  the  crime,  but  it  is  one  which  can  hardly  es- 
cape detection.  An  analysis  of  the  tissues  might  be  required,  in 
order  to  determine  the  nature  of  the  substance  used.  It  appears 
from  a  trial  which  took  place  at  the  York  Summer  Assizes,  1853, 
that  this  mode  of  attempting  to  produce  criminal  abortion  has  been 
the  subject  of  a  prosecution  in  this  country.  It  was  established  by 
the  evidence  that  some  liquid  was  injected  into  the  vagina  with  a 
syringe,  but  there  was  no  proof  of  the  nature  of  this  liquid ;  and  as 
it  was  not  shown  to  be  of  a  noxious  nature,  the  learned  judge  who 
tried  the  case  directed  an  acquittal.  ("  Lancet,"  July,  23,  1853,  p. 
89.)  If  it  is  essential  that  medical  proof  should  be  given  that  the 
liquid  injected  was  of  a  noxious  nature,  then  a  loop-hole  is  left  for 
the  perpetration  of  the  crime  with  impunity.  I  am  informed  by  an 
obstetric  practitioner  of  experience  that  an  abortion  might  be  in- 
duced by  the  frequent  employment  of  injections  of  water  alone,  and 
that  this  is  occasionally  resorted  to  in  practice,  as  a  safe  and  conve- 
nient mode  of  effecting  it.  Numerous  innocent  liquids  might  be 
substituted  for  water.  The  words  of  the  recent  statute,  however,  by 
"  other  means  whatsoever,"  would  doubtless  be  considered  to  cover 
the  use  of  any  liquid,  whether  noxious  or  innoxious. 

In  general,  when  the  criminal  means  taken  to  procure  abortion 
are  effectual  in  causing  the  expulsion  of  the  child,  it  comes  into  the 
world  dead ;  but  it  may  be  born  alive  and  die  after  its  birth.  Under 
these  circumstances,  although  no  violence  is  applied  directly  to  the 
body  of  the  child,  but  its  death  is  simply  the  result  of  immaturity 
or  the  feeble  state  in  which  it  was  born,  the  person  causing  such 
abortion  might  render  himself  liable  to  an  indictment  for  murder. 

Signs  of  Abortion  in  the  Living  and  Dead. — These  have  been  al- 
ready considered  in  a  previous  chapter.  (See  "Delivery,"  ante,  pp. 
430  and  437.)  The  examination  may  extend  to  the  woman  either 
living  or  dead.  In  the  former  case  there  will  be  some  difficulty,  if 
the  abortion  has  occurred  at  an  early  period  of  gestation,  and  seve- 
ral days  have  elapsed  before  the  examination  is  made  ;  in  the  latter 
case  the  investigation  is  not  always  free  from  difficulty.  One  fact 
here  requires  to  be  especially  noticed.  It  is  believed  by  many 
physiologists  that  menstruation  is  a  state  in  some  measure  vicarious 
to  conception,  and  the  appearances  presented  by  the  generative  organs 
during  the  menstrual  period,  are  somewhat  similar  to  those  which 
are  observed  after  conception  in  its  early  stage.  Mr.  Whitehead 
remarks,  that  in  persons  who  have  died  while  the  menses  were  flow- 
ing, the  uterine  walls  were  thickened  and  spongy,  and  the  mucous 
lining  was  more  or  less  swollen  and  suffused.  The  neck  and  lips  of 
the  uterus  were  swollen,  the  orifice  was  open,  and  the  vaginal  mem- 
brane and  clitoris  involved  in  the  increased  action.  One  of  the 
ovaries  was  found  larger  and  more  congested  than  ordinarily,  pre- 


APPEARANCES    IN    THE    BODY.  457 

senting  evidences  of  tlie  recent  escape  of  an  ovum.  ("  On  Abor- 
tion," p.  196.)  Unless  these  facts  are  attended  to,  an  examiner  may 
form  an  erroneous  opinion  respecting  the  chastity  of  a  deceased 
female.  For  some  remarks  on  the  mode  of  conducting  the  exami- 
nation of  the  woman,  and  of  the  embryo  or  foetus  in  cases  of  abor- 
tion, see  "  Annales  d'Hygiene"  for  1856  (vol.  1,  pp.  149  and  153). 

Important  questions  may  arise  when  it  is  alleged  that  abortion 
has  been  caused  by  the  use  of  instruments,  and  death  is  referred  to 
peritonitis  as  the  result  of  their  employment.  In  these  cases  a 
medical  opinion  should  not  be  based  upon  the  statements  either  of 
the  female  or  of  her  friends,  but  upon  some  distinct  and  satisfactory 
medical  proofs  that  mechanical  violence  has  been  done  to  the  uterus, 
its  contents,  or  its  appendages.  Peritonitis,  or  inflammation  of  the 
lining  membrane  of  the  abdomen,  may  arise  from  a  variety  of  causes. 
If  we  assign  it  to  a  particular  cause,  and  thus  implicate  another  in 
a  felonious  cause,  we  should  do  this  only  upon  medical  facts  obtained 
by  an  examination  of  the  dead  body ;  we  should  deal  with  such  cases 
as  if  we  knew  nothing  of  their  history.  In  May,  1863,  I  was  con- 
sulted by  Mr.  Lewis,  coroner  for  Essex,  in  reference  to  the  death  of 
a  woman  named  Susannah  Barker.  It  was  supposed  that  her  death 
had  been  caused  by  attempts  made  to  produce  criminal  abortion.  It 
appeared  that  after  three  days'  illness  deceased  was  taken  in  labor, 
and  was  delivered  of  a  dead  child,  which  was  between  the  sixth  and 
seventh  month  of  uterine  age.  She  died  a  few  hours  afterwards. 
On  an  inspection  of  her  body,  it  was  found  that  the  cause  of  death 
was  peritonitis.  She  had  previously  complained  of  great  pain  in 
her  abdomen,  and  there  was  no  doubt  that  peritonitis  was  developed 
before  she  was  delivered ;  in  fact,  the  peritonitis  appeared  to  be  the 
direct  cause  of  the  abortion.  She  admitted  to  her  medical  attendants 
that  she  had  taken  some  powders  to  cause  miscarriage,  and,  further, 
that  a  person  calling  himself  a  medical  man  had,  about  a  week  be- 
fore, introduced  two  instruments  into  her  body  which  had  caused  her 
great  pain.  Besides  extreme  inflammation  of  the  peritoneum,  which 
was  the  direct  cause  of  death,  the  heart,  lungs,  and  stomach  were 
healthy,  and  the  uterus  presented  no  appearances  excepting  those 
arising  from  recent  delivery ;  it  was  perfectly  natural,  and  free  from 
all  marks  of  injury.  There  was  no  injury  to  the  vagina,  nor  any 
wound  in  the  peritoneum  itself.  There  was  no  mark  of  violence  on 
the  body  of  the  child;  in  short,  this  could  have  sustained  no  injury, 
as  the  membranes  surrounding  it  were  not  ruptured.  The  medical 
gentleman  who  examined  this  case  thought  that  the  fatal  peritonitis 
had  been  caused  by  the  introduction  of  instruments  into  the  vagina, 
and  that  this  might  occur  without  leaving  after  death  any  traces  of 
their  employment.  At  the  same  time  it  was  admitted  that  a  speculum 
used  in  the  ordinary  way  would  not  produce  peritonitis,  and  it  was 
alleged  in  defence  that  a  speculum  only  had  been  used. 

The  connection  of  the  peritonitis  with  the  alleged  manipulations 
of  the  unlicensed  practitioner  rested  more  on  surmise  than  proof. 
The  absence  of  any  bruise,  puncture,  or  laceration  affecting  the 
vagina,  uterus  or  foetus,  with  the  fact  that,  whatever  may  have  been 


458  FEIGNED    ABORTION. 

the  instruments  used,  the  membranes  were  left  entire,  rendered  it 
impossible  to  assign  the  peritonitis  with  absolute  certainty  to  the  acts 
of  the  person  who  was  charged  with  causing  the  death  of  the  woman. 
For  anything  that  appeared  to  the  contrary,  he  might  have  used  a 
speculum,  and  it  is  well  known  that  this  instrument,  although  fre- 
quently introduced  into  the  vagina,  does  not  cause  peritonitis.  The 
connection  of  the  peritonitis  with  instrumental  violence,  therefore, 
was  not  in  this  case  established,  and  the  jury  by  their  verdict  dis- 
charged the  suspected  person.  They  could  not  have  done  otherwise, 
lor  there  was  not  the  slightest  medical  proof  that  any  instrument  had 
been  introduced  into  the  vagina  with  a  felonious  intention. 

Feigned  Abortion. — For  various  motives,  into  the  consideration  of 
which  it  is  here  unnecessary  to  enter,  a  woman  may  charge  another 
with  having  attempted  or  perpetrated  a  crime  of  abortion.  Such  a 
charge  is  not  common,  because,  if  untrue,  its  falsity  may  be  easily 
demonstrated.  A  young  woman,  admitted  into  Guy's  Hospital  in 
April,  1846,  charged  a  policeman  (who,  according  to  her  statement, 
had  had  forcible  intercourse  with  her)  with  having  given  her  some 
substance  to  produce  abortion,  and  with  having  subsequently  effected 
this  mechanically.  She  was  not  examined  until  nearly  two  months 
after  the  alleged  perpetration  of  the  crime,  when  the  late  Dr.  Lever 
found  that  there  was  no  reason  to  believe  she  had  ever  been  preg- 
nant. This  was  a  case  of  feigned  abortion.  When  charges  of  this 
serious  kind  are  brought  forward,  they  are  always  open  to  the 
greatest  suspicion,  unless  made  immediately  after  the  alleged  attempt, 
as  it  is  then  only  that  an  examination  can  determine  whether  they 
are  true  or  false.  If  so  long  delayed,  as  in  this  instance,  without 
any  satisfactory  reason,  the  presumption  is  that  they  are  false. 

Legal  Relations. — [See  "  Eevised  Criminal  Code  of  Pennsylvania."' 
§§  87,  88. — P.]  In  the  statute  for  the  consolidation  of  the  criminal 
law  (24  &  25  Vic,  chap.  100,  ss.  58  &  59),  the  nature  of  this  crime, 
and  the  proofs  required  to  establish  it  have  been  more  explicitly 
stated  than  in  former  acts.  By  clause  58  (on  attempts  to  procure 
abortion),  it  is  enacted  that  "  Every  woman,  being  with  child,  who,  with 
intent  to  procure  her  own  miscarriage,  shall  unlawfully  administer 
to  herself  any  poison  or  other  noxious  thing,  or  shall  unlawfully 
use  any  instrument  or  other  means  whatsoever  with  like  intent,  and 
whosoever,  with  intent  to  procure  miscarriage  of  any  woman,  whe- 
ther she  be  or  be  not  with  child,  shall  unlawfully  administer,  &c,  shall 
be  guilty  of  felony."  Formerly,  women  who  endeavored  to  produce 
abortion  in  themselves  were  not  guilty  of  any  offence  against  the 
law. 

In  Beg.  v.  Warboy  (Cent.  Crim.  Court,  August,  1862),  the  prisoner, 
a  widow,  was  convicted  as  an  accessory  before  the  fact  to  the  feloni- 
ous using  by  one  Morgan  of  a  certain  instrument  upon  herself  with 
intent  thereby  to  produce  miscarriage. 

The  latter  portion  of  clause  58  makes  it  immaterial  whether  the 
woman  Avere  or  were  not  with  child,  in  accordance  with  the  decision 
of  the  judges  in  Reg.  v.  Goodhall  (1  Den.  C.  C.  p.  187),  and  Reg.  v. 
Goodchild  (2  C.  and  K.  p.  293.)     Clause  59  is  to  the  following  effect : 


ABORTION.      LEGAL    RELATIONS.  459 

"Whosoever  shall  unlawfully  supply  or  procure  any  poison  or  other 
noxious  thing,  knowing  that  the  same  is  intended  to  be  unlawfully 
used  or  employed  with  intent  to  procure  the  miscarriage  of  any 
woman,  whether  she  be  or  be  not  with  child,  shall  be  guilty  of  a 
misdemeanor;  and  being  convicted  thereof,  shall  be  liable,  at  the 
discretion  of  the  court,  to  be  kept  in  penal  servitude  for  the  term  of 
three  years,  or  to  be  imprisoned  for  any  term  not  exceeding  two 
years.1'  This  clause  is  intended  to  check  the  obtaining  of  poison, 
&c,  for  the  purpose  of  causing  abortion,  by  making  both  the  person 
who  supplies  and  the  person  who  procures  it  guilty  of  misdemeanor. 
It  will  be  observed,  in  reference  to  these  clauses,  that  the  means 
employed,  whatever  their  nature,  must  have  been  used  with  an  in- 
tent to  procure  the  miscarriage  of  a  woman,  a  point  which  will  be 
sufficiently  established  by  a  plain  medical  statement  of  the  means 
employed.  Supposing  that  a  drug  has  been  used,  the  witness  will 
have  to  state  whether  it  is  "a  poison  or  other  noxious  thing;"  for 
this  must  be  proved  in  order  that  the  prisoner  should  be  convicted 
of  the  crime.  I  must  refer  the  reader  to  what  has  been  said  else- 
where (ante,  p.  65),  in  order  that  he  may  be  able  to  judge  how  far 
the  substance  administered  would  fall  under  the  description  above 
given.  Whether  it  would  or  would  not  have  the  effect  intended,  i.  e. 
of  inducing  abortion,  is  perfectly  immaterial.  Some  uncertainty 
may  exist  as  to  the  strict  meaning  of  the  word  noxious :  all  will 
allow  that  the  word  implies  something  injurious  to  the  system,  but 
a  difference  of  opinion  may  arise  among  medical  witnesses  with  re- 
spect to  its  application  to  the  substance  under  discussion — as,  for 
example,  with  respect  to  rue  or  savin.  (See  p.  448.)  A  substance 
must  be  regarded  as  injurious  to  the  body,  or  noxious,  according  to 
the  form,  quantity,  or  frequency  with  which  it  is  administered. 
Savin,  ergot,  and  rue  are  irritant :  they  become  noxious  when  given 
in  large  doses,  or  in  small  doses  frequently  repeated.  ("  Ann. 
d'Hyg."  1838,  vol.  2,  p.  180.)  Aloes  and  castor  oil  are  innocent 
when  taken  in  small  doses;  but  they  acquire  noxious  or  injurious 
properties  when  administered  frequently,  or  in  large  quantity,  to  a 
pregnant  female.  To  confine  the  term  "noxious,"  therefore,  to 
what  is  strictly  speaking  a  poison  per  se,  would  be  giving  a  latitude 
to  attempts  at  criminal  abortion,  which  would  render  the  law  in- 
operative. (See  the  case  of  Reg.  v.  Stroud,  Abingdon  Sum.  Ass. 
1846.)  The  small  quantity  of  the  substance  taken  at  once  does  not 
affect  the  question,  provided  the  dose  be  frequently  repeated.  A 
case  in  which  I  was  consulted  by  Mr.  Reynolds  (a  former  pupil), 
was  tried  at  the  Exeter  Winter  Assizes,  1844.  Two  powders, 
weighing  each  one  drachm,  were  prescribed  by  the  prisoner :  one 
consisted  of  colocynth,  the  other  of  gamboge,  and  with  them  was 
half  an  ounce  of  a  liquid  (balsam  of  copaiba).  They  were  to  be 
mixed  together,  and  a  fourth  part  to  be  taken  four  mornings  follow- 
ing. Mr.  Reynolds  said,  in  answer  to  the  question  whether  such  a 
mixture  was  noxious  or  injurious,  that  each  dose  would  be  an  active 
purgative,  and  might  thereby  tend  to  produce  abortion.  One  dose 
would  not  be  productive  of  mischief  in  a  healthy  countrywoman, 


460  ABORTION.      NOXIOUS    SUBSTANCES. 

but  its  frequent  repetition  might  lead  to  serious  consequences.  In 
a  trial  which  took  place  at  the  Norwich  Lent  Assizes,  1846  {Reg.  v. 
Whisker),  it  was  proved  that  the  prisoner  had  caused  to  be  taken  by 
the  prosecutrix  a  quantity  of  wh ite  hellebore,  in  powder,  for  the  pur- 
pose  of  procuring  abortion.  One  medical  witness  said  he  considered 
hellebore  to  be  noxious  to  the  system,  but  he  knew  of  no  case  in 
which  it  had  produced  death ;  and  under  these  circumstances  he  did 
not  feel  himself  justified  in  calling  it  a  poison.  Another  medical 
Avitness  stated  that,  in  his  opinion,  it  belonged  to  the  class  of  poi- 
sons. The  judge,  in  summing  up,  told  the  jury  that  that  was  to  be 
regarded  as  a  poisonous  drug  which,  in  common  parlance,  was  gen- 
erally understood  and  taken  to  be  such  ;  and  he  thought  the  evidence 
sufficiently  strong  to  bring  hellebore  within  the  meaning  of  the 
statute.  The  jury  found  the  prisoner  guilty,  alleging  that  in  their 
belief  white  hellebore  was  a  poison.  ("  Med.  Gaz."  vol.  37,  p.  830.) 
The  only  circumstance  calling  for  remark  in  this  case  is,  that  any 
doubt  should  have  been  entertained  by  a  medical  practitioner  re- 
specting the  poisonous  properties  of  white  hellebore.  It  is  a  power- 
ful vegetable  irritant,  and  has  caused  death  in  several  instances  ;  yet 
on  this  occasion  it  appears  to  have  been  admitted  to  be  noxious,  but 
not  poisonous  !  The  nature  of  the  substance  administered,  and  that 
it  is  noxious,  should  be  proved.  No  speculative  evidence  is  favor- 
ably received  when  some  portion  of  the  substance  cannot  be  pro- 
cured. In  Reg.  v.  Taylor  (Exeter  Winter  Ass.,  1859)  some  powders 
had  been  given  by  the  prisoner  to  a  girl  with  the  view  of  inducing 
abortion.  No  portion  of  the  powders  could  be  obtained  for  exami- 
nation :  but  two  medical  gentlemen  who  heard  the  evidence  gave 
their  opinion  that  the  powders  were  of  a  noxious  nature.  In  the 
defence,  it  was  urged  that  this  had  not  been  proved.  The  jury 
adopted  this  view,  and  returned  a  verdict  of  acquittal. 

In  reference  to  the  proof  of  this  crime,  it  is  not  required,  under 
the  circumstances,  that  any  specific  injury  should  have  been  done  to 
the  woman,  or  that  abortion  should  have  followed  in  order  to  com- 
plete the  offence.  There  is  every  reason  to  believe  that  the  crime 
is  frequent,  but  its  perpetration  is  secret.  Applications  are  continu- 
ally made  to  druggists  by  the  lower  class  of  people  for  drugs  for 
this  purpose :  the  applicants  appear  to  have  no  idea  of  the  criminality 
of  the  act.  (See,  in  reference  to  the  frequency  of  this  crime,  a  paper 
in  the  "Medical  Gazette,"  vol.  46,  p.  487;  also  "Med.  Times  and 
Gaz.1'  Nov.  21,  1857,  pp.  524,  537.) 

[The  frightful  frequency  of  intentional  abortion  in  this  country 
has  long  been  notorious,  no  less  than  the  extraordinary  ignorance  as 
to  its  criminality,  even  among  well-educated  persons.  The  recent 
a1  ilc  efforts  of  Profs.  Storer,  Hodge,  and  others,  especially  of  Dr. 
Storer,  with  the  formal  action  of  the  American  Medical  Association 
(;'  Trans.,"  xii.  p.  75)  will  do  much  towards  effecting  a  much  needed 
reformation  of  public  opinion,  as  well  as  of  legal  practice,  in  this 
matter.  Dr.  Storer  (in  chap.  vii.  of  his  series  of  articles  on  Criminal 
Abortion,  published  in  vol.  iii.  1859,  of  the  "N.  A.  Med.-Chir.  Rev." 
oi'  Philada.)  gives  a  complete  and  comprehensive  exhibit  of  the  laws 


CRIMINAL    ABORTION.      JUDICIAL    DECISIONS.  461 

of  each  of  the  United  States  and  of  the  ruling  decisions  in  relation 
to  criminal  abortion.  His  concluding  summary  is  sufficiently  impor- 
tant to  justify  our  quoting  it  in  full,  at  the  same  time  that  we  must 
refer  to  the  previous  pages  of  the  same  paper  for  a  minute  and  well 
arranged  statement  of  the  statutory  and  judicial  practice  in  each  of 
the  individual  States. 

"The  destruction  of  an  unborn  child  is  not  at  the  present  day 
murder  at  the  common  law,  though  such  was  formerly  the  case  (1 
Eussell,  'Crimes,'  671;  1  Vesey,  86;  3  Coke,  'Inst.,'  50;  1  Hawkins, 
C.  B.,  s.  16;  1  Hale,  434;  1  East,  P.  C,  90;  3  Chitty,  '  Crim.  Law,' 
798 ;  Wharton,  '  Crim.  Law,'  537) ;  to  constitute  which  crime,  the 
person  killed  must  at  the  time  of  death  have  been  alive  (Davis, 
'  Crim.  Justice.'  486),  as  we  have  shown  the  foetus  to  be  from  the 
time  of  conception,  and  '  a  reasonable  creature  in  being'  (Archbold, 
'  Crim.  Pleading,'  490) ;  a  quality  in  this  connection  denied  to  the 
child  by  the  law,  though  in  all  other  relations  it  inconsistently  allows 
and  affirms  it ;  as  it  does  also,  and  always,  from  the  moment  of  birth, 
even  though  the  funis  is  undivided  and  the  placenta  still  attached. 
(Regina  v.  Trilbe,  2  Moody,  C.  C,  260,  413.) 

"  To  cause  abortion  after  quickening  is  not,  as  such,  murder  or 
manslaughter  at  common  law,  but  a  high  misdemeanor.  (The  /State 
v.  Cooper,  2  Zabriskie,  52 ;  Hanes,  '  U.  S.  Digest,'  5.) 

"  Whether  to  cause,  or  to  attempt,  abortion  before  quickening  is 
a  penal  offence  at  common  law,  has  been  differently  decided.  In 
several  of  the  States,  as  Maine,  Massachusetts,  and  New  Jersey,  it 
has  been  ruled  by  the  Supreme  Court  not  to  be  indictable,  even  as 
an  assault,  if  done  with  the  consent  of  the  woman ;  on  the  ground 
that  only  in  case  of  high  crimes  is  the  person  assaulted  incapable  of 
assenting.  (The  Commonwealth  v.  Parker,  9  Metcalf,  263 ;  The  Com- 
monwealth v.  Bangs,  9  Mass.,  387 ;  The  State  v.  Cooper,  2  Zabriskie, 
57  ;  Hanes,  '  U.  S.  Digest,'  5 ;  Smith  v.  State,  33  Maine  (3  Bed.),  48.) 
The  Pennsylvania  court,  however,  has  discarded  this  doctrine,  and 
lias  decided  that  the  moment  the  womb  is  instinct  with  embryo  life, 
and  gestation  has  begun,  the  crime  may  be  perpetrated.  (Bishop,. 
'  Crim.  Law,'  386 ;  Mills  v.  The  Commoniv.,  1  Harris,  Pa.,  631,  633.) 

"  The  distinction  alluded  to  with  regard  to  quickening,  is  allowed 
by  an  acknowledged  legal  authority  (Wharton,  '  Crim.  Law  of  the 
U.  S.,'  537)  to  be  at  open  variance  not  only  with  medical  experience 
but  with  all  other  principles  of  the  common  law.  (1  Russel,  '  Crimes,' 
661;  1  Vesey,  86;  3  Coke,  'Inst.,'  50;  1  Hawkins,  e.  13,  s.  16; 
Bracton,  i.  3,  c.  21.)  The  civil  rights  of  an  infant  in  utero  are  respected 
equally  throughout  gestation ;  at  every  stage  of  which  process, 
no  matter  how  early,  it  may  be  appointed  executor  ('  Bac.  Ab.,'  tit. 
Infants),  is  capable  of  taking  as  legatee  (2  Vernon,  710),  or  under  a 
marriage  settlement  (Doe  v.  Clark,  2  II.  Bl.,  399 ;  2  Vesey,  jr.,  673 ; 
Thellussonr.  Woot/ford,  4  Vesey,  340 ;  Swift  v.  Dvffield,  6  Serg.  & 
Rawle,  38),  may  take  specifically  as  '  a  child'  under  a  general  de- 
vise (Fearne,  4'29),  and  may  obtain  an  injunction  to  stay  waste.  (2 
Vernon,  710;  rThe  Commonwealth  v.  Demain,  6  'Penn.  Law  Juurn.,' 
29  ;  Brightly,  441.) 


462  CRIMINAL    ABORTION.      JUDICIAL    DECISIONS. 

"  When,  in  an  attempt  to  procure  an  abortion,  there  is  an  evident 
intent  to  produce  the  death  of  the  mother,  and  her  death  does  actu- 
ally occur,  such  attempt  becomes  murder  at  common  law.  (1  Hale, 
90;  The  Gominonw.v.  Chauncey,  1  Ashmead,  227;  Smith  v.  State,  33 
Maine  (3  Eed.),  48);  but  when  nothing  more  is  intended  than  to 
commit  the  misdemeanor,  it  is  only  manslaughter  (Ibid.;  Hanes, 
'  U.  S.  Digest,'  5\  being  an  instance  of  homicide  from  individual 
malice  toward  a  third  party,  when  the  fatal  blow  falls  on  the  deceased 
by  mistake.  It  has  been  said,  however,  that  this  last  is  not  the  true 
d<  n-trine,  the  destruction  of  an  infant  in  utero  being,  even  at  common 
law,  in  some  respects  felonious,  and  the  act  in  its  nature  malicious 
and  deliberate,  and  necessarily  attended  with  danger  to  the  person 
on  whom  it  is  performed.     ("Wharton,  '  Law  of  Homicide,'  44.) 

"  The  use  of  violence  upon  a  woman,  with  an  attempt  to  produce 
her  miscarriage  without  her  consent,  rules  Chief  Justice  Shaw  of 
Massachusetts,  is  an  assault  highly  aggravated  by  such  wicked  pur- 
pose, and  would  be  indictable  at  common  law.  So  where,  upon  a 
similar  attempt,  the  death  of  the  mother  ensues,  the  party  making 
such  an  attempt,  with  or  without  her  consent,  is  guilty  of  murder, 
on  the  ground  that  it  is  an  act  done  without  lawful  purpose,  danger- 
ous to  life,  and  that  the  consent  of  the  woman  cannot  take  away  the 
imputation  of  malice,  any  more  than  in  case  of  a  duel,  where  in  like 
manner  there  is  the  consent  of  the  parties.  (The  Commonw.  v.  Par- 
ker, 9  Metcalf,  263,  265;  Davis,  '  Crim.  Jus.,'  281.) 

"  Though  to  kill  the  foetus  in  utero  is  as  such,  by  the  common  law, 
no  murder,  yet  if  it  be  born  alive,  and  die  subsequently  to  birth  from 
the  wounds  it  received  in  the  womb,  or  from  the  means  used  to  expel 
it,  the  offence  becomes  murder  in  those  who  cause  or  emplov  them. 
(1  Blackstone,  129;  Rex  v.  Senior,  1  Moody,  C.  C,  346;  3  Inst.,  50; 
Wharton,  C.  L.,  537;  Ibid.,  'Law  of  Homicide,'  93.)  If  a  person,  in- 
tending to  procure  abortion,  does  an  act  which  causes  the  child  to 
be  born  earlier  than  its  natural  time,  and  therefore  in  a  state  much 
less  capable  of  living,  and  it  afterwards  die  in  consequence  of  such 
premature  exposure,  the  person  who  by  this  misconduct  brings  the 
child  into  the  world,  and  puts  it  into  a  situation  in  which  it  cannot 
live,  is  guilty  of  murder,  though  no  direct  injury  to  the  child  be 
proved ;  and  the  mere  existence  of  a  possibility  that  something  might 
have  been  done  to  prevent  the  death,  does  not  lessen  the  crime.  (Rex 
v.  West,  2  Carr.  &  Kir.,  784  ;  1  Bishop,  C.  L.,  255 ;  Wharton,  '  Law 
oi  Homicide,'  93.) 

"The  earlier  English  statutes,  from  their  peculiar  phraseology, 
held  pregnancy  essential  for  the  commission  of  the  crime  (Rex  v. 
Scudder,  1  Moody,  216  ;  3  Car.  &  P.,  605  ;  overruling  Rex  v.  Phillips, 
3  Campbell,  73 ;  Russell,  Cr.,  763,  note) ;  yet  an  attempt  to  produce 
abortion  is  now  indictable  at  common  law  "(if  made  without  her  con- 
sent?) though  it  fail  by  reason  of  the  woman  being,  in  fact,  and 
contrary  to  the  belief  of  the  party,  not  pregnant.  (Regina  v.  Oood- 
child,  2  Car.  &  Kir.,  293;  Rex  v.  Goodhall,  1  Den.,  C.  C,  187;  3 
Campbell,  76.)  For  though  as  no  man  would  attempt  what  he  abso- 
lutely knew  he  could  not  in  fact  perform,  nor  would  be  deemed  in 


CRIMINAL    ABORTION.      JUDICIAL    DECISIONS.  463 

law  to  have  so  attempted,  and  as  every  one  being  conclusively  pre- 
sumed to  understand  the  law,  no  man  can  legally  intend  what  is 
legally  impossible,  the  rule  as  to  facts  is  different;  for  men  are  not 
conclusively  held  by  the  law  to  know  facts.  And  if  a  man  fails  in 
what  he  undertakes,  because  of  an  impossibility  in  fact,  which  he 
did  not  know,  he  is  just  as  answerable  as  if  the  failure  were  from 
any  other  cause.     (1  Bishop,  '  Crim.  Law,'  518.) 

"  We  have  seen  the  mistaken  basis,  as  regards  the  criminalty  of 
abortion,  on  which  the  common  law  is  founded,  and  that  while  it 
recognizes  the  distinct  existence  of  the  foetus  for  civil  purposes,  it 
here  considers  its  being  as  totally  engrossed  in  that  of  the  mother. 

"  A  recent  authority  thus  accounts  for  and  defends  the  mistake. 
The  wealth  and  prosperity  of  the  country,  it  is  assumed,  and  the 
growth  and  efficiency  of  its  population,  are  alike  matters  of  general 
concern,  and  therefore  the  law  takes  them  under  its  care.  As  to 
population,  there  are  in  civil  jurisprudence  such  rules,  as  that  the 
husband  may  hold  the  lands  of  his  deceased  wife  during  his  life,  if 
before  her  death  a  living  child  was  born,  but  not  otherwise ;  the  law 
thus  offering,  in  effect,  a  reward  for  issue.  It  does  not  compel  ma- 
trimony, because  that  would  be  an  infringement  of  private  rights ; 
but  for  the  same  end,  it  does  punish  abortions.  (Bishop,  '  Crim. 
Law,'  385.) 

"  Another  writer  has  also  implied  that  the  common  law,  in  making 
foeticide  penal,  had  in  view  the  great  mischiefs  which  would  result 
from  even  its  qualified  toleration;  namely,  the  removal  of  the  chief 
restraint  upon  illicit  intercourse,  and  the  shocks  which  would  be  sus- 
tained thereby  by  the  institution  of  marriage  and  its  incidents ; 
among  which  the  delicacy  of  women.  (Wharton,  '  Crim.  Law,'  541.) 

"  In  unison  with  these  opinions,  Judge  Coulter,  of  Pennsylvania, 
has  ruled,  that  '  it  is  not  the  murder  of  a  living  child  which  consti- 
tutes the  offence,  but  the  destruction  of  gestation.'  (1  Harris,  Pa., 
631,  633.) 

"  If  our  previous  assumptions  of  the  actual  character  of  criminal 
abortion  be  granted,  and  we  believe  that  they  have  been  proved  to  a 
demonstration,  it  must  follow  from  the  subsequent  remarks,  that  the 
common  law,  Doth  in  theory  and  in  practice,  is  insufficient  to  control 
the  crime ;  that  in  many  States  of  this  Union,  the  statutory  laws  do 
not  recognize  its  true  nature ;  that  they  draw  unwarrantable  dis- 
tinctions of  guilt;  that  they  are  not  sufficiently  comprehensive, 
directly  allowing  many  criminals  to  escape,  permitting  unconsum- 
mated  attempts,  and  improperly  discriminating  between  the  measures 
employed  ;  that  they  require  proofs  often  unnecessary  or  impossible 
to  afford  ;  that  they  neglect  to  establish  a  standard  of  justification, 
and  thereby  sanction  many  clear  instances  of  the  crime ;  that  by  a 
system  of  punishments  wholly  incommensurate  with  those  inflicted 
for  all  other  offences  whatsoever,  they  thus  encourage  instead  of 
preventing  its  increase ;  and  that  in  many  respects  they  are  at  va- 
riance, not  merely  with  equity  and  abstract  justice,  but  with  the 
fundamental  principles  of  law  itself."  ''Contributions  to  Obstetric 
Jurisprudence."     By  Horatio  R.  Storer,  M.  D.,  of  Boston.     "Crimi- 


464      PREMATURE    LABOR.      MEDICAL    RESPONSIBILITY. 

nal  Abortion,"  part  vii.,  from  "  N.  Am.  Med.-Chir.  Eev."  vol.  iii.,  No. 
5,  Sept.  1859,  pp.  851  to  854.  See  also  the  other  five  numbers  of 
vol.  iii.  of  the  same  journal  for  the  remainder  of  this  excellent  series 
of  papers  on  the  subject. — H.] 

On  Inducing  Premature  Labor.  Medical  Responsibility. — It  may  be 
proper  to  offer  her  a  few  remarks  upon  the  common  practice  of  in- 
ducing premature  labor ;  in  certain  cases  of  disease,  of  deformity  of 
the  pelvis,  and  in  cases  of  excessive  vomiting  from  pregnancy.  This 
practice  has  been  condemned  as  immoral  and  illegal ;  but  it  is  im- 
possible to  admit  that  there  can  be  any  immorality  in  performing 
an  operation  to  give  a  chance  of  saving  the  life  of  a  woman,  when, 
by  neglecting  to  perform  it,  it  is  almost  certain  that  both  herself 
and  the  child  will  perish.  (See,  on  the  morality,  safety,  and  utility 
of  the  practice,  Kamsbotham's  "  Obstet.  Med."  p.  315.)  The  ques- 
tion respecting  its  illegality  cannot  be  entertained ;  for  the  means 
are  administered  or  applied  with  the  bona  fide  hope  of  benefiting 
the  female,  and  not  with  any  criminal  design.  It  is  true  that  the 
law  makes  no  exception  in  favor  of  medical  men  who  adopt  this 
practice,  nor  does  it  in  the  Statute  on  wounding  make  any  exceptions 
in  favor  of  surgical  operations ;  but  that  which  is  performed  with- 
out evil  intention  would  not  be  held  to  be  unlawful.  The  necessity 
for  the  practice  ought  to  be  apparent :  thus,  for  instance,  it  should 
be  shown  that  delivery  was  not  likely  to  take  place  naturally,  with- 
out seriously  endangering  the  life  of  a  woman.  It  is  questionable 
whether,  under  any  circumstances,  it  would  be  justifiable  to  bring 
on  premature  expulsion,  merely  for  the  purpose  of  attempting  to 
save  the  life  of  a  child,  since  the  operation,  unless  performed  with 
care,  is  accompanied  with  risk  to  the  life  of  the  mother.  The 
grounds  upon  which  many  eminent  authorities  have  objected  to  this 
practice  are:  1.  That  there  are  few  cases  in  which  parturition,  if 
left  to  itself,  might  not  take  place  at  the  full  period;  2.  The  tolera- 
tion of  the  practice  would  lead  to  great  criminal  abuse ;  3.  It  is 
attended  with  danger  to  the  mother  and  child.  It  is  undoubtcdlv 
true  that  parturition  will  sometimes  take  place  safely  at  the  full 
time,  even  when  the  deformity  of  the  pelvis  is  apparently  so  great 
as  to  lead  many  accoucheurs  to  suppose  natural  delivery  to  be 
utterly  impossible.  Dr.  Lilburn  has  reported  the  case  of  a  woman 
who  labored  under  great  deformity  of  the  pelvis,  but  who  was  twice 
delivered  in  safety,  and  the  child  survived.  ("Med.  Gaz."  vol.  19, 
p.  933.)  It  is  therefore  not  improbable  that  many  cases  of  the  kind 
are  prematurely  treated,  which  if  left  to  themselves,  would  probably 
do  well  without  interference.  Hence  a  cautious  selection  should  be 
made,  because  the  operation  is  necessarily  attended  with  some  risk 
to  the  woman  and  child.  All  that  we  can  say  is,  that,  according  to 
general  professional  experience  it  places  her  in  a  better  position 
than  she  would  be  in  if  the  case  were  left  to  itself.  It  appears  to 
me  that  before  a  practitioner  resolves  upon  performing  an  operation 
of  this  kind  he  should  hold  a  consultation  with  others ;  and,  before 
it  is  performed,  he  should  feel  well  assured  that  natural  delivery 
cannot  take  place  without  greater  risk  to  the  life  of  the  mother  than 


CHEMICAL    EVIDENCE.      BLOOD    STAINS.  465 

the  operation  itself  would  create.  These  rules  may  not  be  observed 
in  practice :  but  the  non-observance  of  them  is  necessarily  attended 
with  some  responsibility  to  a  practitioner.  In  the  event  of  the  death 
of  the  mother  or  child,  he  exposes  himself  to  a  prosecution  for  a 
criminal  offence,  from  the  imputation  of  which  even  an  acquittal 
will  not  always  clear  him  in  the  eyes  of  the  public.  If  the  child 
were  born  alive,  and  died  merely  as  a  result  of  its  immaturity,  this 
might  give  rise  to  a  charge  of  manslaughter.  Within  a  recent 
period  several  practitioners  have  been  tried  upon  charges  of  criminal 
abortion — whether  justly  or  unjustly  it  is  not  necessary  to  consider ; 
but  they  had  obviously  neglected  to  adopt  those  simple  measures  of 
prudence,  the  observance  of  which  would  have  been  at  once  an 
answer  to  a  criminal  charge.  Because  one  practitioner  may  have 
frequently  and  successfully  induced  premature  labor,  without  ob- 
serving these  rules,  and  without  any  imputation  on  his  character, 
this  cannot  shield  another  who  may  be  less  fortunately  situated. 
A  charge  is  only  likely  to  arise  when  a  man  has  been  unfortunate, 
and  the  responsibility  of  one  operator  cannot  be  measured  by  the 
success  of  others. 

Proof  of  pregnancy  is  not  essential  to  the  crime  of  abortion. 
The  attempt  on  a  woman  proved  not  to  be  pregnant,  involves  a 
person  in  equal  responsibility.  So  if  the  body  expelled  is  a  monster, 
an  extra-uterine  conception  or  a  blighted  foetus  (a  mole)  the  crime 
of  abortion  is  as  complete  as  if  the  woman  was  delivered  of  a  child. 
It  will  be  observed  that  in  the  statute  the  word  miscarriage  is  used. 
In  a  popular  sense  (and  here  a  popular  appears  to  have  been  pur- 
posely selected  in  preference  to  a  medical  term),  miscarriage  signifies 
the  violent  expulsion  not  merely  of  a  child  but  ot  moles  and  other 
diseased  growths,  or  even  of  coagula  of  blood.  In  these  last- 
mentioned  cases,  the  woman  is  not  actually  pregnant  although  she 
and  the  accused  may  imagine  that  she  is.  But  whether  the  uterus 
contains  these  morbid  growths,  or  whether  the  organ  is  in  the  virgin 
state,  the  person  who  has  used  the  means  with  intent  may  still  be 
convicted  of  an  attempt  to  procure  abortion. 

Clbemical  Evidence.  Blood  in  Abortion.  Liquor  Amnii. — In  the 
event  of  an  abortion  having  taken  place,  stains  produced  by  blood 
or  by  the  waters  (liquor  amnii)  may  be  found  on  the  linen  of  a  wo- 
man, and  a  practitioner  may  be  required  to  say  whether  these  stains 
are  of  a  nature  to  throw  any  light  upon  the  perpetration  of  the  crime. 
A  woman  who  has  aborted  may  allege  that  the  stains  are  those  of 
the  menstrual  discharge.  Speaking  generally,  there  is  no  practical 
distinction  between  menstrual  and  other  blood.  The  menstrual 
blood  contains  less  fibrin,  is  commonly  acid  and  watery  from  admix- 
ture with  the  mucous  discharges,  and  when  examined  by  the  micro- 
scope it  presents  epithelial  scales,  or  cells  derived  from  the  mucous 
membrane.  These  scales  or  cells  belong  to  the  columnar  variety. 
Not  much  reliance  can  be  placed  upon  their  discovery,  since  the 
mucous  membrane  of  the  organs  of  respiration  is  lined  with  similar 
cells.  Hence  expectorated  blood  might  be  mistaken  for  menstrual. 
Cells  of  a  similar  shape  line  the  whole  of  the  mucous  membrane  from 
30 


466  CHILD-MURDER.      NATURE    OF    THE    CRIME. 

the  stomach  to  the  anus.  The  blood  of  piles  might  thus  be  con- 
founded with  menstrual  blood.  The  blood  discharged  in  abortion 
will  present  the  usual  characters  of  blood  elsewhere  described;  but 
it  may  be  diluted  by  the  waters  simultaneously  discharged  (p.  239). 
This  question  received  the  special  attention  of  the  French  Academy 
a  few  years  since  in  reference  to  the  crime  of  abortion;  and  the 
report  made  was  to  the  effect  that  in  the  present  state  of  science  there 
was  no  certain  method  by  which  the  blood  of  menstruation  could  be 
practically  distinguished  from  the  blood  discharged  in  a  case  of 
abortion  or  infanticide  ("Ann.  d'Hyg.,"  1846,  vol.  i.  p.  181.)  In  a 
more  recent  case,  MM.  Devergie  and  Chevallier  were  required  to  state 
whether  certain  stains  on  the  dress  of  a  woman,  supposed  to  have 
aborted,  were  or  were  not  caused  by  the  waters  (liquor  amnii).  A 
chemical  analysis  merely  revealed  the  presence  of  an  albuminous 
liquid.  The  most  elaborate  experiments  satisfied  the  reporters  that 
neither  by  the  odor,  nor  by  any  other  process,  could  the  liquor  amnii, 
dried  on  linen,  be  identified.  See  "  Ann.  d'Hyg.,"  1852,  vol.  2,  p. 
414.)  It  may,  however,  be  of  importance  to  observe  that  this  liquid 
slightly  discolors  and  stiffens  the  fibre  of  the  stuff  on  which  it  has 
been  effused,  and  that  it  can  be  readily  extracted  by  cold  water.  The 
solution  possesses  all  the  properties  of  albumen.  The  amount  of 
albumen  contained'in  the  liquor  amnii  decreases  as  gestation  advances. 
At  the  fourth  month  it  forms  10.77  per  cent,  of  the  liquid ;  at  the 
fifth  month  7.67  ;  at  the  sixth  month  6.67  ;  and  at  the  ninth  month 
only  0.82.  M.  Chevalher's  experiments  show  that  the  amniotic  liquid 
has  all  the  usual  chemical  properties  of  a  very  diluted  solution  of 
albumen  ("  Ann.  d'Hyg.,"  1856,  vol.  i.  p.  156). 


INFANTICIDE. 


CHAPTER    XLIV. 

Nature  of  the  crime.— medical  evidence  at  inquests — uterine 
age  or  maturity  of  the  child. — characters  of  the  child 
from  the  sixth  to  the  ninth  month. — signs  of  maturity. — 
rules  for  inspecting  the  body. 

By  infanticide,  we  are  to  understand  in  medical  jurisprudence  the 
murder  of  a  new-born  child.  The  English  law,  however,  does  not 
regard  child-murder  as  a  specific  crime ;  it  is  treated  like  any  other 
case  of  murder,  and  is  tried  by  those  rules  of  evidence  which  are 
admitted  in  cases  of  felonious  homicide.  In  stating  that  homicide 
is  the  term  applied  to  the  murder  of  a  new-horn  child,  it  is  not  thereby 
implied  that  the  wilful  killing  should  take  place  within  any  particu 


UTERINE    AGE    OR    MATURITY.  467 

lar  period  after  birth.  Provided  it  be  proved  that  the  child  has 
actually  died  from  violence,  it  matters  not  whether  it  has  been  de- 
stroyed within  a  few  minutes,  or  not  until  several  days  after  its  birth. 
In  the  greater  number  of  cases  of  infanticide,  however,  we  find  that 
the  murder  is  commonly  perpetrated  either  at  the  time  of  birth  or 
within  a  few  hours  afterwards.  Although  the  law  of  England  treats 
a  case  of  infanticide  as  one  of  ordinary  murder,  yet  there  is  a  differ- 
ence in  the  nature  of  the  medical  evidence  required  to  establish  the 
murder  of  a  new-born  child.  It  is  well  known  that  many  children 
come  into  the  world  dead,  and  that  others  die  from  various  causes 
soon  after  birth ;  in  the  latter  the  signs  of  their  having  lived  are 
frequently  indistinct.  Hence,  to  provide  against  the  danger  of  er- 
roneous accusations,  the  law  humanely  presumes  that  every  new- 
born child  has  been  born  dead,  until  the  contrary  appears  from  the 
medical  or  other  evidence.  The  onus  of  proof  that  a  living  child 
has  been  destroyed,  is  thereby  thrown  on  the  prosecution,  and  no 
evidence  imputing  murder  can  be  received,  unless  it  be  first  made 
certain,  by  medical  and  other  facts,  that  the  child  survived  its  birth, 
and  was  actually  living  when  the  alleged  violence  was  offered  to  it. 
Hence  there  is  a  most  difficult  duty  cast  upon  a  medical  witness  on 
these  occasions. 

In  most  instances,  however,  the  body  of  the  child  is  found,  an 
inquest  is  held,  and  medical  evidence  is  demanded.  In  giving  evi- 
dence at  a  coroner's  inquest  in  a  case  of  child-murder,  as  much  care 
should  be  taken  by  a  practitioner  as  if  he  were  delivering  it  before  a 
judge  at  the  assizes.  Some  medical  witnesses  are  disposed  to  treat 
an  inquest  with  indifference,  and  to  be  careless  in  their  evidence, 
thinking  probably  that  should  the  case  come  to  a  trial,  they  could 
easily  prepare  themselves,  and  amend  any  statements  which  had  been 
hastily  made  before  a  coroner's  jury.  But  it  should  be  remembered 
that  the  depositions  taken  by  this  officer  are  placed  at  the  trial  in 
the  hands  of  the  judge,  as  well  as  of  the  prisoner's  counsel ;  and 
should  a  witness  deviate  in  his  evidence  from  that  which  he  gave 
at  the  inquest,  or  should  he  attempt  to  amend  or  explain  any  of 
the  statements  then  made,  so  that  they  might,  by  the  ingenuity  of  a 
barrister,  be  represented  as  having  a  new  bearing  on  the  prisoner's 
case,  he  would  expose  himself  not  merely  to  a  severe  cross-examina- 
tion, but  probably  to  the  censure  of  the  court.  If  medical  men  were 
to  reflect  that  in  delivering  their  opinions  before  a  coroner  and  jury 
they  are,  in  many  instances,  virtually  delivering  them  before  a  supe- 
rior court,  it  is  certain  that  many  unfortunate  exposures  would  be 
easily  avoided. 

Uterine  Age  or  Maturity  of  the  Child. — One  of  the  first  questions 
which  a  witness  had  to  consider  in  a  case  of  alleged  child-murder 
is  that  which  relates  to  the  age  or  probable  degree  of  maturity 
which  the  deceased  child  may  have  attained  in  utero.  The  reason 
for  making  this  inquiry  is,  that  the  chances  of  natural  death,  in  all 
new-born  children,  are  great  in  proportion  to  their  immaturity ;  and 
that,  supposing  them  to  have  survived  birth,  the  signs  of  their  having 
breathed  are  commonly  obscure.     It  is  found  that  the  greater  number 


4l63  INFANTICIDE.      APPEARANCES 

of  children  who  are  the  subjects  of  these  investigations,  have  reached 
the  eighth  or  ninth  month  of  gestation  ;  yet  charges  of  murder  might 
he  extended  to  the  wilful  destruction  of  children  at  the  seventh 
month  or  under,  provided  the  evidence  of  life  after  birth  was  clear 
and  satisfactory. 

The  following  are  the  characters  whereby  we  may  judge  of  the 
uterine  age  of  a  child  from  the  sixth  to  the  ninth  month  of  gestation, 
a  period  which  may  be  considered  to  comprise  cases  of  abortion  as 
well  as  child-murder: — 

1.  Between  the  si xth  and  seventh  months:  The  child  measures, 
from  the  vertex  to  the  sole  of  the  foot,  from  ten  to  twelve  inches, 
and  weighs  from  one  to  three  pounds.  The  head  is  large  in  propor- 
tion to  the  trunk  ;  the  eyelids  are  adherent,  and  the  pupils  are  closed 
by  membranes  (membranse  pupillares).  The  skin  is  of  a  reddish 
color,  and  the  nails  are  formed ;  the  hair  loses  the  silvery  lustre 
which  it  previously  possessed,  and  becomes  darker.  Ossification 
proceeds  rapidly  in  the  chest  bone,  and  in  the  bones  of  the  foot ;  the 
brain  continues  smooth  on  its  surface ;  there  is  no  appearance  of 
convolutions.  In  the  male  the  testicles  will  be  found  in  the  ab- 
dominal cavity,  lying  upon  the  psoa3  muscles  immediately  below 
the  kidneys. 

2.  Between  the  seventh  and  eighth  months:  The  child  now  mea- 
sures between  thirteen  and  fourteen  inches  in  length,  and  weighs 
from  three  to  four  pounds.  The  skin  is  thick,  of  a  more  decidedly 
fibrous  structure,  and  covered  with  a  white  unctuous  matter  which 
appears  for  the  first  time.  Fat  is  deposited  in  the  cellular  tissue, 
whereby  the  body  becomes  round  and  plump  ;  the  skin  previously 
to  this  is  of  a  reddish  color,  and  commonly  more  or  less  shrivelled ; 
the  nails,  which  are  somewhat  firm,  do  not  quite  reach  to  the  ex- 
tremities of  the  fingers ;  the  hair  is  long,  thick,  and  colored ;  ossifi- 
cation advances  throughout  the  skeleton  ;  valvulae  conniventes 
appear  in  the  small  intestines,  and  meconium  is  found  occupying  the 
caecum  and  colon.  The  testicles  in  the  male  about  this  period  com- 
mence their  descent ;  or  rather,  the  child's  head  being  downwards, 
their  ascent  towards  the  scrotum.  The  time  at  which  these  organs 
change  their  situation  is  probably  subject  to  variation.  According 
to  J.  Hunter,  the  testicles  are  situated  in  the  abdomen  at  the  seventh, 
and  in  the  scrotum  at  the  ninth  month.  Burns  believes  that  at  the 
eighth  month  they  will  commonly  be  found  in  the  inguinal  canals. 
The  observation  of  the  position  of  these  organs  in  a  new-born  male 
child  is  of  considerable  importance  in  relation  to  maturity,  and  it 
may  have  an  influence  on  questions  of  legitimacy  as  well  as  of  child- 
murder.  Mr.  Curling  thus  describes  their  change  of  position :  At 
different  periods  between  the  fifth  and  sixth  months  of  foetal  exist- 
ence, or  sometimes  even  later,  the  testicle  begins  to  move  from  its 
situation  near  the  kidney  towards  the  abdominal  ring,  which  it 
usually  reaches  about  the  seventh  month.  During  the  eighth  month 
it  generally  traverses  the  inguinal  canal,  and  by  the  end  of  the  ninth 
arrives  at  the  bottom  of  the  scrotum,  in  which  situation  it  is  com- 
monly found  at  birth.     ("  Diseases  of  the  Testis,1'  2d  ed.,  p.  17.)     Its 


INDICATIVE    OF    UTEKINE    AGE.  469 

absence  from  the  scrotum  does  not  necessarily  indicate  that  the  child 
is  immature,  because  the  organ  sometimes  does  not  reach  the  scrotum 
until  after  birth. 

3.  Between  the  eighth  and  ninth  months :  The  child  is  from  fif- 
teen to  sixteen  inches  in  length,  and  weighs  from  four  to  five  pounds. 
The  eyelids  are  no  longer  adherent,  and  the  membranse  pupillares 
have  disappeared.  The  quantity  of  fat  deposited  beneath  the  skin 
is  increased,  and  the  hair  and  nails  are  well  developed.  The  surface 
of  the  brain  is  grooved  or  fissured,  but  presents  no  regular  convolu- 
tions ;  and  the  cineritious  matter  is  not  yet  apparent.  The  meconium 
occupies  almost  entirely  the  large  intestines ;  and  the  gall-bladder 
contains  some  traces  of  a  liquid  resembling  bile.  The  testicles  in  the 
male  may  be  found  occupying  some  part  of  the  inguinal  canal,  or 
they  may  be  in  the  scrotum.  The  left  testicle  is  sometimes  in  the 
scrotum,  while  the  right  is  situated  about  the  external  ring. 

4.  Ninth  Month.  *  Signs  of  Maturity.—  At  the  ninth  month  the 
average  length  of  the  body  is  about  eighteen  inches,  and  its  weight 
from  six  to  seven  pounds ;  the  male  child  is  generally  rather  longer, 
and  weighs  rather  more  than  the  female.  Extraordinary  deviations 
in  length  and  weight  are  occasionally  met  with.  Mr.  Owens  has  re- 
corded a  case  in  which  a  child  at  delivery  measured  twenty -four 
inches  in  length,  and  weighed  seventeen  pounds  twelve  ounces 
("  Lancet,"  December,  1838),  and  Dr.  Meadows  has  reported  another 
in  which  a  child  measured  after  death  thirty-two  inches,  and  weighed 
eighteen  pounds  two  ounces.  It  survived  four  hours.  ("  Med.  Times 
and  Gaz."  August  4,  1860.)  In  a  case  which  I  was  required  to  ex- 
amine in  June,  1842,  the  child,  a  male,  measured  twenty-two  inches, 
and  weighed  twelve  pounds  and  a  half.  (For  some  practical  remarks 
on  this  subject,  by  Dr.  Ellsiisser,  see  Henke's  "  Zeitschrift,  1841, 
vol.  2,  p.  235.)  According  to  Dr.  Duncan,  the  length  and  weight  of 
a  child  vary  according  to  the  age  of  the  mother.  They  are  greatest 
among  children  when  the  mother  is  from  25  to  29  years  of  age. 
When  a  woman  is  25,  the  child  weighs  less.  The  child  of  a  woman 
at  22,  weighed  seven  pounds  three  ounces,  and  that  of  a  woman  at 
30,  seven  pounds  seven  ounces.  The  length  varied  in  a  less  degree, 
being,  for  the  different  ages,  at  or  about  nineteen  inches.  ("  Ed. 
Monthly  Journal,"  Dec.  1864,  p.  500.) 

At  the  full  period  the  head  of  a  child  is  large,  and  forms  nearly 
one-fourth  of  the  whole  length  of  the  body.  The  cellular  tissue  is 
filled  with  fat,  so  as  to  give  considerable  plumpness  to  the  whole 
form,  while  the  limbs  are  firm,  hard,  and  rounded :  the  skin  is  pale ; 
the  hair  is  thick,  long,  and  somewhat'  abundant ;  the  nails  are  fully 
developed,  and  reach  to  the  ends  of  the  fingers — an  appearance, 
however,  which  may  be  sometimes  simulated  in  a  premature  child, 
by  the  shrinking  of  the  skin  after  death.  The  testicles  in  the  male 
are  generally  within  the  scrotum.  Ossification  will  be  found  to 
have  advanced  considerably  throughout  the  skeleton.  The  surface 
of  the  brain  presents  convolutions,  and  the  cineritious  or  gray  matter 
begins  to  show  itself.     The  internal  organs,  principally  those  of  the 


470  INFANTICIDE.      INSPECTION    OF    THE    BODY. 

chest,  undergo  marked  changes,  if  the  act  of  respiration  has  been 
performed  by  the  child  before,  during,  or  after  its  birth. 

The  characters  which  have  been  here  described  as  belonging  to  a 
child  at  the  different  stages  of  gestation,  must  be  regarded  as  repre- 
senting an  average  statement.  They  are,  it  is  well  known,  open  to 
numerous  exceptions ;  for  some  children  at  the  ninth  month  are  but 
little  more  developed  than  others  at  the  seventh.  Twins  are  gene- 
rally smaller  and  less  developed  than  single  children : — the  average 
weight  of  a  twin  child  is  not  more  than  five  pounds,  and  very  often 
below  this.  The  safest  rule  to  follow  in  endeavoring  to  determine 
the  uterine  age  of  a  child  is  to  rely  upon  a  majority  of  the  charac- 
ters which  it  presents.  That  child  only  can  be  regarded  as  mature, 
which  presents  the  greater  number  of  the  characters  described,  that 
are  met  with  in  children  at  or  about  the  ninth  month  of  gestation. 

If  the  age  of  the  child  has  been  determined :  whether  it  be  under 
or  over  the  seventh  month,  the  rules  for  a  further  investigation  will 
be  the  same.  Should  the  child  be  under  the  seventh  month,  the 
medical  presumption  will  be,  that  it  was  born  dead ;  but  if  it  has 
arrived  at  the  full  period,  then  the  presumption  is  that  it  was  born 
alive. 

Conclusions. — The  following  may  be  taken  as  a  summary  of  the 
principal  facts  upon  which  our  opinion  respecting  the  uterine  age  of 
a  child  may  be  based : — 

1.  At  six  months. — Length,  from  nine  to  ten  inches;  weight,  one 
to  two  pounds ;  eyelids  agglutinated ;  pupils  closed  by  membranas 
pupillares ;  testicles  not  apparent  in  the  male. 

2.  At  seven  months. — Length,  from  thirteen  to  fourteen  inches ; 
weight,  three  to  four  pounds ;  eyelids  not  adherent ;  membranse  pu- 
pillares disappearing ;  nails  imperfectly  developed ;  testicles  not 
apparent  in  the  male. 

3.  At  eight  months. — Length,  from  fourteen  to  sixteen  inches ; 
weight,  from  four  to  five  pounds ;  membrame  pupillares  absent ; 
nails  perfectly  developed,  and  reaching  to  the  ends  of  the  fingers ; 
testicles  in  the  inguinal  canal. 

4.  At  nine  months. — Length,  from  sixteen  to  twenty-one  inches ; 
weight,  from  five  to  nine  pounds;  membranae  pupillares  absent;  head 
well  covered  with  fine  hair ;  testicles  in  the  scrotum ;  skin  pale ;  the 
finger  nails  well  formed  and  reaching  to  the  ends  of  the  fingers ; 
features  perfect — these  and  the  body  are  ivell  developed  even  when  the 
length  and  weight  of  the  child  are  less  than  those  above  assigned. 

5.  The  point  of  attachment  of  the  umbilical  cord,  with  respect  to 
the  length  of  the  body,  affords  no  certain  evidence  of  the  degree  of 
maturity. 

Inspection  of  the  Body. — The  questions  which  a  medical  jurist  has 
to  solve,  in  examining  the  body  of  a  new-born  child,  are — 1.  'To 
determine  its  age,  or  the  stage  of  uterine  life  which  it  has  reached  ; 
2.  Whether  it  has  lived  to  breathe;  3.  Whether  it  has  been  born 
alive ;  4.  The  period  of  time  which  has  elapsed  since  its  death ;  5. 
The  cause  of  death,  whether  violent  or  natural. 

Hence,  before  commencing  the  inspection — 


PROOFS    OF    LIFE    BEFORE    RESPIRATION.  471 

1.  The  length  (measured  from  the  summit  of  the  head  to  the  sole 
of  the  foot)  and  weight  of  the  body  should  be  taken ;  2.  The  pre- 
sence or  absence  of*  external  foetal  peculiarities  noticed ;  3.  Any 
peculiar  marks  or  indications  of  deformity  whereby  identity  may  be 
sometimes  established ;  4.  All  marks  of  violence,  in  the  shape  of 
wounds,  bruises,  or  lacerations,  and  the  kind  of  instrument  or  weapon 
by  which  they  were  probably  produced ;  5.  Whether  the  umbilical 
cord  has  been  cut  and  tied,  or  lacerated;  the  appearance  of  the 
divided  vessels,  and  the  length  of  that  portion  which  is  still  attached 
to  the  body  of  the  child;  6.  The  presence  or  absence  of  vernix 
caseosa  about  the  groins,  arm-pits,  or  neck — the  presence  of  this 
substance  proves  that  a  child  has  not  been  washed  or  attended  to  ; 
7.  It  will  be  necessary  to  state  whether  there  are  about  the  body 
any  marks  of  putrefaction,  indicated  by  a  separation  of  the  cuticle, 
change  of  color  in  the  skin,  or  offensive  odor.  It  is  obvious,  that 
unless  these  circumstances  are  noticed  before  the  inspection  is  com- 
menced, they  may  be  entirely  lost  as  evidence.  Notes  should  be 
made  on  the  spot,  and  the  original  retained,  even  if  copies  be  subse- 
quently made. 


CHAPTEE    XLY. 

Evidence  of  life  before  respiration. — putrefaction  in  utero. 
— evidence  of  life  after  respiration. — color,  volume,  con- 
sistency, and  absolute  weight  of  the  lungs. — static  test. — ■ 
weight  increased  by  respiration. 

• 
The  question  whether  a  child  was  or  was  not  born  alive,  is  of  great 
importance  in  a  case  of  alleged  child-murder ;  and  it  is  unfortunately 
one  which,  in  respect  to  the  proofs  upon  which  medical  evidence  is 
commonly  founded,  has  given  rise  to  considerable  controversy. 
When  it  is  stated  that  in  most  cases  of  alleged  infanticide  which  end 
in  acquittals  in  spite  of  the  strongest  moral  presumptions  of  guilt, 
the  proof  fails  on  this  point  only,  it  must  be  obvious  that  this  ques- 
tion especially  claims  the  attention  of  a  medical  jurist.  The  medical 
evidence  of  a  child  having  been  alive,  when  violence  was  offered  to 
it  at  its  birth  or  afterwards,  may  be  divided  into  two  parts:  1,  that 
which  is  obtainable  before  the  act  of  respiration  is  performed ;  and 
2,  that  which  is  obtainable  afterwards.  At  present  it  will  be  proper 
to  confine  our  attention  to  the  question,  whether  the  child  was 
legally  living  when  it  was  maltreated — the  fact  of  its  having  been 
born  alive  will  be  a  matter  for  future  consideration.  These  two 
questions  have  been  frequentlv  but  improperly  associated,  thus 
rendering  the  subject  confused ;  but  it  must  be  so  obvious  as  scarcely 
to  require  stating,  that  violence  of  a  murderous  kind  may  be  offered 
to  a  living  child  before  it  is  entirely  born ;  and  that  owing  to  this 
violence  it  may  come  into  the  world  dead. 


472  MEDICAL    PROOFS    OF    LIFE. 

Proofs  of  Life  before  Respiration. — It  was  formerly  supposed,  if 
the  lungs  contained  no  air,  that  the  child  could  not  have  breathed, 
and  must  have  been  born  dead;  but  this  is  how  proved  to  be  an 
error.  Children  have  been  known  to  breathe  feebly,  and  continue 
in  existence  many  hours  without  visibly  distending  the  cells  of  the 
lungs  with  air — the  absence  of  air  from  the  lungs,  therefore,  fur- 
nishes no  proof  either  that  respiration  has  not  been  performed,  or 
that  the  child  has  not  lived.  The  restoration  of  many  children 
apparently  born  dead  is  a  clear  proof  that  many  are  born  living 
who  might  be  pronounced  dead,  simply  because  breathing  and  life 
have  been  considered  synonymous  terms.  That  our  law-authorities 
will  admit  evidence  of  life  in  a  child  before  the  establishment  of 
respiration,  is  clear  from  the  decision  in  Rex  v.  Brain,  in  which  the 
judge  said,  that  a  child  might  be  born  alive,  and  not  breathe  for 
some  time  after  its  birth  ("  Archbold,  Crim.  Plead."  367),  as  also 
from  the  charge  of  Coltman  J.  in  the  case  of  Rex  v.  Sellis  (Norf. 
Spr.  Circ.  1887).  In  this  instance  it  was  alleged  that  the  prisoner 
had  murdered  her  child  by  cutting  off  its  head.  The  judge  directed 
the  jury,  that  if  the  child  was  alive  at  the  time  of  the  act,  it  was  not 
necessary,  in  order  to  constitute  murder,  that  it  should  have  breathed. 
In  fact,  it  would  appear  that  respiration  is  regarded  as  only  one 
proof  of  life ;  and  the  law  will,  therefore,  receive  any  other  kind  of 
evidence  which  may  satisfactorily  show  that  the  child  has  lived, 
and  make  up  for  the  proof  commonly  derived  from  the  state  of  the 
lungs.  It  will  be  first  necessary  for  a  medical  practitioner  to  prove 
that  the  child  under  examination  has  recently  died,  or  in  other 
words,  that  there  are  good  grounds  for  believing  it  to  have  been 
recently  living.  Hence,  if  the  body  is  highly  putrefied,  either  from 
the  child  having  died  in  the  uterus  some  time  before  birth,  or  from 
its  having  been  born  and  Its  body  not  discovered  until  putrefaction 
had  far  advanced  both  internally  and  externally,  the  case  is  utterly 
hopeless.  The  medical  witness  will  in  general  be  compelled  to 
abandon  the  investigation,  because  the  body  can  furnish  no  evidence 
whatever  of  life  after  birth.  The  examination  of  the  thoracic  organs 
would  throw  no  light  on  the  case,  for  here  we  are  assuming  that  the 
lungs  are  in  their  foetal  condition. 

Evidence  from  Marks  of  Violence. — It  has  been  proposed  to  seek 
for  evidence  of  life,  under  these  circumstances,  by  observing  the 
characters  presented  by  marks  of  violence  on  the  body.  In  gene- 
ral, when  children  are  murdered,  the  amount  of  violence  inflicted  is 
considerably  greater  than  that  which  is  required  to  destroy  them, 
whereby  satisfactory  proofs  of  the  crime  are  occasionally  obtained. 
On  the  other  hand,  the  body  of  a  still-born  child,  dead  from  natural 
causes,  is  often  covered  with  liviclities  and  ecchymoses;  the  foetal 
blood  does  not  coagulate  with  the  same  firmness  as  in  the  adult : 
hence  the  evidence  derivable  from  the  extent,  situation,  and  charac- 
ters of  marks  of  violence,  is  generally  of  too  vague  and  uncertain 
a  kind  to  allow  of  the  expression  of  a  medical  opinion  that  the  child 
was  living  when  the  violence  was  offered  to  it.  The  characters 
which  have  been  already  described  as  peculiar  to  wounds  and  con- 


BEFOEE    KESPIKATION.      CONCLUSIONS.  473 

fusions  inflicted  during  life,  may  be  met  with  in  a  child,  whether  it 
has  breathed,  or  died  without  breathing.  So,  again,  these  characters 
are  open  to  the  exceptions  there  pointed  out ;  for  they  will  be  equally 
present,  supposing  the  wounds  to  have  been  inflicted  immediately 
after  the  cessation  of  respiration  or  circulation  in  the  child,  or  after 
the  cessation  of  circulation  only — if  the  act  of  respiration  has  not 
been  performed.  Marks  of  violence  on  the  body  of  a  child  that 
had  died  in  utero  twenty-four  or  forty-eight  hours  before  it  was  born, 
would  not  present  the  characters  of  injuries  inflicted  on  the  living. 
There  would  be  no  ecchymosis  and  no  effused  coagula  of  blood. 
These  marks,  when  they  exist,  although  they  may  establish  that  a 
child  was  either  living  or  but  recently  dead  at  the  time  they  were 
inflicted,  can  never  show  that  it  was  born  alive.  Injuries  met  with 
on  the  bodies  of  children  alleged  to  have  been  born  dead  ought,  how- 
ever, to  be  of  such  a  nature  as  to  be  readily  explicable  on  the  sup- 
position of  their  having  arisen  from  accident.  If,  from  their  nature, 
extent,  or  situation,  they  are  such  as  to  evince  a  wilful  design  to 
injure,  it  is  a  fair  ground  for  a  jury — not  for  a  medical  witness,  to 
inquire  why  these  extensive  wounds,  or  other  marks  of  violence, 
were  inflicted  on  a  child,  if,  as  it  is  alleged,  it  was  really  born  dead. 
It  must  be  confessed  that  in  such  a  case  there  would  be  a  strong 
moral  presumption  of  murder,  although  medical  proof  of  life,  or 
actually  live  birth,  might  totally  fail. 

As  a  summary  of  these  remarks,  it  may  be  observed,  that  although 
physiologically  a  child  may  live  for  a  certain  period  after  its  birth 
without  breathing — and  legally  its  destruction  during  this  period 
would  amount  to  murder,  yet  there  are  at  present  no  satisfactory 
medical  data  to  enable  a  witness  to  express  a  positive  opinion  on  this 
point.  If  other  evidence  were  adduced  of  a  child  having  lived  and 
been  destroyed  under  these  circumstances — as  where,  for  example, 
a  woman  causes  herself  to  be  delivered  in  a  water-bath,  or  an  accom- 
plice covers  the  mouth  of  an  infant  m  the  act  of  birth,  or  imme- 
diately after  it  is  born — a  medical  witness  would  be  justified  in 
asserting  that  the  absence  of  the  signs  of  respiration  in  the  lungs 
was  no  proof  that  the  child  had  been  born  dead.  Indeed,  it  is  appa- 
rent that  the  process  could  not  be  established,  owing  to  the  criminal 
means  actually  employed  to  prevent  it.  Whether  a  jury  would  con- 
vict upon  such  evidence  is  doubtful ;  but  this  is  of  no  importance 
to  the  witness : — his  statements  ought  always  to  be  made  according 
to  correct  and  well-ascertained  medical  principles,  and  not  for  the 
purpose  of  procuring  either  the  conviction  or  acquittal  of  persons 
accused  of  offences  against  the  law.  In  general,  thosemises  in  which 
questions  relative  to  life  before  respiration  might  arise  are  stopped 
in  the  Coroner's  court — the  usual  practice  being,  when  the  signs  of 
respiration  are  absent  or  imperfect,  to  pronounce  that  the  child 
was  born  dead.  If  the  lungs  sank  in  water,  the  presence  of  marks 
of  violence  on  the  body  would  be  considered  as  furnishing  no  evi- 
dence : — for  the  sinking  of  the  lungs  would  in  general  be  taken  as  a 
proof  of  still-birth. 

There  is  a  class  of  cases  in  which  a  child  is  born  alive,  but  its 


474:  PROOFS    OF    LIFE    AFTER    RESPIRATION. 

lungs  remain  in  the  foetal  condition,  i.e.  they  present  no  appearance 
of  having  received  air  by  the  act  of  breathing.  These  are  cases  of 
atelectasis  (p.  480).  The  appearances  in  the  body  are  the  same  as  in 
still-born  children.  Prof.  Donders,  who  met  with  one  of  these  cases 
in  which  he  pronounced  a  child  to  be  still-born  when  it  was  distinctly 
proved  that  it  had  lived  twelve  hours,  says  truly,  "  Where  the  signs 
of  an  extra-uterine  life,  which  does  not  betray  itself  by  air  in  the 
lungs  are  to  be  found,  futurity  must  declare." 

The  absence  of  air  from  the  lungs  may  really  be  the  result  of  the 
forcible  prevention  of  respiration  in  the  act  of  birth.  There  cannot 
be  the  slightest  medical  doubt  that  living  children  are  occasionally 
thus  destroyed:  they  die,  not  from  the' actual  infliction  of  violence, 
but  because,  either  through  design  or  accident,  the  performance  of 
that  act  which  is  necessary  to  maintain  existence  when  the  child  is 
born,  is  prevented.  Such  a  case  has  not  yet  been  decided,  although 
from  the  dicta  of  our  judges,  it  would  probably  involve  a  charge 
of  murder. 

Proofs  of  Life  after  Respiration. — There  is  no  doubt  that  the  proof 
of  the  act  of  respiration  furnishes  the  best  and  strongest  evidence 
of  a  child  having  lived  at  or  about  the  time  it  was  born.  It  does 
not,  however,  show  that  a  child  has  been  bom  alive.  The  physical 
changes  in  the  body  of  a  child,  which  result  from  the  establishment 
of  this  process  take  place  in  the  lungs  immediately,  and  in  the  heart 
and  its  appendages  more  slowly.  It  is  therefore  chiefly  to  the  Iwngs 
that  a  medical  witness  looks  for  proofs  of  respiration.  Sometimes, 
however,  these  organs  are  found  in  their  foetal  condition,  or  nearly 
so : — for  although  a  child  may  have  survived  its  birth  many  hours, 
there  may  be  no  evidence  of  the  fact  from  the  state  of  the  lungs. 
To  such  cases  the  remarks  now  about  to  be  made  cannot  of  course 
apply : — the  proofs  of  life  must  then  be  sought  for  elsewhere,  and 
if  none  can  be  found,  the  case  is  beyond  the  reach  of  medical  evi- 
dence. But  it  is  obvious  thai  the  occasional  occurrence  of  cases  of 
this  description  can  presenPno  objection  to  our  still  seeking  for 
proofs  of  life  in  the  state  of  the  lungs,  any  more  than  the  fact  of 
poison  not  being  always  discovered  in  the  body  of  one  who  has  died 
from  poisoning  would  be  a  bar  to  our  seeking  for  the  proofs  of  poi- 
son in  any  unknown  case  which  presented  himself.  It  is  the  more 
necessary  to  insist  upon  this  point,  because  some  have  held,  that,  as 
we  cannot  always  derive,  proofs  of  life  from  an  examination  of  the 
lungs  of  new-born,  children,  we  should  abandon  all  evidence  of  this 
description  and^le^ve  thS  case  in  its  original  obscurity.  The  very 
object  of  mefRcal  jurisprudence  is,  to  endeavor  to  remove  these 
difficulties,  and  to  show  in  every  department  of  the  science,  the 
degree  to  which  we  may  safely  trust  the  medical  proofs  of  crime, 
however  insufficient,  inconsistent,  or  contradictory  they  may  at  first . 
sight  appear. 

Examination  of  the  Lungs. — The  cavity  of  the  chest  may  be  conve- 
niently laid  opgto"4)y  carrying  incisions  from  below  the  clavicles 
downwards  on  each  side  from  about  half  the  length  of  the  ribs  back- 
wards.    The  diaphragm  aitould   be  separated  from   the   cartilages 


EXAMINATION    OF    THE    LUNGS.  475 

without  opening  the  abdomen;  the  ribs  sawn  or  cut  through, 
and  the  flap  formed  by  the  anterior  parietes  of  the  chest  turned 
upwards.  The  differences  in  the  relative  position  of  the  organs  of 
the  chest  before  and  after  respiration  may  be  thus  stated:  1.  If  a 
child  has  not  breathed,  the  thymus  gland,  as  large  as  the  heart,  will 
be  found  occupying  the  upper  and  middle  portions  of  the  chest;  the 
heart  within  its  membrane  (pericardium)  is  situated  in  the  lower 
and  middle  portion,  and  is  rather  inclined  to  the  left  side.  The  lungs 
are  placed  quite  in  the  back  part  of  the  chest,  so  as  often  to  give  the 
impression  that  they  are  wanting.  In  some  instances  they  project 
slightly  forwards  by  their  anterior  margins,  but  in  no  instance,  unless 
congested,  infiltrated,  or  otherwise  diseased,  do  they  cover  and  con- 
ceal the  heart.  The  thymus  gland  is  sometimes  of  a  pale  fawn,  at 
others  of  a  deep  livid  color ;  but  there  is  no  perceptible  difference 
in  this  organ  in  new-born  childen,  before  or  after  the  performance  of 
respiration.  2.  On  the  other  hand,  when  a  child  has  fully  breathed, 
the  most  striking  differences  will  be  observed  in  the  color  and 
prominence  of  the  lungs.  They  are  of  a  light  red  hue,  project  for- 
wards, appear  to  fill  the  entire  cavity  of  the  chest,  and  cover,  and  in 
great  part  conceal  by  their  anterior  margins,  the  heart  and  its  mem- 
brane. We  may  meet  with  every  variety  in  the  appearances  between 
these  two  extremes;  for  the  process  of  respiration  often  requires  a 
considerable  time  in  order  that  it  should  be  fully  established,  espe- 
cially in  children  which  are  of  a  weakly  constitution  or  prematurely 
born.  Hence  the  lungs  will  be  found  to  occupy  their  respective 
cavities  to  a  greater  or  less  extent,  and  to  cover  the  pericardium 
more  or  less,  not  according  to  the  length  of  time  which  a  child  has 
lived,  but  according  to  the  perfection  with  which  respiration  has 
been  performed.  Although,  as  a  general  rule,  the  lungs  are  more 
perfectly  filled  with  air  in  proportion  to  the  time  during  which  a 
child  survives  its  birth,  yet  this  is  open  to  numerous  exceptions. 
The  physical  characters  of  the  lungs  now  require  notice. 

Color. — The  color  of  the  lungs  before  respiration  is  bluish-red,  or 
deep  violet,  but  it  is  subject  to  variation.  Some  medical  jurists  have 
compared  it  to  the  color  of  the  spleen.  A  short  exposure  to  air  will 
materially  brighten  the  color  in  the  parts  exposed,  so  that  it  should 
be  observed  and  recorded  immediately  on  opening  the  chest.  After 
respiration,  the  lungs  acquire  a  light  red  hue  in  proportion  to  the 
degree  in  which  the  process  has  been  performed.  If  imperfectly 
established,  they  will  be  mottled,  generally  about  the  anterior  sur- 
faces and  margins,  the  patches  of  light  red  being  intermixed  with  the 
livid  foetal  hue,  and  being  slightly  raised,  as  if  by  distension,  above 
the  general  surface  of  the  organs.  The  light  red  tint  changes  after 
a  short  exposure  to  air,  to  a  bright  scarlet. 

Volume. — Before  respiration  the  lungs  are  in  general  scarcely  visible, 
unless  forcibly  drawn  forwards  in  the  chest.  When  it  has  been  per- 
fectly accomplished,  the  volume  is  so  much  increased,  that  the  bag 
of  the  heart  (pericardium)  is  almost  concealed  by  them.  Eespiration 
must,  however,  have  been  perfectly  performed  in  order  that  this 
condition  should  exist  to  the  full  extent  described. 


476  INFANTICIDE.      STATE    OF    THE    LUNGS. 

Consistency. — The  lungs,  before  respiration,  feel  like  the  liver,  or 
any  other  of  the  soft  organs  of  the  body.  They  are  firm  under  the 
finger,  but  their  substance  may  be  lacerated  by  violent  compression. 
After  respiration  has  been  fully  performed,  there  is  a  distinct  sensa- 
tion of  what  is  termed  crepitation,  on  compressing  them,  i.  e.  air  is 
felt  within  them.  If  a  thin  section  of  the  lung  is  submitted  to  exa- 
mination with  a  low  power  of  the  microscope,  before  respiration,  it  will 
present  the  solid  appearance  of  a  section  of  the  liver,  spleen,  or  kid- 
ney, after  respiration,  air-cells  will  be  distinctly  seen  in  it.  These 
conditions  of  the  lungs  must,  of  course,  depend  on  the  degree  to  which 
respiration  has  been  carried.  The  lungs  of  children  that  have  lived 
for  a  considerable  time  after  birth  will  sometimes  give  no  feeling  of 
crepitation  under  the  finger.  Generally  speaking,  lungs  of  this  kind 
present  the  other  foetal  characters ;  thus  they  are  small  and  of  a  livid 
color,  and  no  air-cells  may  be  detected  on  a  microscopical  examina- 
tion. 

Absolute  Weight  of  the  Lungs.  The  Static  Test. — The  absolute 
weight  of  the  lungs  before  respiration  is  less  than  that  which  they 
have  after  the  establishment  of  the  process.  From  this  an  inference 
has  been  drawn  that  the  absolute  weight  of  the  lungs  in  an  unknown 
case,  compared  with  certain  averages,  will  aid  the  inquirer  in  ascer- 
taining whether  respiration  has  or  has  not  been  performed.  In  order 
to  determine  the  weight  the  lungs,  these  organs  should  be  carefully 
separated  by  dissection  from  the  heart  and  thymus  gland,  and 
removed  with  the  trachea  and  bronchi  attached.  Previously  to  their 
removal,  ligatures  should  be  placed  on  the  pulmonary  vessels,  so  that 
no  blood  may  escape  from  the  lungs.  They  should  now  be  weighed 
and  the  weight  accurately  noted  in  grains.  The  average  weight 
before  respiration,  derived  from  nine  cases,  was  found  to  be  649  grains. 
According  to  Dr.  Traill,  the  weight  varies  from  430  to  600  grains. 
It  is  of  importance  in  taking  the  weight  of  these  organs  to  observe 
whether  the  child  is  at  or  near  maturity,  and  whether  its  body  is 
fully  developed,  or  of  about  the  average  size  and  weight ;  owing  to  a 
neglect  of  this  rule,  it  is  highly  probable  that  comparisons  have  been 
made  of  the  absolute  weight  of  the  lungs  in  children  of  different  ages, 
which  a  full  statement  of  the  facts  would  not  have  justified.  If 
it  be  small  and  immature,  or  unusually  large,  the  lungs  will  weigh 
either  less  or  more  than  the  average.  The  average  weight  of  the  lungs 
after  respiration  derived  from  three  cases,  was  927  grains ;  but  in 
making  an  estimate  of  this  kind,  much  will  depend  upon  the  degree  to 
which,  respiration  has  been  carried.  In  three  cases,  in  which  the 
children  lived  half  an  hour,  six  hours,  and  twenty-four  hours  respec- 
tively, the  process  had  been  so  imperfectly  performed,  that  the  lungs 
varied  but  little  in  weight  from  the  average  before  respiration.  ("  G. 
H.  Kep."  No.  Y.)  The  truth  is,  we  cannot  compare  the  lungs  of 
children  as  to  weight,  by  the  time  which  they  may  have  survived  birth, 
but  rather  hj  the  degree  to  which  the  lungs  have  been  penetrated  by  air. 
Another  circumstance  must  also  be  considered  in  basing  an  opinion  on 
the  absolute  weight  of  the  lungs.  Although  there  does  not  appear  to 
be  any  strict  normal  relation  between  the  weights  of  the  body  and 


BEFORE    AND    AFTER    RESPIRATION.  477 

lungs  in  new-born  children,  yet  it  is  certain  that  in  the  bodies  of  child- 
ren of  unusual  weight,  the  lungs  will  be  found  much  heavier  than  the 
average,  whether  the  child  has  breathed  or  not.  The  body  may  vary 
from  six  to  eighteen  pounds ;  the  lungs  under  these  circumstances  will 
also  differ  in  weight. 

The  healthy  lungs  of  mature  new-born  children,  become  heavier 
after  respiration,  and  according  to  its  degree  ;  and  where  a  deviation 
from  this  rule  is  observed,  it  may  probably  be  explained  by  the 
circumstance  that  the  lungs  of  an  immature,  have  been  compared 
with  those  of  a  mature  child — the  lungs  of  an  undeveloped  twin 
with  those  of  one  not  a  twin,  or  the  lungs  of  one  which  has  breathed 
imperfectly  with  those  of  another  in  which  respiration  has  become 
well  established.  The  following  table  represents  the  weight  of  the 
lungs,  in  four  cases :  it  will  show  how  much  the  organs  are  liable  to 
vary  in  weight  after  birth,  according  to  the  degree  of  respiration : — 

Case  1.  Born  dead Weight,  687  grs. 

2.  Lived  6  hours  ....  "         774 

3.  Lived  24  hours  ....  "         675 

4.  Lived  9  hours  ....  "         851 

Eelying  upon  the  mere  weight  of  the  lungs,  it  might  be  inferred 
from  this  table  that  the  organs  would  weigh  less  in  a  child  which 
had  survived  its  birth  twenty-four  hours,  than  in  another  which  had 
been  born  dead,  and  that  there  would  be  very  little  difference  in 
the  weight,  whether  the  child  lived  six  hours  or  nine  days;  but 
when  it  is  stated  that  in  Case  3  the  lungs  had  every  foetal  character 
possessed  by  those  in  Case  1,  and  that  in  Case  4  respiration  had 
been  obviously  very  imperfectly  performed,  the  difficulty  is  removed. 
Such  cases  should  rather  be  compared  with  the  lungs  in  the  foetal 
than  in  the  respired  state.  They  merely  show  what  is  very  well 
known  to,  and  admitted  by  all  medical  jurists,  that  there  are  some 
instances  in  which  the  fact  of  respiration  cannot  be  determined  by 
the  application  of  the  static,  or  any  other  test  to  the  lungs,  simply 
because  they  contain  no  air.  Increased  weight,  therefore,  is  only 
one  among  several  circumstances  to  which  a  medical  jurist  should 
attend. 

Great  weight  of  the  lungs  can  obviously  furnish  no  proof  of  respi- 
ration, unless  this  is  accompanied  by  the  other  physical  chano-es 
indicative  of  the  process ;  as,  for  example,  increase  in  volume  from 
the  presence  of  air,  crepitation,  and  the  detection  of  air-cells  by  the 
microscope.  If  the  lungs  are  heavy,  and  at  the  same  time  contain 
little  or  no  air,  the  increase  of  weight  must  depend  upon  disease  or 
other  abnormal  causes — not  upon  respiration.  In  one  case  which  I 
had  to  examine  the  lungs  were  large,  and  weighed  upwards  of  1200 
grains.  They  contained  no  air  ;  when  divided  into  thirty  pieces,  not 
one  portion  floated,  nor  could  any  air  be  seen  on  the  closest  examina- 
tion. It  was  therefore  clearly  impossible  to  ascribe  a  weight  so  much 
above  the  average  to  the  effects  of  respiration.  On  the  other  hand 
in  a  case  communicated  to  me  by  Mr.  Cann  of  Dawlish,  the  lung's 
of  a  new-born  child  apparently  full-grown,  although  fully  distended 
with  air,  weighed  only  626  grains.    In  this  case  the  body  of  the  child 


478  SPECIFIC    GRAVITY    OF    THE    LUNGS. 

weighed  only  six  pounds,  and  a  quantity  of  blood  had  no  doubt 
escaped  from  the  lungs,  owing  to  the  pulmonary  vessels  not  having 
been  tied  before  their  removal  from  the  chest.  It  must  not  be  for- 
gotten that  all  the  physical  characters  presented  by  lungs  that  have 
respired  are  liable  to  certain  fallacies  ;  but,  as  in  the  evidence  derived 
from  tests  used  in  poisoning,  these  may  be  removed,  or  the  force  of 
the  objection  diminished,  by  not  basing  an  opinion  on  one  or  two 
conditions  only.  We  should  take  the  whole  combined ;  for  it  would 
be  as  wrong  to  regard  great  weight  in  the  lungs  taken  alone  as  an 
absolute  proof  of  respiration,  as  it  would  be  to  draw  the  same  in- 
ference from  a  mere  change  in  the  color,  volume,  or  consistency  of 
the  organs. 

M.  Ploucquet  proposed  to  determine  whether  the  act  of  respira- 
tion had  taken  place  or  not  by  a  comparison  of  the  absolute  weight 
of  the  lungs  with  the  weight  of  the  body  of  a  child.  This,  which 
has  been  called  the  test  of  Ploucquet,  is  based  on  the  fallacy  that 
there  is  an  invariable  relation  between  the  weights  of  the  lungs  and 
bodies  of  new-born  children.  No  such  relation  exists,  and  this 
method  of  arriving  at  a  solution  of  the  question  of  respiration,  has 
been  abandoned  by  all  medical  jurists. 

The  Specific  Gravity  of  the  Lungs. — The  specific  gravity  of  the 
lungs  is  greater  before  than  after  respiration ;  for  although  the  organs 
become  absolutely  heavier  by  the  establishment  of  the  process,  this 
is  owing,  not  to  the  air,  but  to  the  additional  quantity  of  blood  re- 
ceived into  them.  The  air  thus  received  so  increases  the  volume  of 
the  lungs  as  to  more  than  counteract  the  additional  weight  derived 
from  the  blood,  and  thus  apparently  to  diminish  their  specific  gravity. 
Under  these  circumstances  they  readily  float  on  water.  From  sev- 
eral experiments,  I  have  found  that  the  specific  gravity  of  the  lungs 
before  respiration,  i.  e.  in  the  foetal  condition,  varies  from  1.04  to 
1.05.  They  are  about  one-twentieth  part  heavier  than  their  bulk  of 
water.  After  respiration,  the  specific  gravity  of  the  lungs  with  the 
air  contained  in  them,  I  found  in  one  experiment  to  be  0.94 ;  i.  e. 
the  organs  were  about  one-seventeenth  part  lighter  than  their  bulk 
of  water.  The  introduction  of  a  small  quantity  of  air  will  render 
the  lungs  buoyant  in  water,  and  an  alteration  of  the  volume  sufficient 
for  this  purpose,  would  not  be  perceptible  to  the  eye.  It  will  be 
understood  that  the  specific  gravity  of  the  substance  of  the  lungs  is 
unchanged ;  the  organs  are  rendered  only  apparently  lighter  by  the 
air  contained  in  their  cells,  on  the  same  principle  as  a  bladder  filled 
with  air.  Hence  it  follows  that  the  apparent  diminution  of  specific 
gravity  wTill  take  place  whether  the  air  is  derived  from  respiration, 
artificial  inflation,  or  putrefaction.  It  is  on  this  property  of  the 
lungs  that  the  application  of  what  is  termed  the  hydrostatic  test,  or 
the  docimasia  puhnonaris,  is  founded — a  subject  which  may  be  appro- 
priately considered  in  another  chapter. 

Conclusions. — The  general  conclusions  which  may  be  drawn  from 
the  contents  of  this  chapter  are: — 

1.  That  a  child  may  be  born  alive  and  be  criminally  destroyed 
before  it  has  breathed. 


INFANTICIDE.      THE    HYDROSTATIC    TEST.  479 

2.  That  the  presence  of  any  marks  indicative  of  putrefaction  in 
the  uterus  proves  that  the  child  must  have  come  into  the  world  dead. 

3.  That  there  are  no  certain  medical  signs  b}>-  which  a  child  which 
has  not  breathed  can  be  proved  to  have  been  living  when  it  was  mal- 
treated. 

4.  That  a  new-born  child  may  be  destroyed  by  the  prevention  of 
respiration  during  delivery. 

5.  That  by  taking  together  the  color,  volume,  consistency,  abso- 
lute weight,  and  buoyancy  of  the  lungs  we  may  be  able  to  draw  an 
inference  whether  the  child  has  or  has  not  breathed. 

6.  That  the  lungs  increase  in  weight  according  to  the  degree  to 
which  respiration  is  established,  and  not  necessarily  according  to  the 
period  which  the  child  has  survived  birth. 

7.  That  no  reliance  can  be  placed  upon  the  test  of  Ploucquet  or  the 
proportionate  weight  of  the  lungs  to  the  body. 


CHAPTEE    XLVI. 

THE  HYDROSTATIC  TEST. — SINKING  OF  THE  LUNGS  FROM  DISEASE  OR 
ATELECTASIS. LIFE  WITH  PERFECT  ATELECTASIS  OR  ENTIRE  AB- 
SENCE OF  AIR  FROM  THE  LUNGS. — ERRONEOUS  MEDICAL  INFER- 
ENCE FROM  SINKING  OF  THE  LUNGS. — FLOATING  OF  THE  LUNGS 
FROM  PUTREFACTION. — EFFECTS    OF  PUTREFACTION  ON  THE  LUNGS. 

The  Hydrostatic  Test. — The  mode  of  employing  this  test  is  ex- 
tremety  simple.  Having  removed  the  lungs  from  the  chest,  they 
should  be  placed,  still  connected  with  the  air-tubes,  upon  the  surface 
of  distilled  or  river  water.  If  they  sink,  it  should  be  noted  whether 
the  sinking  takes  place  rapidly  or  slowly.  If  they  both  sink,  the 
two  lungs  should  be  tried  separately ;  for  it  is  sometimes  found  that 
one,  commonly  the  right,  will  float,  while  the  other  will  sink.  Sup- 
posing that  both  lungs  sink,  it  will  then  be  proper  to  divide  each 
into  twelve  or  fifteen  pieces,  and  place  these  pieces  separately  on 
water.  If,  after  this,  they  all  sink,  the  inference  is,  that  although 
the  child  may  have  lived  and  survived  its  birth,  there  is  no  evidence 
of  its  having  breathed.  On  the  other  hand,  the  organs  when  placed 
on  water  may  float;  it  should  then  be  noticed  whether  they  float 
high  above  the  surface,  or  at  or  below  the  level  of  the  water  ;  some- 
times they  indifferently  float  or  sink.  These  differences  will  lead  to 
a  conclusion  respecting  the  degree  to  which  respiration  has  taken 
place.  It  will  now  be  proper  to  separate  the  lungs,  and  determine 
whether  the  buoyancy  is  due  to  one  or  both.  Each  lung  should  be 
divided,  as  before,  and  each  piece  separately  tried.  If  all  the  pieces 
float,,  even  after  firm  compression,  we  have  good  evidence,  carter  is 
paribus,  that  respiration  has  been  very  perfectly  performed.  Should 
any  of  the  divided  portions  sink  in  water,  either  before  or  after  com- 


480  SINKING    OF    THE    LUNGS    IN    WATER. 

pression,  our  opinion  should  be  modified  accordingly.  Some  have 
recommended  that  the  lungs  should  be  placed  on  water  with  the  heart 
and  thymus  gland  attached ;  but  there  appears  to  be  no  good  reason 
for  this,  since  it  is  as  easy  to  form  an  opinion  of  the  degree  of  buoy- 
ancy possessed  hj  the  lungs,  from  the  readiness  with  which  they 
float,  as  by  observing  whether  or  not  they  have  the  power  to  support 
these  two  organs. 

With  regard  to  the  inference  derivable  from  the  use  of  this  test, 
it  should  be  observed  that  the  floating  of  the  lungs  in  water  is  not, 
as  it  is  often  incorrectly  represented  to  be,  a  proof  that  a  child  has 
been  horn  alive;  nor  is  the  fact  of  their  sinking  in  water  any  proof 
that  a  child  was  born  dead.  The  floating,  under  the  limitations  to  be 
described,  proves  only  that  a  child  has  breathed,  the  sinking,  either 
that  it  has  not  breathed,  or  breathed  but  imperfectly.  The  fact  of  a 
child  having  been  born  living  or  dead,  has,  strictly  speaking,  no  re- 
lation to  the  employment  of  the  hydrostatic  test.  There  are  cases  of 
infanticide  which  may  be  readily  established  without  resorting  to 
this  test,  and  others  which  cannot  be  proved  by  its  use ;  all  that  the 
law  requires  is  proof  that  a  child  has  been  born  living;  and  whether 
this  proof  be  furnished  by  the  state  of  the  lungs  through  the  hydro- 
static test,  or  in  any  other  manner,  is  of  no  moment.  The  signs  of 
life  are  commonly  sought  for  in  the  lungs,  because  it  is  in  these  or- 
gans that  the  changes  produced  by  a  new  state  of  existence  are  most 
distinctly  perceived ;  but  this  examination  may  be  dispensed  with 
when  the  woman  confesses  that  the  child  was  born  alive ;  when  others 
have  seen  it  manifest  life  by  motion  or  otherwise  after  its  birth ;  or, 
lastly,  in  cases  where,  without  being  seen,  it  has  been  heard  to  cry. 
The  crying  of  a  child  has  been  admitted  as  evidence  of  live  birth  on 
several  trials  for  infanticide ;  although,  as  it  is  elsewhere  stated,  a 
child  may  utter  a  cry  and  die  before  its  body  is  entirely  born. 
Among  the  objections  which  have  been  urged  to  the  employment  of 
the  Irvdrostatic  test,  we  have  first  to  consider  those  which  concern 
the  sinking  of  the  lungs  in  water. 

Sinking  of  the  Lungs  from  Disease  or  Atelectasis. — It  is  said  that  the 
hydrostatic  test  cannot  show  whether  a  child  has  or  has  not  survived 
its  birth,  because  the  lungs  of  children  that  have  lived  for  a  consi- 
derable period  have  been  observed  to  sink  entirely  in  water.  In 
some  instances  this  may  depend  on  disease,  tending  to  consolidate 
the  air-cells,  as  hepatization  or  scirrhus — in  others,  on  oedema  or  con- 
gestion:  but  these  cases  can  create  no  difficulty,  since  the  cause  of 
the  lungs  sinking  in  water,  would  be  at  once  obvious  on  examina- 
tion. The  hepatized  portion  of  lung  may  be  known  by  the  firmness 
with  which  it  resists  cutting  with  a  knife,  as  also  by  the  fact  that 
it  is  impossible  to  distend  it  artificially  with  air.  On  the  other  hand, 
there  are  cases  in  which  the  lungs  appear  healthy  and  unaffected : 
all  that  we  can  perceive  is,  that  they  retain  their  foetal  condition. 
This  is  a  very  different  state  from  that  of  hepatization,  because  the 
lungs  may,  in  this  case,  be  made  to  receive  air  by  artificial  inflation. 
It  is  remarkable  that  life  should  continue  for  many  hours,  and  some- 
times even  for  days,  under  such  a  condition ;  but  the  occasional  exist- 


CASES    OF    ATELECTASIS.  481 

ence  of  this  state  of  the  lungs  in  a  living  child  is  placed  beyond  all 
dispute  ;  the  explanation  of  the  causes  upon  which  it  depends — how 
it  is  that  a  child  may  live  for  honrs  or  days,  and  no  signs  of  respira- 
tion be  discovered  in  its  body  after  death,  is,  however,  involved  in 
difficulty.  The  lungs  appear  to  be  simply  unexpanded,  or  to  retain 
their  foetal  condition ;  a  state  to  which  the  name  of  atelectasis  has 
been  given.  This  condition  may  be  found  in  the  whole  or  in  a  part 
of  the  organs. 

Dr.  Albert  met  with  a  case,  in  which  a  child  died  thirty-six  hours 
after  its  birth,  having  been  attacked  by  convulsions  at  intervals 
during  that  time.  On  inspection  the  whole  of  the  right,  and  the 
lower  portion  of  the  left  lung  were  found  to  be  in  their  foetal  condi- 
tion, and  they  immediately  sank  when  immersed  in  water.  There 
was  no  diseased  appearance  in  the  organs,  and  the  undistended  por- 
tions were  easily  filled  by  blowing  air  into  them.  (Henke's  "  Zeits- 
chrift,"  1837,  vol.  ii.  p.  422.)  M.  Depaul  found  that  in  many  cases 
in  which  children  had  died  suddenly  after  breathing  for  several  hours 
or  days,  there  was  no  other  morbid  appearance  to  be  perceived  than 
an  unexpanded  condition  of  a  large  portion  of  the  lungs.  ("  Med. 
Gaz.,"  vol.  xxxix.  p.  288.) 

It  is  quite  necessary  for  a  medical  jurist  to  be  aware  that  the  state 
of  the  lungs  which  is  here  called  atelectasis,  is  by  no  means  unfre- 
quent  among  new-born  children,  although  attention  has  been  only  of 
late  years  drawn  to  the  subject.  When  no  portion  of  air  is  found  in 
the  lungs  of  a  child,  there  is  no  test  by  which  such  a  case  can  be 
distinguished  from  one  in  which  the  child  has  come  into  the  world 
dead.  These  cases  of  atelectasis  are  ordinarily  set  down  as  excep- 
tions to  a  general  rule ;  but  I  believe  they  are  more  common  than 
some  medical  jurists  are  inclined  to  admit.  In  examining  the  body 
of  a  child,  the  history  of  which  is  unknown,  it  is  proper  that  the 
possible  occurrence  of  such  cases  should  be  well  borne  in  mind.  It 
appears  to  me  not  improbable  that  many  such  come  yearly  before 
coroners  in  this  country,  and  that  they  are  dismissed  as  cases  of  still- 
born children,  notwithstanding  that  marks  of  violence  are  often 
found  upon  the  bodies.  If,  as  it  has  been  already  observed,  the 
lungs  sink  in  water,  this  fact  alone  is  commonly,  although  improperly,, 
regarded  as  sufficient  evidence  of  still-birth.  This  is  assuredly  putting 
the  most  humane  interpretation  on  the  circumstances,  and  so  far  the 
result  is  not  to  be  objected  to ;  but  we  should  take  care,  in  carrying 
out  this  principle,  that  we  do  not  throw  obstacles  in  the  way  of  a 
subsequent  judicial  inquiry,  and  lead  to  the  concealment  of  crime. 
Professor  Bernt  met  with  an  instance  in  which  a  seven-months'  child 
died  two  hours  after  birth;  and  when  its  lungs  were  divided  and 
placed  in  water,  every  portion  sank.  Remer  has  reported  another, 
in  which  the  lungs  sank  in  water,  both  entire,  as  well  as  when 
divided,  although  the  child  had  survived  its  birth  at  least  four 
days,  fllenke,  "  Lehrbuch  der  G.  M.,"  p.  374.)  In  this  case  the 
navel-string  separated  naturally  before  death.  Orfila  found,  in  a  child 
which  had  lived  eleven  hours,  every  portion  of  the  lungs  when  divi- 
ded, to  sink  on  immersion.  In  three  other  instances,  in  which  the 
31 


432  ERRONEOUS    MEDICAL    INFERENCES. 

children  survived  birth  four,  six,  and  ten  hours,  the  lungs  also  sank 
when  divided;  two  of  these  were  mature.  ("Med.  Leg.,"  vol.  i.  p. 
375.) 

Dr.  Vernon  attended  a  healthy  woman,  who  was  delivered  of  a 
child  at  about  the  sixth  month  of  her  pregnancy.  The  child  was  born 
before  his  arrival,  and  he  heard  it  crying  strongly  from  under  the 
bed-clothes  as  he  entered  the  room.  After  removal  from  the  mother, 
the  child  cried  at  intervals,  and  it  was  observed  that  its  chest  rose 
and  fell  as  in  ordinary  breathing.  It  lived  five  hours,  and  it  then 
appeared  to  die  from  feebleness  and  exhaustion.  It  was  a  female 
child,  and  very  small ;  the  body  weighed  2  lbs.  13  oz.,  and  its  length 
was  12f  inches;  the  e}relids  were  adherent.  The  lungs  were  of  a 
purplish-red  color,  and  slightly  overlapped  the  bag  of  the  heart: 
they  sank  in  water  both  entire  and  when  divided  into  small  pieces; 
they  were  not  crepitant,  and  broke  down  under  firm  compression : 
there  was  no  appearance  of  air-cells  in  a  section  of  the  lungs  when 
examined  by  the  microscope.  The  ductus  arteriosus  and  foramen 
ovale  were  in  their  fcetal  state.  ("Lancet,"  Feb.  3,  1855,  p.  121.) 
A  still  more  remarkable  case  recently  occurred  to  Prof.  Bonders  of 
Ft  retch.  (Report  by  Dr.  Moore,  "Dublin  Medical  Press,"  Nov.  22, 
1865,  p.  156.)  The  body  of  the  child  was  sixteen  inches  in  length, 
and  weighed  nearly  five  pounds.  It  was  probably  a  seven  months' 
child.  The  lungs  were  of  a  brown  color,  and  sank  in  water  entire 
and  Avhen  divided.  There  was  no  crepitation,  and  on  pressure  only 
a  reddish  fluid  without  air  escaped.  The  bladder  was  empty :  there 
was  no  food  in  the  stomach,  but  there  was  meconium  in  the  large 
intestine.  From  this  state  of  facts,  Prof.  Donders  concluded  that  the 
child  was  immature — stilJ-born — only  a  short  time  dead,  and  remain- 
ing in  the  uterus  only  a  short  time  after  death.  It  transpired,  how- 
ever, that  the  child  had  been  born  alive,  had  survived  its  birth  twelve 
hours,  and  had  cried  distinctly  after  it  was  born.  As  the  luugs 
could  be  readily  inflated,  and  as  the  child  had  cried,  he  concluded 
that  air  had  been  received  into  the  lungs,  and  had  been  again  slowly 
expelled,  the  child  dying  in  a  kind  of  asphyxiated  state.  I  ma}*  add 
to  these  instances  two  which  have  occurred  under  my  own  observa- 
tion. In  one,  the  case  of  a  mature  male  child,  the  lungs  sank  in 
water,  although  the  child  had  survived  birth  for  a  period  of  six  hours. 
In  the  other,  the  case  of  a  female  twin,  the  child  survived  twenty-four 
hours;  and  after  death  the  lungs  were  divided  into  thirty  pieces ; 
but  not  a  single  piece  floated;  showing  therefore  that,  although  life 
had  been  thus  protracted,  not  one-thirtieth  part  of  the  structure  of 
the  lungs  had  received  from  respiration  sufficient  air  to  render  it 
buoyant.  ("  Guy's  Hospital  Reports,"  No.  5,  p.  355.)  In  the  latter 
instance  no  particular  remark  was  made  during  life  respecting  the 
breathing  of  the  child. 

These  cases  show  most  clearly  that  buoyancy  of  the  lungs  is  not 
a  necessary  consequence  of  a  child  having  lived  and  breathed  for 
some  time  after  birth.  Probably,  had  these  cases  called  for  medico- 
legal inquiry,  the  lungs  would  have  been  cut  to  pieces;  the  sinking 
of  the  divided  pieces  in  water,  either  before  or  after  compression, 


INFANTICIDE.      MEDICAL    EVIDENCE.  483 

would  have  been  set  clown  as  negativing  the  act  of  respiration,  and, 
unless  other  strong  evidence  had  been  forthcoming,  it  would  have 
been  asserted  that  the  children  had  been  born  dead.  Here,  again, 
we  perceive  the  necessity  of  not  hastily  assuming  that  a  child  has 
been  born  dead,  because  its  lungs  sink  in  water.  There  may  be  no 
good  medical  evidence  of  such  a  child  having  lived  after  birth,  but 
assuredly  the  mere  sinking  does  not  warrant  the  common  and  posi- 
tive dictum,  that  the  child  was  necessarily  dead  when  born ;  it  would 
be  as  reasonable  to  pronounce,  in  a  question  of  poisoning,  that  the 
fact  of  an  individual  having  died  from  poison  was  negatived  by  the 
non-discovery  of  a  poisonous  substance  in  the  stomach  of  the 
deceased. 

It  must  be  apparent,  on  reflection,  that  cases  of  this  description 
are  beyond  the  reach  of  the  hydrostatic  as  well  as  of  all  other  tests 
applied  to  the  respiratory  organs ;  because  the  lungs  do  not  receive 
and  retain  a  sufficient  quantity  of  air  to  give  buoyancy  after  death, 
although  the  children  may  have  lived  some  hours.  The  hydrostatic 
test  is  no  more  capable  of  showing  that  such  children  as  these  have 
lived,  than  it  is  of  indicating  from  what  cause  they  have  died.  Facts 
of  this  kind  demonstrate  that  a  passive  existence  may  be  for  some 
time  maintained  under  a  state  of  the  respiratory  process  not  to  be 
discovered  after  death.  In  the  opinion  of  some,  these  cases  form  a 
serious  objection  to  the  hydrostatic  test;  but  it  is  difficult  to  under- 
stand how  they  can  affect  its  general  application — or  why,  because 
signs  of  respiration  do  not  always  exist  in  the  lungs  of  children  that 
have  lived,  we  are  not  to  rely  upon  them  when  they  are  actually 
found.  These  singular  instances  prove  that  we  are  greatly  in  want 
of  some  fact  to  indicate  life  after  birth,  ivhen  the  signs  of  respiration 
are  absent.  Until  we  discover  this  we  must,  of  course,  make  the 
best  use  of  that  knowledge  which  lies  at  our  disposal ;  taking  care 
to  apply  it  to  those  cases  alone  ^  to  which  experience  shows  it  to  be 
safely  adapted.  In  the  mean  time,  the  common  inference  that  a 
child  has  been  born  dead  because  its  lungs  sink  in  water,  is  never 
likely  to  implicate  an  innocent  party ;  it  can  only  operate  by  some- 
times leading  to  the  liberation  of  the  guilty. 

It  has  been  recommended  that  medical  jurists  should  consider  as 
dead  every  child  that  has  not  breathed,  i.  e.  whose  lungs  sink  in  water  ; 
but  they  who  gave  this  advice  at  the  same  time  admit  that  children 
may  come  into  the  world  living  without  breathing,  and  the  law 
holds,  under  the  decision  of  its  expounders,  that  respiration  is  only 
one,  and  not  an  exclusive,  proof  of  life.  In  order  to  establish  life, 
or  even  live  birth,  respiration  need  not  always  be  proved,  either  in 
civil  or  criminal  cases.  A  medical  jurist  would,  therefore,  be  no 
more  justified  in  asserting  that  all  such  children  were  necessarily 
born  dead,  than  that  they  were  born  living.:  and  in  stating  what  is 
the  plain  and  obvious  truth,  it  is  not  possible  that  his  statement  can 
ever  be  the  means  of  involving  an  innocent  person.  It  is  certain, 
however,  in  departing  from  the  truth  and  stating  what  is  contrary 
to  well-known  facts,  that  when  the  lungs  of  a  child  sink  in  water, 
it  is  safe  and  just  to  eonsider  such  child  as  having  been  born  d  a  (., 


434  FLOATING    OF    THE    LUNGS    IN    WATEK. 

he  is  incurring  the  risk  of  exculpating  a  really  guilty  person ;  for 
it  cannot  be  too  strongly  borne  in  mind,  that  a  woman  is  not  now 
charged  with  murder,  merely  because  the  lungs  of  her  child  float 
or  sink  in  water,  but  because  there  are  upon  its  body  marks  of  vio- 
lent injuries  apparently  sufficient  to  account  for  the  death  of  a  new- 
born child,  or  there  are  strong  moral  presumptions  of  her  guilt. 

Floating  of  the  Lungs  from  other  causes  than  Respiration. — Another 
series  of  objections  has  been  urged  to  the  hydrostatic  test,  based  on 
the  fact  that  the  lungs  may  receive  air  and  acquire  buoyancy  from 
other  causes  than  respiration.  These  causes  are  two :  putrefaction 
and  artificial  inflation.  Putrefaction. — The  lungs  of  a  still-born 
child,  when  allowed  to  remain  in  the  chest,  are  slow  in  undergoing 
putrefaction ;  but,  nevertheless,  they  sooner  or  later  acquire  sufficient 
air  to  render  them  buoyant  in  water.  When  the  lungs  are  putrefied, 
this  will  be  determined,  in  general,  by  putrefaction  having  extended 
throughout  all  the  soft  parts  of  the  body.  The  organs,  according  to 
the  degree  of  putrefaction,  will  be  found  soft,  of  a  dark  green  or 
brown  color,  and  of  a  highly  offensive  odor ;  the  serous  membrane 
covering  the  surface  will  be  raised  in  large  visible  bladders,  from 
which  the  air  may  be  forced  out  by  very  moderate  compression.  It 
has  been  remarked  that,  under  the  same  conditions,  gaseous  putre- 
faction takes  place  as  rapidly  in  the  liver,  heart,  and  thymus-gland 
of  a  new-born  child,  as  in  the  lungs ;  we  should,  therefore,  notice 
the  general  state  of  the  body.  The  distension  of  the  lungs  with  gas 
from  putrefaction  cannot  be  easily  overlooked  or  mistaken  for  the 
air  of  respiration.  The  answer  to  any  objection  founded  on  the 
putrefied  state  of  these  organs,  must  at  once  suggest  itself.  It  is 
impossible  that  any  well-informed  medical  witness  can  expect  to 
obtain  satisfactory  evidence  from  experiments  on  lungs  in  such  a 
condition.  He  should  abandon  the  case  and  declare  that  in  regard 
to  the  question  of  respiration,  medical  evidence  cannot  establish 
either  the  affirmative  or  the  negative.  The  fact  of  his  not  being 
able  to  give  the  evidence  required,  cannot  be  imputed  as  a  matter 
of  blame  to  him  or  ascribed  to  any  deficiencies  in  the  hydrostatic 
test ;  this  is  due  to  purely  accidental  circumstances. 

In  a  case  reported  by  Henke,  the  lungs  and  other  organs  in  the 
body  of  a  child  were  found  in  an  advanced  state  of  putrefaction.  A 
medical  witness  gave  an  opinion  that  the  child  was  born  dead,  but 
the  prisoner  afterwards  confessed  that  it  had  been  born  living.  The 
medical  opinion  could  have  been  no  more  than  a  conjecture,  the 
condition  of  the  body  not  allowing  any  correct  conclusion  to  be 
drawn.  This  fact  shows  that  it  is  always  better  to  leave  a  doubtful 
case  as  we  find  it,  than  to  express  a  positive  opinion  that  the  child 
has  been  born  living  or  dead.  If  on  these  occasions  a  witness  were 
simply  to  assure  a  jury,  that  medical  evidence  could  not  solve  the 
question  whether  the  child  had  lived  or  not — if  he  were  to  assert, 
what  is  really  the  fact,  that  his  experiments  would  not  allowr  him  to 
say  whether  the  child  had  or  had  not  breathed — it  is  certain  that  no 
innocent  person  would  ever  be  convicted  or  a  guilty  person  ac- 
quitted, upon  his  evidence.     It  is  for  a  jury  only  to  judge  of  guilt 


ARTIFICIAL    INFLATION    OF    THE    LUNGS.  485 

from  all  the  circumstances  laid  before  them ;  but  it  is  assuredly  not 
for  a  medical  witness  to  prevent  further  investigation,  and  put  an 
end  to  the  case,  when  there  is  good  reason  for  doubt.  It  is  his  duty 
to  state  that  doubt,  and  leave  the  decision  of  guilt  or  innocence  in 
the  hands  of  the  court. 

Conclusions. — The  general  conclusions  which  may  be  drawn  re- 
specting the  application  of  the  hydrostatic  test  in  cases  of  infanti- 
cide, are  the  following  : — • 

1.  That  the  hydrostatic  test  can  only  show  whether  a  child  has  or 
has  not  breathed — it  does  not  enable  us  to  determine  whether  a 
child  has  been  born  living  or  dead. 

2.  That  the  lungs  of  children  that  have  lived  after  birth  may  sink 
in  water,  owing  to  their  not  having  received  air,  or  to  their  being  in 
a  diseased  condition. 

3.  That  a  child  may  live  for  some  time  when  only  a  portion  of  the 
lungs  has  been  penetrated  by  air. 

4.  That  a  child  may  survive  birth  even  for  twenty-four  hours, 
when  no  part  of  its  lungs  has  been  penetrated  by  air. 

5.  Hence  the  sinking  of  the  lungs  (whether  whole  or  divided)  in 
water  is  not  a  proof  that  a  child  has  been  born  dead. 

6.  That  the  lungs  of  children  which  have  not  breathed  and  have 
been  born  dead,  may  float  on  water  from  putrefaction. 

7.  That  the  lungs  as  situated  in  the  chest  undergo  putrefaction 
very  slowly — that  if  but  slightly  putrefied,  the  gases  may  be  easily 
forced  out  by  compression,  and  if  much  putrefied,  either  the  case 
must  be  abandoned,  or  other  sources  of  evidence  sought  for. 


CHAPTER    XLVII. 

Floating  of  the  lungs  from  artificial  inflation. — inflation 
not  distinguishable  from  imperfect  respiration. — results 
of  compression. — improper  objections  to  the  hydrostatic 
test. — respiration  before  birth. — respiration  a  sign  of  life, 
not  of  live  birth. — general  conclusions. 

Artificial  Inflation. — It  has  been  alleged  that  the  lungs  of  a  still- 
born child  may  be  made  to  assume  by  artificial  inflation,  i.  e.  by 
blowing  air  into  them,  all  the  characters  assigned  to  those  which  have 
undergone  respiration.  Thus,  it  is  said,  a  child  may  not  have  breathed, 
and  yet  the  application  of  the  hydrostatic  test  would  in  such  a  case 
lead  to  the  inference  that  it  had.  It  will  be  seen  that  the  force  of 
this  objection  goes  to  attack  directly  the  inference  derivable  from 
the  discovery  of  air  in  the  lungs.  There  is  only  one  form  under 
which  this  objection  can  be  admitted,  namely,  as  it  applies  to  lungs 
which  have  been  inflated  while  lying  in  the  cavity  of  the  chest.  Any 
experiments  performed  on  them  after  their  removal  from  this  cavity, 


486  ARTIFICIAL    INFLATION    OF    THE    LUNGS. 

can  have  no  practical  bearing,  since  in  a  case  of  infanticide  we  have 
to  consider  only  the  degree  to  which  the  lungs  may  be  distended 
with  air  by  a  person  who  is  fairly  endeavoring  to  resuscitate  a  still- 
born child.  Assuming  that  the  experiment  has  been  successfully 
performed,  and  that  the  lungs  have  been  artificially  inflated,  they 
would  resemble  in  their  partial  distension  with  air  and  other  physi- 
cal characters,  those  of  children  which  had  breathed  imperfectly. 
Like  them,  they  may  float  on  water ;  but  on  cutting  them  into 
pieces,  some  of  these  would  be  found  to  sink.  If  the  pieces  which 
float  are  firmly  compressed  either  by  means  of  a  folded  cloth  or  be- 
tween the  fingers,  they  will  lose  their  air  and  sink.  When  this 
pressure  is  produced  under  water,  it  will  be  seen  that  bubbles  of 
air  escape,  but  mere  pressure  with  the  fingers  will  not  in  general 
suffice  to  expel  the  whole.  The  same  result  is  obtained  when  the 
divided  portions  of  lungs  which  have  breathed  imperfectly  are  sub- 
mitted to  pressure.  If,  however,  the  act  of  breathing  has  been  per- 
fectly performed,  and  the  air-cells  are  well  filled,  the  air  cannot  be 
expelled  by  pressure  or  by  any  force  short  of  the  destruction  of  the 
substance  of  the  lungs.  This  difference  in  the  effect  of  pressure  has 
been  hitherto  regarded  as  a  criterion  to  distinguish  lungs  that  have 
fully  breathed  from  those  which  have  been  simply  inflated;  but  Dr. 
Hicks  met  with  a  case  which  shows  that  pressure  will  not  always 
effect  the  expulsion  of  air,  artificially  introduced  into  the  lungs  of 
a  child  born  dead;  hence  by  an  exclusive  reliance  on  this  method, 
a  medical  man  might  be  led  to  infer  that  a  lung  artificially  inflated 
had  received  air  by  respiration.  Dr.  Hicks  delivered  a  woman  of  a 
full-grown  child ;  it  was  still-born,  and  there  was  no  effort  at  respi- 
ration. An  attempt  was  made  to  resuscitate  the  child,  but  unsuc- 
cessfully, by  blowing  air  into  the  lungs  through  a  catheter.  On 
inspection,  the  lungs  were  observed  to  be  of  large  size,  but  they 
did  not  present  the  usual  appearances  of  lungs  which  had  breathed. 
A  lthough  about  three-fourths  of  the  organs  had  received  air  by  in- 
flation, they  were  of  a  pale-fawn  color,  like  the  thymus  gland;  still 
the  air  was  contained  in  the  minute  air-cells.  They  floated  on  water 
as  well  as  all  the  pieces  (fifteen  or  sixteen)  into  which  they  were 
divided.  When  compressed  between  the  fingers  under  water,  small 
bubbles  of  air  escaped:  but  no  amount  of  compression  short  of  de- 
stroying their  structure  caused  these  pieces  to  sink.  A  fact  of  this 
kind,  although  perhaps  exceptional,  shows  that  the  non-expulsion 
of  air  from  lungs  by  compression,  must  not  be  regarded  as  an  abso- 
lute proof  of  respiration.  It  must  be  taken  with  other  circum- 
stances, e.  g.  absolute  weight  and  color,  as  a  fact,  to  show  that  the 
child  has  either  breathed,  or  has  had  its  lungs  perfectly  inflated  in 
a  bond  fide  attempt  to  restore  life  after  birth,  either  by  the  mother 
or  by  some  person  present  at  the  birth.  In  cases  of  this  kind,  the 
only  course  left  open  to  a  medical  witness  is,  to  state  that  the  evi- 
dence derived  from  experiments  on  the  lungs  left  it  uncertain 
whether  the  child  in  question  had  breathed,  or  had  had  its  lungs 
artificially  inflated.  A  jury  will  then  know  how  to  return  their  ver- 
dict;  for  it  must  be  remembered,  they  have  always  circumstances, 


ERRONEOUS    APPLICATIONS    OF    HYDROSTATIC    TEST.      487 

as  well  as  medical  opinions,  to  guide  their  judgment ;  and  it  is  upon 
the  whole,  and  not  upon  a  part,  of  the  evidence  laid  before  them 
that  their  verdict  is  founded. 

In  concluding  these  remarks  upon  the  objections  to  the  hydrostatic 
test,  it  may  be  observed  that  medical  practitioners  have  differed 
much  at  different  times  in  their  ideas  of  what  it  was  fitted  to  prove. 
About  sixty  years  ago,  it  would  seem  that  this  test  was  regarded 
by  some  as  capable  of  furnishing  evidence  of  murder !  Thus  we 
find  Dr.  Hunter  asking  the  question,  "How  far  may  we  conclude 
that  the  child  was  born  alive,  and  probably  murdered  by  its  mother,  if 
the  lungs  swim  in  water?"  Later  authorities,  and,  indeed,  many  in 
the  present  day,  assert  that  the  test  is  capable  of  proving  whether  a 
child  has  been  born  alive  or  not !  From  what  has  already  been  stated, 
as  well  as  from  the  most  simple  reflection  on  the  circumstances  accom- 
panying the  birth  of  a  child,  I  think  it  must  be  evident  that  the  hydro- 
static test  is  no  more  capable  of  showing  whether  a  child  has  been  born 
alive  or  dead  than  it  is  of  proving  whether  it  has  been  murdered  or 
has  died  from  natural  causes.  The  majority  of  those  who  have  made 
experiments  on  this  subject  have  only  pretended  to  show,  by  the  use 
of  this  and  other  tests,  whether  or  not  a.  child  has  breathed;  the  tests 
merely  serve  to  furnish  in  many  cases  good  proof  of  life  from  the 
state  of  the  lungs ;  and  slight  reflection  will  render  it  apparent  that 
in  no  case  are  they  susceptible  of  doing  more.  Even  here  their 
utility  is  much  restricted  by  numerous  counteracting  circumstances, 
a  knowledge  of  which  is  essential  to  him  who  wishes  to  make  a  prac- 
tical application  of  them.  (See  "  Edin.  Med.  and  Surg.  Jour."  vol. 
26,  p.  365.) 

If  asked  to  state  in  what  cases  the  pulmonary  tests  are  capable  of 
assisting  a  medical  jurist,  the  answer,  it  appears  to  me,  would  be : 
1st.  They  will  clearly  show  that  a  new-born  child  has  lived,  when, 
during  its  life,  it  has /idly  and  perfectly  breathed.  Cases  of  this  des- 
cription form  a  certain  number  of  those  which  come  before  our  courts 
of  assize.  To  them  the  most  serious  objections  are  not  applicable ; 
and  the  few  which  might  be  made  to  the  medical  inferences  are  not 
difficult  to  answer.  2dly.  They  will  allow  a  witness  to  say,  that  the 
lungs  must  have  received  air  either  by  respiration,  or  by  artificial 
inflation.  These  are  the  cases  in  which  a  child  has  died  soon  after 
birth,  and  where  the  respiratory  changes  are  but  imperfectly  mani- 
fested in  the  lungs.  They  probably  form  a  large  proportion  of  those 
which  fall  under  the  jurisdiction  of  the  criminal  law.  It  might  be 
considered,  that  the  qualification  in  the  inference  here  drawn  would 
neutralize  its  force ;  but  it  must  be  remembered,  that  there  are  few 
instances  of  actual  and  deliberate  child-murder  wherein  artificial 
inflation  could  become  even  a  possible  defence  for  an  accused  person. 
So  unusual  is  this  kind  of  defence,  that  among  the  numerous  trials 
for  infanticide  which  have  taken  place  in  this  country  for  many 
years  past,  I  have  not  been  able  to  meet  with  a  single  instance  in 
which  it  was  alleged,  as  an  objection  to  the  medical  evidence  derived 
from  the  buoyancy  of  the  lungs,  that  the  prisoner  had  inflated  them 
in  order  to  resuscitate  her  child.     The  reason  is  obvious;  had  such 


488      ERRONEOUS    APPLICATIONS    OF    HYDROSTATIC    TEST. 

a  defence  been  attempted,  the  whole  of  the  circumstantial  evidence 
would  at  once  have  set  it  aside.  When,  in  the  suspected  murder  of 
an  adult,  a  medical  man  swears  that  a  fatal  wound  was  such  that  the 
deceased  might  have  inflicted  it  on  himself,  or  that  the  prisoner 
might  have  produced  it,  he  is  placing  the  jury  in  a  position  very 
similar  to  that  in  which  he  places  them  in  a  case  of  child-murder, 
when  he  says  that  the  child  might  have  breathed,  or  its  lungs  might 
have  been  artificially  inflated.  How  would  a  jury  decide  in  the  two 
cases  ?  Assuredly,  by  connecting  certain  facts  with  which  a  medical 
witness  is  not  concerned,  but  which  may,  in  their  opinion,  satisfac- 
torily supply  the  place  of  what  is  deficient  in  his  evidence.  It  is 
not  for  him  to  speculate  on  the  probabilities  of  respiration,  or  of  ar- 
tificial inflation ;  but  it  is  for  them  to  consider  whether  the  accused 
was  or  was  not  likely,  under  the  particular  circumstances  of  the 
case,  to  have  resorted  to  an  experiment  of  this  nature.  It  has  been 
suggested  that  some  person  might  inflate  the  lungs  of  a  dead  child, 
in  order  to  raise  a  charge  of  murder  against  its  mother ;  but  this  sug- 
gestion presupposes,  on  the  part  of  a  criminal,  a  profound  knowledge 
of  the  difficulties  of  medical  jurisprudence ;  and  even  then  the  ques- 
tion of  murder  does  not  depend  merely  on  the  presence  of  air  in  the 
lungs.  Such  a  case  is  very  unlikely  to  present  itself;  indeed,  its 
occurrence  is  no  more  probable  than  that  in  poisoning  it  should  be 
considered  a  good  defence  that  some  person  might  have  introduced 
poison  into  the  body  by  injections  after  death.  The  circumstances 
of  the  case  will  commonly  furnish  a  sufficient  answer  to  such  hypo- 
thetical views. 

The  hydrostatic  test  ought  not,  therefore,  to  be  lightly  condemned 
or  rejected  upon  a  speculative  objection,  which,  in  nine-tenths  of  the 
cases  of  child  murder,  could  not  possibly  exist.  Let  it  be  granted 
to  the  fullest  extent,  that  a  conscientious  medical  jurist  cannot 
always  draw  a  positive  distinction  between  the  effects  of  respiration 
and  artificial  inflation  on  the  lungs ;  still  a  jury  may  be  in  a  situa- 
tion to  relieve  him  from  this  difficulty.  In  short,  it  would  be  as 
reasonable  to  contend  that  all  persons  charged  with  murder  should 
be  acquitted  because  homicidal  are  not  always  to  be  distinguished 
from  suicidal  wounds,  as  to  argue  that  all  cases  of  infanticide  should 
be  abandoned  because  these  two  conditions  are  not  distinguishable 
by  any  certain  medical  signs.  If  juries  do  frequently  dismiss  such 
cases,  it  is,  I  apprehend,  to  be  ascribed  rather  to  their  great  unwil- 
lingness to  become  the  means  of  administering  what  they  consider 
to  be  severe  laws,  than  to  their  want  of  power  to  balance  and  decide 
on  the  probabilities  laid  before  them.  If  the  pulmonary  tests  were 
wholly  set  aside,  it  is  easy  to  conceive  what  would  be  the  conse- 
quences. Let  us  suppose  that  a  new-born  child  is  found,  under  sus- 
picious circumstances,  with  its  throat  cut ;  we  are  called  upon  to 
admit  that  it  is  impossible  for  medical  evidence  to  establish  whether 
the  child  has  lived  or  not,  and  therefore  we  are  to  decline  making  an 
inspection  of  its  body.  But  this  would  be  the  same  as  declaring 
that  child-murder  could  never  be  proved  against  an  accused  part  v. 
and  that  new-born  children  might  henceforth  be  destroyed  with  im- 


RESPIRATION"    BEFORE    OR    DURING    BIRTH.  489 

punity !  It  appears  to  me  that  conduct  of  this  kind  on  the  part  of 
a  medical  witness,  would  be  wholly  unwarrantable ;  for  we  may 
sometimes  acquire,  by  an  inspection,  as  great  a  certainty  of  respira- 
tion having  been  performed,  and  therefore  of  a  child  having  lived, 
as  of  any  other  fact  of  a  medico-legal  nature.  Cases  of  poisoning 
often  give  rise  to  greater  difficulties  to  a  medical  jurist ;  as  where, 
for  example,  he  attempts  to  found  his  opinion  of  the  cause  of  death 
on  symptoms  alone  or  on  appearances  in  the  dead  body.  But  we 
may  put  the  question  in  this  light.  In  the  body  of  a  healthy  full- 
grown  child,  which  has  but  recently  died,  we  find  the  lungs  filling 
the  cavity  of  the  chest,  of  a  light  red  color,  spongy,  crepitant  be- 
neath the  finger,  weighing  at  least  two  ounces,  and,  when  divided 
into  numerous  pieces,  each  piece  floating  on  water,  even  after  violent 
compression.  Is  it  possible  in  such  a  case  to  doubt  that  respiration 
has  been  performed  ?  If  there  is  no  certainty  here,  it  appears  to  me 
that  medical  experience  is  but  little  fitted  in  any  case  to  guide  us 
in  our  inquiries.  It  would  be  difficult  to  point  out  an  instance  in 
which  an  affirmative  medical  opinion  would  be  more  surely  warranted 
by  the  data  upon  which  it  was  founded. 

Respiration  Before  or  During  Birth. — It  has  been  already  stated 
that  the  pulmonary  tests  are  fitted  to  prove  only  whether  a  child  has 
or  has  not  lived  to  breathe.  Neither  the  hydrostatic  nor  any  other  test 
can  positively  show  that  the  body  of  a  child  was  entirely  born  alive 
when  the  act  of  breathing  was  performed.  As  this  is  a  subject 
which  generally  gives  rise  to  some  discussion  in  cases  of  child-mur- 
der, I  shall  here  make  a  few  remarks  on  it.  1st.  Respiration  may 
be  performed  while  the  child  is  in  the  uterus,  after  the  rupture  of 
the  membranes — the  mouth  of  the  child  being  at  the  os  uteri.  This 
is  what  is  termed  vagitus  uterinus ;  its  occurrence,  although  extremely 
rare,  seems  to  me  to  rest  upon  undisputed  authority.  2dly.  A  child 
may  breathe  while  its  head  is  in  the  vagina  either  during  a  presenta- 
tion of  the  head  or  of  the  breech.  This  has  been  termed  vagitus 
vaginalis.  It  is  not  very  common,  but  it  must  be  set  down  as  a  pos- 
sible occurrence.  3dly.  A  child  may  breathe  while  its  head  is  pro- 
truding from  the  outlet;  in  this  position  respiration  may  be  as 
completely  set  up  in  a  few  moments  by  its  crying,  as  we  find  it  in 
some  children  that  have  actually  been  born,  and  have  survived  their 
birth  for  several  hours.  This  is  the  most  usual  form  of  respiration 
before  birth.  In  the  vagitus  uterinus  or  vaginalis  the  lungs  receive 
but  a  very  small  quantity  of  air ;  in  respiration  after  protrusion  of 
the  head  the  lungs  may  be  sometimes  found  moderately  well  filled, 
although  never,  perhaps,  possessing  all  the  characteristic  properties 
of  those  which  have  fully  respired.  The  well-known  occurrence  of 
respiration  under  either  of  these  three  conditions,  strikingly  displays 
the  fallacy  of  making  this  process,  as  some  have  done,  the  certain 
boundary  of  extra- uterine  life.  A  child  may  breathe  in  the  uterus 
or  vagina,  or  with  its  head  at  the  outlet,  and  die  before  its  body  is 
born;  the  discovery  of  its  having  respired  would  not,  therefore,  be 
any  sort  of  proof  of  its  having  enjoyed  what  has  been  termed  "  extra- 
uterine life."     (For  a  well-marked  case  of  this  kind,  see  "  Med.  Gaz." 


490  INFANTICIDE.      GENERAL    CONCLUSIONS 

vol.  38,  p.  394;  and  another,  communicated  to  me  by  Dr.  Crothers, 
of  Coy,  will  be  found  in  "Guy's  Hospital  Reports,"  October,  1850, 
p.  231.)  The  deatli  of  a  child  which  has  breathed  in  the  uterus  or 
vagina,  from  natural  causes  before  its  entire  birth,  is  a  possible  occur- 
rence; hut  its  death  from  natural  causes  before  birth,  after  it  has 
breathed  by  the  protrusion  of  its  head  from  the  outlet,  is  an  unusual 
event.  All  that  we  can  say  is — -it  may  take  place ;  but  death  under 
these  circumstances  would  be  the  exception  to  a  very  general  rule. 
Oberkamp  states  that,  in  four  successive  deliveries  of  the  same 
woman,  the  children  breathed  during  delivery,  but  died  before  they 
were  born. 

Respiration  a  Sign  of  Life,  not  of  Live  Birth. — The  hydrostatic  test 
is  only  capable  of  determining  that  respiration  has  taken  place;  it  can- 
not show  whether  this  process  was  established  during  birth  or  after- 
wards. The  fact  of  a  child  having  the  power  of  breathing  before  it 
is  entirely  born,  does  not  therefore  constitute  the  smallest  objection 
to  its  employment ;  although  upon  this  ground,  we  find  the  use  of  it 
in  any  case  denounced  by  many  eminent  members  of  the  medical 
and  legal  professions.  Thus,  Archbold  says,  "  Very  little  confidence 
is  placed  in  this  test  as  to  the  lungs  floating,  particularly  if  the  child 
were  dead  any  length  of  time  before  the  experiment  was  made."' 
("  Criminal  Pleading,"  p.  367.)  Mathews  speaks  of  the  test  as  being 
"quite  exploded"  ("Digest,"  p.  251);  and  Jervis  makes  the  same 
remark  ("On  Coroners,"  p.  127).  It  is  obvious  that  most  members 
of  the  law  who  have  treated  this  subject  have  adopted,  without  suffi- 
cient examination,  the  statements  of  Dr.  William  Hunter.  This 
author  observes:  "A  child  will  commonly  breathe  as  soon  as  its 
mouth  is  born  or  protruded  from  the  mother ;  and  in  that  case  may 
lose  its  life  before  its  body  be  born,  especially  when  there  happens 
to  be  a  considerable  interval  between  what  we  may  call  the  birth  of 
the  child's  head  and  the  protrusion  of  its  body.  And  if  this  may 
happen  where  the  best  assistance  is  at  hand,  it  is  still  more  likely  to 
happen  when  there  is  none,  that  is,  where  the  woman  is  delivered 
by  herself."  ("On  the  Uncertainty  of  the  Signs  of  Murder  in  the 
Case  of  Bastard  Children."  p.  33.) 

Dr.  Hunter  here  exposes,  in  plain  language,  the  fallacy  of  trusting 
to  signs  of  respiration  alone  as  evidence  of  a  child  having  been  born 
alive.  The  truth  of  his  remarks  is,  in  the  present  day,  generally 
admitted;  and  if,  among  medico- legal  writers,  we  find  some  still 
treating  of  respiration  as  a  certain  proof  of  live  birth,  it  is  from  their 
not  having  sufficiently  considered  the  probability  of  a  child  breathing 
and  dying  before  its  body  is  entirely  extruded. 

Conclusions. — -The  general  conclusions  respecting  the  employment 
of  the  hydrostatic  test,  to  be  drawn  from  the  contents  of  this  chapter, 
are : — 

1.  That  the  artificial  inflation  of  the  lungs  of  a  child  born  dead 
will  cause  them  to  float  in  water. 

2.  That  lungs  artificially  inflated  while  in  the  chest  resemble  those 
organs  in  which  respiration  has  been  only  imperfectly  established. 

3.  That  in  cases  of  inflation  of  the  lungs  in  the  chest,  the  air  may 


FROM    THE    STATE    OF    THE    LUNGS.  491 

be  generally  expelled  from  the  divided  portions  of  lung  lyy  firm 
compression  so  as  to  cause  them  to  sink. 

4.  That  the  same  result  occurs  with  lungs  in  which  respiration 
has  been  imperfectly  established. 

5.  That  when  lungs  have  undergone  perfect  respiration,  the  air 
cannot  be  expelled  by  compression  of  the  divided  parts,  so  as  to  cause 
them  to  sink. 

6.  That  the  artificial  inflation  of  foetal  lungs  causes  no  alteration 
of  weight,  and  as  the  weight  increases  in  proportion  to  the  degree  of 
respiration,  so  in  healthy  lungs,  with  great  buoyancy,  there  should 
be  great  weight  if  the  air  has  been  derived  from  respiration. 

7.  That  we  should  base  our  judgment  of  a  child  having  breathed, 
upon  great  weight  and  great  buoyancy  of  the  lungs  combined,  that 
the  one  condition  without  the  other  is  open  to  the  objection,  that  the 
air  may  not  have  been  derived  from  respiration. 

8.  That  a  floating  of  the  lungs  in  water  proves,  casteris  paribus, 
that  a  child  has  breathed  either  at,  during,  or  after  birth :  it  does 
not  prove  that  a  child  was  born  alive,  or  that  it  has  died  a  violent 
death. 

9.  That  the  sinking  of  the  lungs,  as  a  result  of  the  expulsion  of 
air  from  them  by  compression,  does  not  necessarily  prove  that  the 
child  was  born  dead.  It  merely  proves  that  the  air  contained  in 
them  was  derived  either  from  artificial  inflation,  or  from  the  imper- 
fect establishment  of  the  respiratory  process. 

10.  That  the  hydrostatic  test  is  not  applicable  to  determine  the 
fact  of  respiration  or  non-respiration  in  all  cases  of  alleged  child- 
murder;  but  that,  with  ordinary  precautions,  it  may  be  safely 
employed  in  the  majority  of  such  cases. 

11.  That  a  child  may  breathe  before,  during,  or  after  birth,  but 
the  hydrostatic  test  will  not  enable  us  to  say,  in  the  greater  number 
of  cases,  at  which  of  these  periods  the  act  of  respiration  was  per- 
formed. 

12.  That  respiration  is  a  sign  of  life,  and  not  necessarily  of  live 
birth. 

13.  Hence  medical  evidence  is  required  to  show  whether  a  child 
breathed  after  it  was  entirely  born,  and  whether  the  act  of  violence 
which  caused  its  death  was  applied  to  it  while  so  breathing. 

These  conclusions  are  here  expressed  with  brevity.  Some  of 
them  may  require  qualification ;  but  for  the  circumstances  which 
qualify  them,  the  reader  is  referred  to  the  contents  of  the  chapter. 


492  INFANTICIDE.      PROPOSED    CHANGES 


CHAPTEE    XLVIII. 
On  the  proofs  of  a  child  having  been  born  ALIVE. — EVIDENCE 

FROM  RESPIRATION. — FROM  MARKS  OF  VIOLENCE. — FROM  NATURAL 
CHANGES  IN  THE  FCETAL  VESSELS. — FROM  THE  DISCOVERY  OF  FOOD 
IN  THE  STOMACH. — GENERAL  CONCLUSIONS. 

On  a  trial  for  child-murder,  the  important  medical  question  has 
hitherto  been :  Was  the  child  completely  born  alive  ?  The  inter- 
pretation set  upon  these  words  by  all  the  judges,  was  that  the  whole 
body  of  a  child  should  be  entirely  delivered  from  the  body  of  the 
mother  before  the  question  of  its  death  from  violence  could  be 
entertained.  Some  learned  judges  even  held  that  a  child  was  not 
legally  born  alive  until  it  was  severed  from  the  body  of  the  mother. 
In  cases  in  which  death  had  obviously  taken  place  from  criminal 
violence,  the  medical  witness  was  suddenly  stopped  in  his  evidence 
by  being  asked  for  some  infallible  proof  of  live  birth  in  a  legal 
sense.  As  a  medical  man,  not  present  at  the  delivery  could  rarely 
be  in  a  condition  to  offer  such  proof,  the  case  broke  down,  and  the 
accused  was  acquitted  of  the  charge  of  murder.  If  a  medical 
witness  ventured  to  say  that  he  formed  his  opinion  of  live  birth 
from  the  presence  of  air  in  the  lungs,  and  the  usual  appearances 
produced  in  these  organs  by  the  act  of  breathing,  he  was  immedi- 
ately met  with  the  objection  that  a  child  might  breathe  during  the 
act  of  birth,  and  die  before  its  body  was  born,  and  yet  the  appear- 
ances would  be  the  same.  To  this  there  was  generally  no  reply ; 
but  every  medical  man  could  perceive  that  an  exceptional  condition 
was  thus  strained  into  a  rule,  simply  to  procure  an  acquittal  on  a 
capital  charge.  Some  children  are  wilfully  injured  and  destroyed 
during  delivery,  but  the  greater  number  are,  no  doubt,  destroyed 
soon  after  they  have  been  entirely  born ;  still  there  is  nothing  of  a 
medical  nature  to  distinguish  one  set  of  cases  from  another.  In 
each  the  child  may  have  breathed,  and  the  lungs  may  contain  air ; 
while,  at  the  same  time,  the  fatal  violence — whether  indicated  by 
wounds,  fractures,  burns,  or  marks  of  strangulation  on  the  neek — 
would  be  the  same ;  there  would  be  no  medical  difference,  and  it  is 
obvious,  from  the  nature  of  things,  there  could  not  be  any  appear- 
ances by  which  the  partially  born  could  be  distinguished  from  the 
completely  born  child.  Medical  evidence  went,  on  these  occasions, 
as  far  as  it  could  be  reasonably  carried.  It  established  two  facts : 
1,  that  the  child  was  living  at  or  about  the  time  of  its  birth,  and 
when  the  violence  was  inflicted  upon  it ;  and,  2,  that  the  violence 
itself  was  sufficient  to  cause  death,  and  was,  in  fact,  the  cause  of 
death. 


IN    THE    CRIMINAL    LAW.  493 

The  Capital  Punishment  Commission,  whose  attention  had  been 
especially  directed  to  the  frequent  failures  of  justice  in  trials  for 
infanticide,  have,  in  their  recent  Eeport  (Dec.  1865),  made  some 
important  suggestions,  which,  if  carried  into  legislation,  will  relieve 
medical  evidence  of  some  of  those  insuperable  difficulties  which  it 
has  hitherto  had  to  encounter  in  cases  of  infanticide,  and  at  the 
same  time  remove  that  which  has  hitherto  been  a  stigma  upon  our 
criminal  law.     I  quote  the  following  passages  from  this  report : — 

"  The  crime  of  infanticide,  as  distinguished  from  murder  in  gene- 
ral, is  not  known  to  the  English  law.  The  moment  a  child  is  born 
alive,  it  is  as  much  under  the  protection  of  the  law  as  an  adult. 

"  14.  We  have  considered  whether  the  failure  of  justice,  which 
undoubtedly  ofteu  occurs  in  such  cases,  may  not  be  obviated  by 
some  change  in  the  law  which  shall  add  to  the  protection  of  new- 
born children.  The  principal  obstacle  which  now  prevents  the  due 
enforcement  of  the  law,  is  the  extreme  difficulty  of  giving  positive 
proof  that  the  child  alleged  to  have  been  murdered  was  completely 
born  alive. 

"  15.  We  have  given  this  important  and  difficult  subject  our 
serious  attention,  and  we  have  arrived  at  the  opinion  that  an  Act 
should  be  passed  making  it  an  offence,  punishable  with  penal  servi- 
tude or  imprisonment  at  the  discretion  of  the  court,  unlawfully  and 
maliciously  to  inflict  grievous  bodily  harm  or  serious  injury  upon  a 
child  during  its  birth  or  within  seven  days  afterwards,  in  case  such 
child  has  subsequently  died.  No  proof  that  the  child  was  com- 
pletely born  alive  should  be  required.  With  respect  to  the  offence 
of  concealment  of  birth,  we  think  that  no  person  should  be  liable 
to  be  convicted  of  such  offence  upon  an  indictment  for  murder,  but 
should  be  tried  upon  a  separate  indictment.  The  accused  should 
not  be  entitled  to  be  acquitted  in  either  of  the  above  cases  if  it 
should  be  proved  on  the  trial  that  the  offence  amounted  to  murder 
or  manslaughter." 

It  would  appear  from  these  paragraphs  that  provided  a  child  has 
died  from  injuries  unlawfully  inflicted  upon  it  either  during  its  birth 
or  within  seven  days  afterwards,  the  person  guilty  of  such  violence 
may  be  convicted  of  a  statutable  offence  involving  a  severe  punish- 
ment. It  will  not  be  necessary  that  the  medical  evidence  should 
prove  that  the  child  was  completely  born  alive,  or  severed  from  the 
body  of  the  mother  at  the  time  that  the  violence  was  inflicted  upon 
it.  This  will  not,  however,  alter  the  state  of  the  law,  or  afreet 
criminal  responsibility,  when  the  facts  establish  an  act  of  murder  or 
manslaughter.  The  proposed  change  is  intended  to  meet  the  two 
medical  difficulties  of  proof  of  complete  birth  and  of  violence  in- 
flicted during  or  after  birth.  The  operation  of  such  an  Act  will  be 
practically  to  repeal  the  punishment  of  death  in  cases  of  infanticide, 
because,  judging  from  past  experience,  the  greater  number  of  these 
charges  will  resolve  themselves  into  the  statutable  offence  punish- 
able with  penal  servitude  or  imprisonment.  Under  the  proposed 
new  system  of  legislation,  the  proof  of  entire  or  complete  birth 
would  be  no  longer  necessary;  but  proof  of  live  birth  is  not  dis- 


49-4  LIVE    BIRTH.      EVIDENCE    FROM    RESPIRATION 

pensed  with  when  the  charge  is  one  of  murder  or  manslaughter. 
Two  sets  of  cases  may  present  themselves  for  medical  evidence:  1, 
those  in  which  violence  is  applied  to  the  child  during  birth,  but 
the  child  is  born  alive,  and  dies  from  the  violence  either  imme- 
diately or  within  a  few  days;  and,  2,  those  in  which  the  violence  is 
applied,  and  the  child  dies  from  its  effects,  before  it  is  born,  or  in 
the  act  of  being  born;  as  in  that  form  of  infanticide  in  which  a 
woman  is  delivered  in  a  bath,  and  the  child,  when  born,  dies  from 
the  prevention  of  respiration,  or  where  a  child  is  deliberately 
strangled  or  suffocated  when  its  head  presents.  In  the  second  set 
of  cases,  there  can  be  no  medical  proof  of  live  birth;  hence,  these 
are  likely  to  be  treated  as  cases  of  still-birth.  The  complete  de- 
struction of  children  during  birth  by  wilful  violence,  can  apparently 
neither  be  defined  nor  punished  as  a  legal  offence.  This  exception 
in  the  proposed  legislation  on  infanticide  obviously  depends  on  the 
impossibility  of  distinguishing  a  child  which  has  died  from  natural 
causes  in  the  act  of  birth  from  one  which  has  been  destroyed  by  in- 
juries inflicted  during  its  birth.  Marks  of  violence  maybe  found  on 
the  dead  bodies  of  both  or  neither,  but  allowing  that  they  are  of  a  fatal 
character,  and  that  the  proof  of  the  exact  time  of  their  infliction  is 
unimportant,  how  is  a  witness  to  be  in  a  position  to  say  that  the 
child  died  from  the  injuries  subsequently  to  its  birth;  and  yet 
without  proof  of  this  a  criminal  may  escape.  The  material  part  of 
the  medical  proof,  then,  on  these  occasions  will  be  to  show  to  the 
satisfaction  of  a  court  that  the  injuries  did  not  prove  fatal  until 
after  the  birth  of  the  child.  The  legal  assumption  in  the  defence 
will  be  that  the  child  died  from  them  before  it  was  born,  and  that  it 
came  into  the  world  dead.  A  difficulty  of  this  kind  may,  however, 
be  removed  by  the  terms  of  the  proposed  new  statute.  One  learned 
judge  has  strongly  expressed  his  opinion  that  the  wilful  destruction 
of  a  child  during  birth,  or  before  it  is  completely  born,  should  be 
treated  as  a  distinct  offence,  and  that  there  should  not  be  an  acquittal 
on  the  ground  that  the  medical  evidence  did  not  prove  the  child  to 
have  been  completely  born;  leaving  it  to  the  discretion  of  the  judge 
to  direct  a  charge  of  murder  to  be  made. 

As  the  question  of  live  birth  may  still  therefore  incidentally  arise, 
it  will  be  necessary  to  consider  the  medical  facts  upon  which  reli- 
ance is  placed  as  furnishing  evidence  of  a  child  having  come  into 
the  world  living,  or  of  its  having  been  born  alive. 

Evidence  from  Respiration. — As  a  general  rule,  there  will  be  no 
perceptible  difference  in  the  state  of  the  lungs,  whether  the  act  of 
respiration  is  performed  by  a  child  during  birth  or  after  it  is  born, 
provided  that  its  death  speedily  follows  its  birth.  But  should  Ave 
find  that  this  process  has  been  perfectly  established,  i.e.  that  the  lungs 
present  all  those  conditions  which  have  been  described  as  character- 
istic of  full  and  perfect  breathing,  there  is  great  reason  to  presume 
that  the  process,  even  if  it  had  commenced  during  birth,  must  have 
continued  after  the  child  was  entirely  born.  This  presumption  be- 
comes still  stronger  when  the  child  is  immature;  for,  generally 
speaking,  such  children  must  be  born  and  continue  to  breathe  for 


AND    FROM    MARKS    OF    VIOLENCE.  495 

many  hours  after  birth,  in  order  that  their  lungs  should  present  the 
characters  of  complete  respiration.  The  process  is  seldom  so  estab- 
lished before  birth  as  to  give  to  these  organs  a  feeling  of  crepitation 
under  pressure  ;  the  existence  of  this  character  should,  therefore,  be 
sought  for.  A  witness  who  relied  upon  it  as  a  conclusive  proof  of 
breathing  after  birth,  might  be  asked  by  counsel,  whether  it  were 
not  possible  for  some  children  to  remain  so  long  at  the  outlet  with 
the  head  protruding,  as  to  render  the  lungs  crepitant  from  frequent 
respiration  before  birth.  Admitting  the  bare  possibility  of  this 
occurrence,  he  should  endeavor  to  ascertain  whether  there  were  any 
probable  cause  which  could  thus  have  protracted  delivery  while  the 
head  of  the  child  was  in  this  position ;  as  also,  what  natural  cause 
could  have  produced  its  death  when  its  head  was  protruding  and 
respiration  had  been  so  freely  performed  as  to  give  crepitation  to  the 
lungs.  The  presence  or  absence  of  the  usual  scalp-tumor  might 
throw  some  light  upon  the  case.  If,  when  present,  it  did  not  prove 
live  birth,  it  might  indicate  protracted  delivery,  and  show  that  the 
child  had  been  recently  living.  The  late  Professor  Casper,  of  Berlin, 
has  cut  the  Grordian  knot  of  this  difficulty,  by  assuming,  that  breath- 
ing before  birth  takes  place  only  in  protracted  delivery,  in  which  the 
assistance  of  an  accoucheur  is  required.  In  those  cases  which  are 
likely  to  give  rise  to  criminal  investigations,  he  assumes  that  the 
birth  of  the  child  takes  place  quickly,  and  that  in  rapid  delivery  the 
child  does  not  breathe  until  it  is  born  alive.  Hence  his  conclusion 
is — if  in  the  body  of  a  child  (secretly  disposed  of)  the  lungs  are  found 
to  contain  air  by  the  hydrostatic  test,  this  air  did  not  enter  the  lungs 
at  or  before  birth  but  afterwards,  and  that  the  child  was  born  alive. 
("  Gerichtl.  Medicin,"  vol.  1,  p.  710.)  Such  a  conclusion  is  not  in 
accordance  with  the  facts  ascertained  regarding  the  act  of  respiration 
in  new-born  children ;  it  may  be  that  they  rarely  die  from  natural 
causes  after  they  have  once  breathed,  but  that  they  can  breathe  and 
cry  during  birth  is  a  fact  which  cannot  be  disputed.  Further,  there 
is  no  test  known  by  which  air  received  into  the  lungs  during  birth, 
can  be  distinguished  from  that  which  has  entered  these  organs  after 
the  child  has  been  born  alive. 

Evidence  from  Marks  of  Violence. — If  marks  of  violence,  ap- 
parently inflicted  about  the  same  time,  are  found  on  different  and 
remote  parts  of  the  body,  and  these  marks  bear  the  characters  of 
those  produced  during  life,  it  is  rendered  probable  that  the  whole 
of  the  body  of  the  child  was  in  the  world  when  they  were  caused. 
Marks  of  severe  violence  on  one  part,  as  the  head  or  breech,  would 
not  always  justify  such  a  presumption,  because  it  might  be  fairly 
objected  that  they  had  been  unintentionally  produced  by  the  woman 
in  her  attempts  at  self-delivery,  and  yet  the  child  not  have  been  born 
alive.  It  would  be  for  a  witness  to  form  an  opinion  from  the  cir- 
cumstances accompanying  the  particular  case,  whether  they  had  been 
thus  occasioned.  From  this  it  will  be  seen  that,  in  making  an  exa- 
mination ui'ter  death,  it  is  proper  that  every  mark  of  injury  on  the 
body  of  a  child,  even  if  slight,  should  be  noted  down.     Abrasions 


496  LIVE    BIRTH.      SOURCES 

of  the  skin,  burns,  and  punctures,  should  be  noted,  and  the  throat 
examined  for  marks  of  pressure  by  a  cork  or  by  the  fingers. 

Evidence  from  Certain  Changes  in  the  Body. — In  a  child  that  has 
been  born  alive,  or  has  survived  its  birth  for  a  period  of  from  twelve 
to  twenty-four  hours,  that  portion  of  the  umbilical  cord  which  is 
contiguous  to  the  abdomen  undergoes  certain  changes;  it  dries  and 
becomes  slowly  shrivelled,  and  in  from  three  to  five  days  it  separates 
from  the  body  with  or  without  cicatrization. 

The  cord  does  not  separate  at  the  part  which  is  tied,  but  close  to 
the  abdomen.  It  separates  generally  within  five  days,  by  a  process 
of  sloughing,  the  skin  connected  with  the  dead  portion  of  the  cord 
presenting  a  red  line,  arising  from  capillary  congestion.  During  the 
separation  of  the  navel-string  the  umbilical  vessels  are  gradually 
closed.  According  to  Billard,  the  obliteration  of  these  vessels  is 
effected  in  a  peculiar  manner.  The  calibre  diminishes  as  a  result  of 
a  concentric  thickening  of  the  coats,  so  that,  while  the  vessel  retains 
its  apparent  size,  its  cavity  is  gradually  blocked  up.  A  quill  would 
represent  the  form  of  the  vessel  in  the  foetal  state,  and  a  tobacco-pipe 
in  the  obliterated  state.  It  is  only  by  cutting  through  the  vessel  that 
the  degree  of  obliteration  can  be  determined.  The  state  of  the  um- 
bilical cord  has  furnished  good  evidence  of  live  birth,  when  the  other 
circumstances  of  the  case  have  yielded  no  information. 

The  changes  in  the  umbilical  cord,  especially  those  indicative  of 
its  separation  and  cicatrization,  clearly  prove  that  a  child  has  sur- 
vived its  birth,  whatever  may  be  the  results  of  experiments  on  the 
lungs:  but  the  difficulty  is,  that  they  require  some  days  for  their 
production,  and  in  practice  it  is  necessary  to  procure  some  signs  of 
survivorship  of  only  a  few  minutes,  or  at  furthest  of  a  few  hours. 
The  same  remark  applies  to  the  exfoliation  of  the  cuticle,  in  a  new- 
born child ;  such  a  condition  of  the  skin  can  rarely  be  found  in  cases 
of  infanticide.  The  absence  of  meconium  from  the  intestines,  and  of 
urine  from  the  bladder,  are  not  proofs  of  live  birth,  for  these  may  be 
discharged  during  birth,  and  yet  the  child  not  be  born  alive. 

State  of  the  Skin. — In  the  greater  number  of  new-born  children, 
the  skin  has  a  dark-red  color,  probably  owing  to  the  first  effect  of 
the  atmosphere  upon  it.  AVithiu  an  hour  it  begins  to  get  of  a  lighter 
red,  and  so  it  remains  for  one  or  two  days.  According  to  Dr.  Elsasser, 
it  becomes  again  darker  about  the  end  of  the  second  or  on  the  third 
day,  and  is  then  of  a  brownish-red  color.  This  lasts  for  three  or 
four  days,  unless  a  yellowness  appears  from  jaundice.  It  is  then 
more  or  less  yellow.  It  is  about  the  sixth  or  seventh  day  that  the 
skin  acquires  a  recldish-white  color  such  as  it  afterwards  retains. 
(Henke's  "Zeitschrift  der  S.  A."  1842,  vol.  2.  p.  223.) 

Evid/nce  from  Changes  in  the  Ueart  and  Foetal  Vessels.  Docimasia 
Oirculationis. — It  has  been  supposed  that  the  state  of  the  diu-tus 
arteriosus,  ductus  venosus,  and  foramen  ovale  would  aid  a  medical 
jurist  in  forming  an  opinion  whether  a  child  had  survived  its  birth. 
In  general,  as  a  result  of  the  establishment  of  respiration,  it  is  found 
that  the  communication  between  the  auricles  of  the  heart  by  the 
foramen  ovale  becomes  closed;  and  that  the  two  vessels  or  ducts, 


OF    MEDICAL    EVIDENCE.  497 

after  gradually  contracting,  become  obliterated,  or  are  converted  into 
fibrous  cords.  Whatever  may  be  tlie  conclusions  from  experiments 
on  the  lungs,  it  has  been  contended  that  the*  closure  of  the  foramen 
and  of  these  vessels  would  infallibly  indicate  that  a  child  had  breathed. 
This  inference,  however,  has  been  too  hastily  drawn.  Eecent 
researches  have  shown  that  there  are  some  serious  objections  to  any 
conclusions  based  on  the  state  of  these  foetal  vessels ;  their  closure, 
as  a  natural  process,  always  takes  place  slowly,  and  sometimes  is  not 
completed  until  many  years  after  birth.  Thus,  then,  in  the  gener- 
ality of  cases  of  infanticide,  in  which  necessarily  the  child  survives 
but  for  a  short  period,  no  evidence  of  the  fact  will  be  procurable  from 
an  examination  of  the  heart  and  fcetal  vessels. 

As  a  general  rule,  the  peculiar  parts  of  the  fcetal  circulation  are 
rarely  obliterated  by  a  normal  process  before  the  eighth  or  tenth  day 
after  birth.  The  obliteration,  according  to  Bernt  and  Orfila,  takes  place 
in  the  following  order:  1.  The  umbilical  arteries ;  2.  The  ductus  veno- 
sus;  3.  The  ductus  arteriosus;  and  4.  The  foramen  ovale.  (Orfila,  "  Med. 
Leg."  1848,  vol.  2.  p.  210.)  The  circumstances  connected  with  the 
closure  of  these  fcetal  vessels  have  been  statistically  investigated  by 
Dr.  Elsasser.  Among  70  still-born  children  they  were  found  open  in  69. 
Among  300  children  who  died  soon  after  birth,  80  out  of  108  prema- 
turely born  and  living  from  one  to  eight  days,  presented  all  the  passages 
open :  127  out  of  192  infants  born  at  the  full  time  had  all  the  passages 
open,  but  partly  contracted.  The  ductus  arteriosus  was  open  in  55 
cases,  and  completely  closed  in  10  cases ;  the  ductus  venosus  was  open 
in  81,  and  completely  closed  in  37  cases;  while  the  foramen  ovale 
was  open  in  47,  and  completely  closed  in  18  cases  only.  These  facts, 
according  to  Dr.  Elsasser,  prove  that  the  vessels  peculiar  to  the  foetal 
circulation  remain  open  as  a  rule  for  some  time  after  birth,  and  that 
it  is  not  possible  to  determine  accurately,  by  days,  the  period  of  their 
closure.  This  physiologist  remarked  that  the  closure  commenced 
and  was  often  completed  in  the  ductus  venosus,  before  it  manifested 
itself  in  the  other  vessels.  The  complete  closure,  in  by  far  the  greater 
number  of  cases,  takes  place  within  the  first  six  weeks  after  birth, 
and  the  instances  of  obliteration  before  birth,  or  before  the  period 
mentioned  after  birth,  must  be  regarded  as  rare  exceptions.  ("Med. 
Times  and  Gaz."  May  21  1853,  p.  530.) 

From  these  facts,  the  docimasia  circulationis  may  be  considered  as 
useless  to  a  medical  jurist.  It  either  proves  nothing,  or  it  may  lead 
to  a  fatal  error.  It  is  the  more  necessary  to  point  out  the  fallacies 
to  which  it  is  liable,  because  hitherto  medical  jurists  have  been  dis- 
posed to  place  great  reliance  upon  it,  in  cases  in  which  medical  evi- 
dence from  the  state  of  the  lungs  was  wanting. 

Evidence  from  the  State  of  the  Alimentary  Canal. — Good  evidence  of 
live  birth  may  be  sometimes  derived  from  the  discovery  of  certain 
liquids  or  solids  in  the  stomach  and  intestines,  such  as  blood,  milk, 
or  farinaceous  or  saccharine  articles  of  food ;  for  it  is  not  at  all 
probable  that  these  substances  should  find  their  way  into  the  stomach 
or  intestines  of  a  child  which  was  really  born  dead. 

1.  Starch. — In  the  case  of  a  new-born  child,  Dr.  Geoghegan  dis^ 
32 


408 


LIVE    BIRTH.      EVIDENCE    FROM 


Fig.  43. 


covered,  by  the  application  of  iodine-water,  the  presence  of  fari- 
naceous food  in  the  contents  of  the  stomach;  hence  the  question  of 
live  birth  was  clearly  settled  in  the  affirmative.  On  another  occasion 
Dr.  Francis  employed  this  method  of  testing  with  satisfactory  results, 
in  a  case  in  which  the  investigation  was  beset  with  unusual  difficulties. 
He  was  required  by  the  coroner  to  examine  the  body  of  a  new-born 
child,  found  under  suspicious  circumstances.  The  examination  of 
the  lungs  left  no  doubt  that  respiration  had  taken  place ;  and  the  fact 
that  the  child  had  been  born  alive  was  fully  established  by  the  dis- 
covery in  the  stomach  of  a  small  quantity  of  farinaceous  food.  On 
digesting  in  distilled  water  a  fragment  of  the  pulp  found  in  this  organ, 
and  adding  a  drop  of  a  solution  of  iodine,  an  intense  indigo-blue 
color  appeared  immediately.  The  application  of  this  chemical  test, 
therefore,  removed  any  doubts  which  might  have  been  entertained 
on  the  question  of  live  birth.  ("  Med.  Gaz."  vol.  37,  p.  460.)  The 
quantity  of  starch  present  may,  however,  be  too  small  to  produce 
with  water  a  solution  which  would  be  colored  by  iodine  in  the 
manner  described.  A  portion  of  the  contents  of  the  stomach 
should  then  be  placed  on  a  glass  slide,  diluted  with  a  little  water  if 
viscid,  and  examined  under  the  microscope  with  a  power  of  about 

300  diameters.  The  granules  (if  present) 
may  then  be  distinctly  seen,  having  the 
shape  peculiar  to  each  variety  of  starch, 
and  not  unfrequently  mixed  with  oil- 
globules  and  epithelial  scales  derived  from 
the  mucous  membrane.  By  the  addition 
of  strong  iodine-water  their  shape  and  size 
will  be  brought  out  by  the  intensely  blue 
color  which  they  acquire.  Blue  frag- 
ments of  an  irregular  shape  indicate  the 
presence  of  bread.  The  an  nexed  engraving 
(Fig.  43)  represents  two  varieties  of  starch, 
either  of  which  may  be  found  in  the 
stomachs  of  infants ;  in  a  the  rounded 
granules  of  wheat  starch  are  represented, 
and  in  h  the  void  granules  of  arrowroot. 
The  micrometrical  measurements  of  the  granules  show,  for  those  of 
wheat,  which  are  irregularly  spherical,  diameters  varying  from 
l-9000th  to  l-1125th  of  an  inch  in  size.  Many  have  an  average 
diameter  of  1 -3000th  of  an  inch.  The  ovoid  granule  of  arrow- 
root is  l-900th  of  an  inch  in  length,  and  l-1800th  of  an  inch  in 
width. 

2.  Sugar. — In  a  case  which  I  was  required  to  examine,  the  pre- 
sence of  sugar  was  readily  detected  in  the  contents  of  the  stomach 
by  the  application  of  Trommer's  test.  In  order  to  apply  this  test,  a 
few  drops  of  a  weak  solution  of  sulphate  of  copper  should  be  added  to 
a  portion  of  the  cold  concentrated  aqueous  extract  of  the  contents  of 
the  stomach.  An  excess  of  a  solution  of  pure  potash  is  then  added, 
and  the  liquid  boiled.  If  sugar  be  present,  the  suboxide  of  copper 
is  immediately  precipitated  of  a  yellowish  or  reddish  color.     With 


Granules  of  wheat- Granules  of  arrow- 
starch,  root. 
Magnified  319  diameters. 


CHEMICAL    ANALYSIS    OF    CONTENTS    OF    STOMACH.      499 


white  sugar  the  same  decomposition  is  effected,  but  more  slowly.  If 
starch  only  be  present,  black  oxide  of  copper  may  be  thrown  down, 
but  there  will  be  no  production  of  a  red  precipitate.  The  formation 
of  the  red  oxide  of  copper  under  these  circumstances  proves  that 
some  saccharine  substance  is  present.  In  reference  to  the  applica- 
tion of  the  sugar-test,  however,  it  must  be  remarked  that  starch  is 
easily  convertible  into  sugar  by  a  chemical  action  of  saliva  or  mucus, 
so  that  the  test  may  appear  to  indicate  sugar  in  small  quantity,  when 
the  result  may  be  really  due  to  the  presence  of  some  converted 
starch. 

3.  Milk. — This  liquid  may  be  found  in  the  stomach  of  a  new-born 


Fig.  44. 


Fig.  45. 


Oil-globules  of  Oil-globules  of 

Human  Milk.  Cow's  Milk. 

Magnified  319  diameters. 


Oil-globules  of  Colostrum  with 

Human  Milk.  granular  bodies. 

Magnified  450  diameters. 


child ;  it  may  be  identified  microscopically  in  the  fluids  of  the 
stomach  by  the  numerous  and  well-defined  oil-globules  which  it  con- 
tains. It  is  not  possible  to  distinguish  human  from  cow's  milk 
under  these  circumstances.  In  both,  the  globules  which  are  spher- 
ical in  all  aspects,  are  remarkable  for  their  transparency  in  the 
centre,  and  their  dark  margin.  They  vary  considerably  in  size.  I 
have  found  those  of  the  cow  to  have  by  measurement  the  following 
diameters:  Maximum,  l-2200th  of  an  inch;  minimum,  l-18000th; 
and  medium  size,  1 -4500th  of  an  inch.  They  are  distinguished 
from  blood-corpuscles  by  their  shape  and  lustre,  and  from  starch 
granules  by  the  fact  that  they  are  not  colored  or  changed  by  iodine- 
water.  Colostrum  is  the  name  applied  to  the  milk  first  secreted  after 
delivery  ;  it  contains,  in  addition  to  oil-globules,  numerous  spherical 
granular  bodies  (Fig.  45,  b).  When  milk  is  present,  lactine  or  sugar 
of  milk  is  generally  found  in  the  contents  of  the  stomach  by  the 
appropriate  sugar-test  (supra).  The  casein,  or  solid  principle  of 
milk,  precipitates  oxide  of  copper  from  the  sulphate;  but  on  adding 
an  excess  of  a  solution  of  potash,  the  oxide  is  redissolved,  forming 
a  purple  or  violet  colored  solution.  It  is  rapidly  coagulated  by  the 
digestive  principle  (pepsine)  contained  in  the  gastric  juice,  so  that 
the  casein  may  be  found  in  small  soft  masses  adhering  to  the  lining 
membrane  of  the  stomach.  It  should  be  observed  that  albumen 
forms  a  deep  violet  colored  solution  with  sulphate  of  copper  and 


500 


SOURCES    OF    MEDICAL    EVIDENCE. 


Fig.  46. 


Tessellated  epithelial  scales, 
a  from  Sharpey:  b  from  observation. 


potash,  but  the  red  suboxide  of  copper  is  not  precipitated  on  boiling 
unless  sugar  is  mixed  with  it. 

4.  Epithelial  Scales. — The  epithelial  scales  commonly  found  asso- 
ciated with  articles  of  food  in  the  stomach  are  of  various  shapes  and 
sizes;  they  are  flat,  oval,  or  rounded,  and  sometimes  polygonal. 
They  are  nucleated,  and  from  their  pavement-like  appearance  they 
are  called  "  tessellated."  In  Fig.  46,  6,  an  epithelial  scale  from  the 
mucous  membrane  of  the  inside  of  the  mouth,  is  represented  magni- 
fied 570  diameters.  In  the  long  axis 
it  was  the  1 -500th  of  an  inch,  and  in 
the  shortest  1 -900th  of  an  inch  in  di- 
ameter. The  central  nucleus  was 
1 -4000th  of  an  inch  in  diameter,  and 
the  small  granules  around  it  1 -9000th 
of  an  inch.  These  epithelial  scales  are 
very  numerous,  much  intermixed,  and 
so  thin  and  transparent  that  they  are 
often  only  distinctly  seen  at  the  edges, 
which  are  occasionally  folded  or  slight- 
ly turned  over. 

Besides  the  substances  mentioned, 
other  solids  and  fluids,  such  as  blood 
and  meconium  (the  fecal  discharges  of  the  foetus)  may  be  found  in 
the  stomach  of  a  new-born  child,  and  a  question  may  arise  whether 
their  presence  indicates  that  the  child  was  fully  born.  It  is  not  im- 
possible that  a  child  might  be  fed  and  exert  a  power  of  swallowing 
when  its  head  protruded  from  the  outlet,  and  its  body  was  still  in 
the  body  of  the  mother.  Children  have  been  known  to  exert  a 
power  of  sucking  or  aspiration  under  these  circumstances,  and  with 
this  a  power  of  swallowing  might  be  exercised.  In  defending  a 
prisoner  on  a  charge  of  child-murder  counsel  would  scarcely  resort 
to  a  defence  of  this  kind.  That  the  starch,  sugar,  or  milk,  &c, 
found  in  the  stomach,  should  have  been  given  to  a  child  when  its 
body  was  only  half-born,  is  so  improbable  an  hypothesis  that  the 
most  inexperienced  lawyer  would  hardly  resort  to  it  to  account  for 
the  presence  of  food  in  this  organ. 

When  the  substances  found  in  the  stomach  are  not  in  the  form  of 
food,  but  are  fluids  connected  with  the  child  or  the  mother,  the  case 
is  different.  These  may  penetrate  into  the  lungs  or  stomach  during 
birth,  either  by  aspiration  or  the  act  of  swallowing:  they  thus 
indicate  that  the  child  was  living,  but  they  do  not  necessarily  show 
that  its  body  was  entirely  in  the  world  when  they  were  swallowed. 
5.  Blood. — An  instance  is  related  by  Dr.  Doring  in  which  a 
spoonful  of  coagulated  blood  was  found  in  the  stomach  of  a  new-born 
child.  The  inner  surfaces  of  the  gullet  and  windpipe  were  also  co- 
vered with  blood.  Dr.  Doring  inferred  from  these  facts  that  the  child 
had  been  born  alive;  for  the  blood,  in  his  opinion,  could  have  en- 
tered the  stomach  only  by  swallowing,  after  the  birth  of  the  child, 
and  while  it  was  probably  lying  with  its  face  in  a  pool  of  blood. 
Taken  alone,  however,  such  an  inference  would  not  be  justifiable 


EVIDENCE    FROM    BLOOD    AND    MECONIUM.  501 

from  the  facts  as  stated.  Blood  might  be  accidentally  drawn  into 
the  throat  from  the  discharges  of  the  mother  during  the  passage  of 
the  child's  head  through  the  outlet,  and  yet  the  child  may  not  have 
been  born  alive.  The  power  of  swallowing  may  be  exerted  by  a 
child  during  birth  either  before  or  after  the  act  of  breathing.  This 
power  appears  to  be  exerted  even  by  the  foetus  in  utero. 

Blood  may  be  recognized  in  the  contents  of  the  stomach  not  only 
by  the  color  which  it  imparts  to  the  mucous  liquids  present,  but  by 
the  aid  of  the  microscope.  This  subject  has  been  already  fully  con- 
sidered in  another  part  of  this  work  (p.  246). 

Dr.  Kobinson  has  made  some  researches  on  the  contents  of  the 
foetal  stomach  during  uterine  life.  He  finds  that  the  substances 
which  naturally  exist  in  the  stomach  of  a  foetus  before  birth  are  of 
an  albuminous  and  mucous  nature.  His  observations  were  made  on 
the  stomachs  of  two  human  foetuses,  and  on  those  of  the  calf,  lamb, 
and  rabbit.  The  conclusions  at  which  he  arrived  were:  1.  That  the 
stomach  of  the  foetus,  during  the  latter  period  of  its  uterine  exist- 
ence, invariably  contains  a  peculiar  substance  differing  from  the 
uterine  liquid  (liquor  amnii),  and  generally  of  a  nutritious  (?) 
nature.  2.  That  in  physical  and  chemical  properties,  this  substance 
varies  in  different  animals,  being  in  no  two  species  precisely  similar. 
3.  That  in  each  foetal  animal  the  contents  of  the  stomach  vary  at 
different  periods ;  in  the  earlier  stages  of  its  development  consisting 
chiefly  of  liquor  amnii,  to  which  the  other  peculiar  matters  are  grad- 
ually added.  4.  That  the  liquor  amnii  continues  to  be  swallowed  by 
the  foetus  up  to  the  time  of  birth,  and  consequently  after  the  formation 
of  these  matters  and  their  appearance  in  the  stomach.  5.  That  the 
mixture  of  this  more  solid  and  nutritious  substance  with  the  liquor 
amnii  constitutes  the  material  submitted  to  the  process  of  chymiiica- 
tion  in  the  foetal  intestines.  He  considers  the  contents  of  the  ali- 
mentary canal  to  be  chiefly  derived  from  the  salivary  secretion,  and 
that  gastric  juice  is  not  secreted  until  after  respiration  has  been 
established.  The  medical  jurist  will  perceive,  therefore,  that  the 
discovery  of  farinaceous  food,  milk,  or  sugar  in  the  stomach  will 
furnish  evidence  of  birth,  since  substances  of  this  kind  are  not  found 
naturally  in  this  organ. 

Dr.  H.  J.  Grosse  states  that  in  the  early  stage  of  uterine  life  the 
alimentary  canal  contains  merely  a  mucous  liquid.  At  the  third 
month  there  is  a  more  copious  secretion — a  clear  non-albuminous 
acid  liquid  is  found  in  the  stomach,  and  a  soft  chymous  liquid  is 
present  in  the  small  intestines.  Up  to  the  fifth  month  the  small  in- 
testines contain  meconium  of  a  grayish  color.  After  this  period 
the  meconium  becomes  gradually  of  a  deeper  color,. and  it  passes  into 
the  large  intestine.  When  the  child  has  attained  uterine  maturity, 
the  meconium  in  the  jejunum  is  whitish  ;  in  the  ileum,  yellow  ;  in  the 
caecum,  greenish-yellow;  in  the  ascending  colon,  green,  with  less 
yellow ;  and  in  the  rectum,  green-black,  like  poppy -juice  (hence  the 
name,  from  ^k^,  "  a  poppy").  It  is  a  mixture  of  the  constituent  parts 
of  bile-colored  granules,  of  epithelium  from  the  mucous  mem- 
brane lining  the  intestines,  and  of  mucous  matters  probably  de- 


502  LIVE    BIRTH.      THE    MECONIUM. 

rived  from  tlie  destruction  of  the  epithelial  cells.  Meconium  is  gene- 
rally discharged  from  the  bowels  of  a  child  within  forty-eighty  hours 
after  birth,  or  at  the  latest  on  the  third  day.  It  then  appears  of  the 
consistency  of  honey,  of  a  very  dark-green  (almost  black)  color,  with 
very  little  yellow  coloring-matter  in  it.  It  has  no  disagreeable  odor. 
It  specific  gravity  is  1.148.  ("  Des  Taches  au  Point  de  vue  Medico- 
legale,"  1863,  p.  75.) 

6.  Meconium. — This  name  is  applied  to  the  excrementitious  matter 
produced  and  retained  in  the  intestines  during  foetal  life.  It  may  be 
found  in  the  stomach  of  a  new-born  child,  and  a  question  will  thence 
arise  whether  its  presence  there  should  be  taken  as  a  proof  of  entire 
live  birth.  It  may  be  discharged  from  the  child  during  delivery,  in 
cases  in  which  there  is  a  difficult  or  protracted  labor.  In  the  act  of 
breathing  it  may  enter  the  throat  with  other  discharges,  and  thus  be 
found  in  the  stomach.  That  a  breathing  child  can  thus  swallow 
meconium  cannot  be  disputed,  but,  assuming  that  in  the  body  of  a 
child  which  has  not  lived  to  breathe  this  substance  is  found  in  the 
air-passages  and  stomach,  how  is  the  conclusion  affected?  In  the 
following  case  Dr.  Fleisher  was  required  to  examine  the  body  of  a 
new-born  child  which  was  said  to  have  been  born  dead.  He  found 
meconium  in  the  large  intestines  (the  colon  and  rectum),  and  a 
greenish-yellow-colored  liquid  in  the  cavity  of  the  stomach,  in  the 
larynx,  windpipe,  and  gullet.  In  the  air-passages  it  was  in  well- 
marked  quantity.  The  lungs  contained  no  air,  but  possessed  all  the 
usual  foetal  characters.  When  cut  into  pieces  and  placed  on  water, 
all  the  pieces  sank.  It  appeared  that  a  woman  was  present  at  the 
birth,  who  observed  that  the  child  did  not  breathe,  but  was  born 
dead.  It  was  not  bathed  or  washed,  and  no  air  was  blown  into  its 
lungs.  From  the  general  appearance  and  properties  of  the  liquid 
found  in  the  stomach  and  air-passages,  Dr.  Fleisher  had  no  doubt  that 
it  was  meconium  from  the  intestines  of  the  child.  It  could  not  have 
been  swallowed  after  the  child  was  born,  but  must  have  been  acci- 
dentally drawn  into  its  throat  by  efforts  to  breathe  during  birth. 
Some  of  the  meconium  had  probably  been  discharged  from  the  bowels 
of  the  child  during  labor,  and  as  the  mouth  passed  over  this  liquid 
a  portion  was  drawn  into  the  throat  by  aspiration.  "When  once  there, 
the  instinctive  act  of  swallowing  would  immediately  convey  a  por- 
tion of  it  into  the  stomach.  As  the  facts  connected  with  the  birth 
were  well  known,  this  appears  to  be  the  only  reasonable  explanation. 
(See  report  of  the  case  in  Casper's  "  Vierteljahrschrift,"  1863,  vol.  1, 
p.  97 ;  also  for  another  case,  "  Med.  Times  and  Gazette,"  August  3, 
1861,  p.  116.) 

The  presence  of  fluids  therefore — such  as  blood,  meconium,  or  the 
watery  discharges  attending  delivery — in  the  stomach  and  air- pass- 
ages of  a  new-born  child,  does  not  prove  live  birth,  but  merely  in- 
dicates the  existence  of  some  living  actions  in  the  child  at  or  about 
the  time  of  its  birth.  In  a  case  which  occurred  to  Dr.  Eamsbotham, 
a  woman  was  suddenly  delivered  of  a  child  while  sitting  over  a 
slop-pail  of  dirty  water.  On  examining  the  bod}^,  it  was  obvious 
that  it  had  not  breathed.     There  was  no  air  in  the  luncs,  but  a 


THE    MECONIUM. 


i03 


quantity  of  dirty  water  like  that  in  the  pail  was  found  in  the  stomach. 
This  could  have  entered  the  organ  only  by  the  act  of  swallowing, 
and,  in  Dr.  Eamshotham's  opinion,  the  child  had  swallowed  the 
liquid  under  some  foetal  attempt  to  breathe.  The  coroner  who 
held  the  inquest  directed  the  jury  that  the  child  was  born  dead : 
but  most  physiologists  will  consider  that  the  power  of  swallowing 
cannot  be  exerted  by  a  dead  child;  and  as  its  body  must  have  been 
entirely  delivered  in  order  to  have  fallen  into  the  liquid,  there  was 
proof  that  it  had  been  born  living,  and  that  in  this  instance  it  had 
died  after  it  was  entirely  born,  by  the  prevention  of  the  act  of 
breathing. 

The  meconium  may  be  generally  recognized  by  its  dirty-green 
color  and  general  appearance,  as  well  as  by  the  absence  of  any  offen- 
sive odor,  which  it  does  not  acquire  until 
after  the  third  or  fourth  day,  when  it  becomes 
mixed  with  feculent  matter.  Its  microsco- 
pical characters  are  represented  in  the  an- 
nexed engraving  (Fig.  47.)  In  the  air  pas- 
sages it  is  sometimes  associated  with  ver- 
nix  caseosa,  and  hairs  derived  from  the 
skin.  ("Med.  Times  and  Gazette,"  June  1, 
1861,  p.  591,  and  Aug.  3,  1861,  p.  117;  see 
also  "Ann.  d'Hyg."  1855,  vol.  2,  p.  445. 

But  little  need  be  said  on  its  chemical 
properties ;  still,  as  the  detection  of  stains  of 
meconium  on  clothing  may  occasionally 
form  a  part  of  the  medical  evidence,  a  few 
observations  are  here  required.  The  stains 
which  it  produces  are  of  a  brownish-green 
color,  very  difficult  to  remove  by  washing. 
They  stiffen  the  stuff,  and  are  usually  slightly 
raised  above  the  surface  without  always 
penetrating  it.  Meconium  forms  with  water 
a  greenish-colored  liquid,  having  an  acid 
reaction ;  a  boiling  heat  does  not  affect  the  solution.  Nitric  acid  and 
sulphuric  acid  with  sugar  yield  with  it  the  green  and  red-colored 
compounds  which  they  produce  with  bile.  Cholesterine  may  be 
separated  from  it  by  hot  ether. 

It  may  be  remarked,  in  reference  to  stains  produced  by  the  fasces 
of  a  child  which  has  survived  birth,  that  until  the  fifth  or  sixth  day 
they  retain  a  dark-green  or  greenish-yellow  color.  On  the  seventh 
day  after  birth,  they  generally  acquire  a  bright-yellow  color,  like 
that  of  the  yelk  of  an  egg ;  and  this  color,  if  the  child  is  in  health, 
they  will  retain  during  all  the  time  that  it  is  suckled. 

The  slightest  consideration  will  show  that  the  various  signs  of  live 
birth  above  described  are  weak,  and  of  purely  accidental  occurrence. 
If  a  child  is  destroyed  either  during  birth,  or  within  a  few  minutes 
afterwards,  there  will  be  no  medical  evidence  to  indicate  the  period 
:it  which  its  destruction  took  place;  the  external  and  internal  ap- 
pearances presented  by  the  body  will  be  the  same  in  the  two  cases. 


Microscopical  appearances  of  Me- 
conium : — a  crystals  of  cholester- 
ine ;  b  epithelial  scales  ;  c  masses 
of  green  coloring-matter  of  bile 
(biliverdia)  ;  d  e.  granules. 
Magnified  -t'  0  diameters. 


50-i  GENERAL    CONCLUSIONS    ON    LIVE    BIRTH. 

It  is  most  probable  that  in  the  greater  number  of  instances  of  child- 
murder,  a  child  is  actually  destroyed  either  during  birth  or  imme- 
diately afterwards ;  and,  therefore,  the  characters  above  described 
can  rarely  be  available  in  practice.  If  any  exception  be  made,  it 
is  with  respect  to  the  nature,  situation,  and  extent  of  marks  of  vio- 
lence ;  but  the  presence  of  these  depends  on  mere  accident.  Hence, 
then,  we  come  to  the  conclusion  that  although  medical  evidence  can 
generally  show,  from  the  state  of  the  lungs,  that  a  child  has  really 
lived,  it  can  rarely  be  in  a  condition  to  prove,  in  a  case  of  infanti- 
cide, that  its  life  certainly  continued  after  its  birth.  We  could  only 
venture  upon  this  inference  when  the  signs  of  breathing  were  full 
and  complete,  or  when  some  article  of  food  was  found  in  the 
stomach. 

Conclusions. — The  general  conclusions  which  may  be  drawn  from 
the  facts  contained  in  this  chapter,  on  the  question  whether  a  child 
has  or  has  not  been  horn  alive,  are  as  follows  : — 

1.  That  if  the  lungs  be  fully  and  perfectly  distended  with  air  by 
the  act  of  breathing,  this  affords  a  strong  presumption  that  the  child 
has  been  born  alive,  since  breathing  during  birth  is  in  general  only 
partial  and  imperfect. 

2.  That  the  presence  of  marks  of  severe  violence  on  various  parts 
of  the  body,  if  possessing  vital  characters,  renders  it  probable  that 
the  child  was  born  alive  when  the  violence  was  inflicted. 

3.  That  certain  changes  in  the  umbilical  vessels,  and  the  separa- 
tion (by  a  vital  process)  and  the  cicatrization  of  the  umbilical  cord, 
as  well  as  a  general  peeling  or  scaling-off  of  the  cuticle,  indicate  live 
birth. 

4.  That  the  absence  of  meconium  from  the  intestines  and  of  urine 
from  the  bladder,  are  not  proofs  that  a  child  has  been  born  alive, 
since  these  liquids  may  be  discharged  during  the  act  of  birth. 

5.  That  the  open  or  contracted  state  of  the  foramen  oval  or  ductus 
arteriosus  furnishes  no  evidence  of  a  child  having  been  born  alive. 
These  parts  may  become  closed  and  contracted  before  birth,  and  there- 
fore be  found  closed  in  a  child  born  dead ;  or  they  may  remain  open 
after  birth  in  a  child  born  living,  even  subsequently  to  the  establish- 
ment of  respiration. 

6.  That  the  presence  of  farinaceous  or  other  food  in  the  stomach 
proves  that  a  child  has  been  entirely  born  alive. 

7.  That  the  presence  of  blood,  meconium,  vernix  caseosa,  or  the 
discharges  in  the  stomach  and  air-passages,  does  not  prove  that  a 
child  was  born  alive. 

8.  That  irrespective  of  the  above  conclusions,  there  is  no  certain 
medical  sign  which  indicates  that  a  child  that  has  died  at  or  about 
the  time  of  birth,  has  been  born  alive. 


NATURAL  CAUSES  OF  DEATH.  505 


CHAPTER   XLIX. 

Causes  of  death  in  new-born  children. — proportion  of  chil- 
dren  BORN    DEAD. NATURAL  CAUSES  OF  DEATH. A   PROTRACTED 

DELIVERY. — DEBILITY. — BLEEDING  FROM  LACERATION  OF  THE  NA- 
VEL STRING. — COMPRESSION  OF  THE  NAVEL-STRING. — MALFORMA- 
TION.— DESTRUCTION  OF  MONSTROUS  BIRTHS. — DEATH  FROM  CON- 
GENITAL DISEASE. 

Causes  of  Death  in  New-horn  Children. — The  next  important  ques- 
tion in  a  case  of  infanticide,  and  that  upon  which  a  charge  of  murder 
essentially  rests,  is  :  What  was  the  cause  of  death  ?  1.  It  is  admitted 
that  a  child  may  die  during  birth  or  afterwards.  2.  In  either  of  these 
cases  it  may  die  from  natural  or  violent  causes.  The  violent  causes 
may  have  originated  in  accident  or  in  criminal  design.  The  last  con- 
dition only  involves  the  corpus  delicti  of  child-murder.  If  death 
has  clearly  proceeded  from  natural  causes,  it  is  of  no  importance  to 
settle  whether  the  cause  operated  during  or  after  birth.  All  charge 
of  criminality  is  thenceforth  at  an  end. 

It  is  well  known  that  of  children  born  under  ordinary  circum- 
stances, a  great  number  die  from  natural  causes  either  during  birth 
or  soon  afterwards ;  and  in  every  case  of  child-murder,  death  will  be 
presumed  to  have  arisen  from  some  cause  of  this  kind  until  the  con- 
trary appears  from  the  medical  evidence.  This  throws  the  onus  of 
proof  entirely  on  the  prosecution.  Many  children  die  before*  per- 
forming the  act  of  respiration ;  and  thus  a  large  number  come  into 
the  world  dead  or  still-born.  The  proportion  of  still-born  among 
legitimate  children,  as  it  is  derived  from  statistical  tables  extending 
over  a  series  of  years,  and  embracing  not  fewer  than  eight  millions 
of  births,  varies  from  one  in  eighteen  to  one  in  twenty  of  all  births. 
("  Brit,  and  For.  Med.  Rev."  No.  7,  p.  235.)  In  immature  and  ille- 
gitimate children,  forming  the  greater  number  of  those  which  give 
rise  to  charges  of  child- murder,  the  proportionate  mortality  is  much 
greater  ;  probably  about  one  in  eight  or  ten.  Still-births  are  much 
more  frequent  in  first  than  in  after- pregnancies.  These  facts  should 
be  borne  in  mind,  when  we  are  estimating  the  probability  of  the 
cause  of  death  being  natural.  Thus,  children  are  much  more  fre- 
quently born  dead  among  primiparous  than  among  non-primiparous 
females.  According  to  Dr.  Lawrence's  observations,  the  proportion 
of  deaths  is  1  to  11  of  the  primiparous  and  1  to  31.2  among  the  non- 
primiparous.  ("  Edin.  Med.  Jour."  March,  1863,  p.  815.)  In  most 
cases  of  child-murder  the  woman  is  primiparous. 

Should  breathing  be  established  by  the  protrusion  of  the  child's 
head  from  the  outlet,  or  during  the  birth  of  the  body,  the  chances 


506  NATURAL    CAUSES    OF    DEATH. 

of  death  from  natural  causes  are  considerably  diminished.  Never- 
theless, as  Dr.  Hunter  long  ago  suggested,  a  child  may  breathe  and 
die.  Thus,  according  to  this  author,  "  If  the  child  makes  but  one 
gasp  and  instantly  dies,  the  lungs  will  swim  in  water  as  readily  as 
if  it  had  breathed  longer  and  had  then  been  strangled."  In  general, 
it  would  require  more  than  one  gasp  to  cause  the  lungs  to  swim 
readily  in  water ;  but  waiving  this  point,  the  real  question  is  :  If 
the  child  breathed  either  during  or  after  birth,  what  could  have 
caused  its  death  ?  The  number  of  gasps  which  a  child  may  make, 
or  which  may  be  required  for  the  lungs  to  swirn  in  water,  is  of  no 
moment ;  the  point  to  be  considered  is,  whether  its  death  was  due  to 
causes  of  an  accidental  or  criminal  nature.  So  again  observes  Dr. 
Hunter :  "  We  frequently  see  children  born,  who,  from  circum- 
stances in  their  constitution  or  in  the  nature  of  the  labor,  are  but 
barely  alive,  and  after  breathing  a  minute  or  two,  or  an  hour  or  two, 
die,  in  spite  of  all  our  attention.  And  why  may  not  this  misfortune 
happen  to  a  woman  who  is  brought  to  bed  by  herself?"  (Op.  cit.) 
The  substance  of  this  remark  is,  that  many  children  may  die  natu- 
rally after  having  been  born  alive ;  and  in  Dr.  Hunter's  time,  these 
cases  were  not  perhaps  sufficiently  attended  to.  In  the  present  day, 
however,  the  case  is  different ;  a  charge  of  child-murder  is  seldom 
raised,  except  in  those  instances  where  there  are  the  most  obvious 
marks  of  severe  and  mortal  injuries  on  the  body  of  a  child  ;  and  un- 
less it  be  intended  to  defend  and  justify  the  practice  of  infanticide, 
it  must  be  admitted  that  the  discovery  of  violence  of  this  kind  on 
the  body  of  a  new-born  infant  renders  a  full  inquiry  into  the  cir- 
cumstances necessary.  Among  the  natural  causes  of  the  death  of  a 
child  may  be  enumerated  the  following : — ■ 

1.  A  Protracted  Delivery. — The  death  of  a  child  may  proceed,  in 
this  case,  from  injury  suffered  by  the  head  during  the  violent  con- 
tractions of  the  uterus,  or  from  an  interruption  to  the  circulation  in 
the  umbilical  cord  before  respiration  is  established.  A  child,  espe- 
cially if  feeble  and  delicate,  may  die  from  exhaustion  under  these 
circumstances.  This  cause  of  death  may  be  suspected  when  a  sero- 
sanguinolent  tumor  (called  cephaldematoma,  or  caput  succedaneum)  is 
found  on  the  head  of  a  child,  and  the  head  itself  is  deformed  or 
elongated ;  internally,  by  the  congested  state  of  the  vessels  of  the 
brain.  The  existence  of  deformity  in  the  pelvis  of  the  woman  might 
corroborate  this  view ;  but  in  primiparous  women  (among  whom 
charges  of  child-murder  chiefly  lie)  with  well-formed  pelves,  delivery 
is  frequently  protracted.  It  is  presumed  that  there  are  no  marks  of 
violence  on  the  body  of  the  child,  excepting  those  which  may  have 
reasonably  arisen  from  accident  in  attempts  at  self-delivery. 

2.  Debility. — A  child  may  be  born  either  prematurely  or  at  the 
full  period,  and  not  survive  its  birth,  owing  to  a  natural  feebleness 
of  system.  This  is  observed  among  immature  children ;  and  it  is  a 
condition  especially  dwelt  on  by  Dr.  Hunter.  Such  children  may 
continue  in  existence  for  several  hours,  breathing  feebly,  and  may 
then  die  from  mere  weakness.     These  cases  may  be  recognized  by 


MALFOEMATIONS.  507 

the  immature  condition  of  the  body  and  the  appearance  of  a  general 
want  of  development. 

8.  Bleeding  from  Laceration  of  the  Navel- String. — A  child  may  die 
from  loss  of  blood,  owing  to  a  premature  separation  of  the  placenta 
or  an  accidental  rupture  of  the  navel-string.  In  the  latter  case  it  is 
said  the  loss  of  blood  is  not  likely  to  prove  fatal  if  breathing  has 
been  established;  but  an  instance  is  reported  in  which  a  child  died 
from  bleeding  even  under  these  circumstances.  (Henke's  "Zeits- 
chrift,"  1839,  Erg.  H.,  p.  200;  also  1840,  vol.  1,  p.  347,  and  vol.  2, 
p.  105 ;  "  Ann.  d'Hyg."  1831,  vol.  2,  p.  128.)  Bleeding  from  the  cord 
has  in  some  cases  taken  place  at  various  periods  after  birth,  and  has 
led  to  the  death  of  the  child.  ("  Edin.  Month.  Jour."  July,  1847,  p. 
70.)  Death  from  bleeding  may  be  commonly  recognized  by  the 
blanched  appearance  of  the  body,  and  a  want  of  blood  in  the  internal 
organs ;  but  there  are  several  instances  on  record,  in  which  the  cord 
was  ruptured  close  to  the  abdomen  without  causing  the  death  of  the 
child.  Bleeding  from  the  vessels  of  the  navel-string  may  prove  fatal 
several  days  after  birth,  even  when  a  child  has  been  properly  at- 
tended to,  and  the  navel-string  has  separated  by  the  natural  process. 
Mr.  Willing  has  reported  a  case  of  this  kind,  in  which,  in  spite  of 
every  application,  the  child  died  from  loss  of  blood  six  days  after 
the  cord  had  separated.  ("  Med.  Times  and  Gaz."  March  25,  1854, 
p.  287.)  The  impossibility  of  arresting  the  bleeding  in  this  case  ap- 
peared to  depend  upon  a  great  deficiency  of  fibrin  in  the  blood,  and 
a  consequent  want  of  tendency  to  coagulation. 

4.  Compression  of  the  Navel-String. — When  a  child  is  born  by  the 
feet  or  buttocks,  the  cord  may  be  so  compressed  under  strong  uterine 
contraction  that  the  circulation  between  the  mother  and  child  will 
be  arrested,  and  the  latter  will  die.  The  same  fatal  compression  may 
follow  when,  during  delivery,  the  cord  becomes  twisted  round  the 
neck.  A  child  has  been  known  to  die  under  these  circumstances  be- 
fore parturition,  the  cord  having  become  twisted  round  its  neck  in 
the  uterus.  ("Med.  Gaz."  Oct.  1840,  p.  122;  also  vol.  19,  pp.  232, 
233.)  On  these  occasions  the  child  is  sometimes  described  to  have 
died  from  strangulation,  but  it  is  evident  that  before  the  establish- 
ment of  respiration  such  a  form  of  expression  is  improper.  There 
are  few  or  no  appearances  indicative  of  the  cause  of  death.  There 
may  be  lividity  about  the  head  and  face,  with  a  mark  or  furrow  on 
the  neck,  and  congestion  of  the  brain  internally ;  it  is,  however,  ne- 
cessary to  remember  that  the  brain  of  a  child  is  always  more  congested 
than  that  of  an  adult. 

5.  Malformation.  Monstrosity. — There  may  be  a  deficiency  or  de- 
fect of  some  vital  organ  which  would  at  once  account  for  a  child 
dying  either  during  delivery  or  soon  after  its  birth.  Two  cases  are 
reported,  in  one  of  which  the  child  died  from  an  absolute  deficiency 
of  the  gullet ;  the  pharynx  terminating  in  a  cul-de-sac  ;  in  the  other, 
the  duodenum  was  obliterated  for  more  than  an  inch,  and  this  mal- 
formation had  occasioned  the  child's  death.  ("  Med.  Gaz."  vol.  26,  p. 
542.)  In  a  third,  recorded  by  Mr.  Fairbairn,  a  child  was  suffocated 
by  a  retraction  of  the  base  of  the  tongue,  owing  to  defect  of  the 


508  NATURAL    CAUSES    OF    DEATH. 

fraenum.  ("  North  Jour.  Med."  March,  1849,  p.  278.)  The  non-estab- 
lishment of  respiration  sometimes  arises  from  the  mouth  and  fauces 
of  the  child  being  filled  with  mucus.  An  enlargement  of  the  thy- 
roid gland  has  occasionally  led  to  the  death  of  a  new-born  child  by 
suffocation.  ("  Edin.  Month.  Jour."  July,  1847,  p.  64.)  The  epiglot- 
tis is  sometimes  fixed  over  the  glottis  so  as  to  prevent  the  entrance 
of  air.  In  a  case  which  occurred  to  Dr.  Hicks,  a  child  was  saved  by 
the  introduction  of  a  finger ;  the  air  suddenly  rushed  in,  and  the 
child  was  enabled  to  breathe.  But  a  child  may  be  born  in  this  state 
when  no  person  is  at  hand  to  assist  the  woman ;  in  this  case  it  will 
die  ;  and  the  lungs  being  found  in  the  foetal  or  unexpanded  condition, 
it  will  be  pronounced  still-born.  Obstruction  of  the  air-passages  is 
a  frequent  cause  of  death  among  still-born  children. 

The  varieties  of  malformation  are  very  numerous,  but  there  can  be 
no  difficulty  in  determining  whether  they  are  such  as  to  account  for 
death.  Persons  are  not  allowed  to  destroy  monstrous  births ;  and 
the  presence  of  any  marks  of  violence  in  such  cases  should  be  re- 
garded with  suspicion.  It  is  the  more  necessary  to  make  this  state- 
ment, as  there  is  an  idea  among  the  vulgar  that  it  is  not  illegal  to 
destroy  a  monstrous  birth.  Mr.  Poole,  of  Cirencester,  communicated 
to  me  a  case  which  occurred  some  years  since  in  his  practice.  A 
lady  was  delivered  of  a  most  hideous  dicephalous  (two-headed) 
monster.  In  his  absence,  and  at  the  earnest  solicitations  of  the 
friends,  the  nurse  destroyed  it.  The  question  was,  was  this  woman 
guilty  of  murder  ?  The  only  case  in  reference  to  this  point  which 
is  recorded  by  medico-legal  writers,  is  that  of  two  women  who  were 
tried  at  the  York  Assizes  in  1812,  for  drowning  a  child  which  was 
born  with  some  malformation  of  the  head,  in  consequence  of  which 
it  was  likely  that  it  could  not  survive  many  hours.  It  did  not  ap- 
pear that  there  had  been  any  malice  or  concealment  on  the  part  of 
the  prisoners,  who  were  not  aware  of  the  illegality  of  the  act.  (Paris 
and  Fonblanque,  ("  Med.  Jur."  vol.  1,  p.  228.)  The  absence  of  ma- 
licious intention  would  probably  lead  to  an  acquittal  on  a  charge  of 
murder,  but  such  an  act  would  doubtless  amount  to  manslaughter ; 
the  degree  of  monstrosity  or  the  viability  of  the  offspring  cannot  be 
received  as  an  extenuating  circumstance.  As  to  the  first,  if  a  liberty 
of  judging  what  was  monstrous  and  what  not,  were  conceded  to  any 
ignorant  nurse,  children  simply  deformed  might  be  put  to  death  on 
this  pretence ;  as  to  the  second,  it  is  held  in  law  that  whoever  accel- 
erates death  causes  it ;  hence  the  fact  that  the  offspring  is  not  likely 
to  live  more  than  a  few  hours  does  not  justify  the  act  of  one  who 
prematurely  destroys  it. 

6.  Atelectasis. — This,  as  it  has  been  elsewhere  explained,  implies 
simply  an  unexpanded  state  of  the  lungs.  In  some  cases  it  is  com- 
pleted, in  others  partial.  (See  ante,  p.  480.)  It  can  scarcely  be 
regarded  as  a  diseased  condition,  as  the  body  of  the  child  may  be 
otherwise  healthy ;  the  lungs  themselves  are  in  a  normal  state,  and 
they  can  be  easily  expanded  by  the  artificial  introduction  of  air. 
That  they  are  not  so  expanded  during  birth  or  afterwards  may  arise 
from  feebleness  in  the  child. 


CONCLUSIONS.  509 

7.  Congenital  Disease. — It  has  been  elsewhere  stated,  that  a  child 
may  be  born  laboring  under  such  a  degree  of  congenital  disease  as 
to  render  it  incapable  of  living.  The  discovery  of  any  of  the  foetal 
organs  merely  in  a  morbid  condition  amounts  to  nothing  unless  the 
disease  has  advanced  to  a  degree  which  would  be  sufficient  to  account 
for  death.  There  are,  doubtless,  many  obscure  affections,  particu- 
larly of  the  brain,  which  are  liable  to  destroy  the  life  of  a  child  with- 
out leaving  any  well-marked  changes  in  the  dead  body.  According 
to  Dr.  Burgess,  apoplexy  and  asphyxia  are  common  causes  of  death 
among  new-born  children.  ("  Med.  Gaz."  vol.  26,  p.  492  ;  Henke's 
"  Zeitschrift  der  S.  A."  1843,  p.  67.)  Probably  diseases  of  the  lungs 
are  of  the  greatest  importance  in  a  medico-legal  point  of  view ;  be- 
cause, by  directly  affecting  the  organs  of  respiration,  they  render  it 
impossible  for  a  child  to  live,  or  to  survive  its  birth  for  a  long 
period.  These  diseases  in  the  foetal  state  are  principally  conges- 
tion, hepatization,  tubercle,  scirrhus,  and  oedema ;  the  existence  of 
any  of  which  it  is  not  difficult  to  discover.  They  render  the  struc- 
ture of  the  lungs  heavier  than  water,  and  thus  prevent  the  organs 
from  acquiring  that  buoyancy  which  in  their  healthier  state  they  are 
known  to  possess.  It  is  not  common  to  find  the  lungs  diseased  through- 
out ;  a  portion  may  be  sufficiently  healthy  to  allow  of  a  partial  per- 
formance of  respiration. 

Conclusions. — The  following  conclusions  may  be  drawn  from  the 
preceding  remarks : — 

1.  That  a  large  number  of  illegitimate  children,  especially  when 
immature,  are  born  dead  from  natural  causes. 

2.  That  a  child  may  die  from  exhaustion  as  the  result  of  a  pro- 
tracted labor. 

3.  That  if  a  child  be  prematurely  born,  or  if  it  be  small  and  weak 
even  at  the  natural  period,  it  may  die  from  mere  debility  or  want  of 
power  in  the  constitution  either  to  commence  or  to  continue  the  act 
of  respiration. 

4.  A  child  may  die  from  loss  of  blood,  owing  to  accidental  rupture 
of  the  cord  during  delivery  ;  it  may  even  die  from  this  cause  after  it 
has  breathed. 

5.  That  fatal  bleeding  is  more  likely  to  occur  when  the  cord  has 
been  cut  close  to  the  addomen  than  when  it  has  been  lacerated  or 
cut  at  a  distance  from  the  navel. 

6.  That  the  division  of  the  cord,  whether  by  rupture  or  incision, 
without  ligature,  is  by  no  means  necessarily  fatal  to  a  healthy 
mature  child. 

7.  That  a  child  may  die  from  accidental  compression  of  the  cord 
during  delivery — the  circulation  between  the  mother  and  child  being 
thereby  arrested  before  respiration  had  commenced. 

8.  That  death  may  speedily  follow  birth  from  some  malformation 
or  defect,  or  defective  condition  of  important  organs. 

9.  That  a  child  may  die  from  congenital  disease  affecting  the  organs 
of  respiration  or  the  air-passages. 


510  VIOLENT    CAUSES    OF    DEATH. 


CHAPTEE   L. 

Violent  causes  of  death. — suffocation. — drowning. — death  of 
the  child  from  cold  and  exposure. — starvation. — death 
from  immaturity. — wounds  in  new-born  children. — frac- 
tures of  the  skull,  accidental  and  criminal. twisting  of 

the  neck. — violence  in  self-delivery. — power  of   locomo- 
tion and  exertion  in  females  after  delivery. 

Violent  Causes  of  Death. — In  this  chapter  we  have  to  consider 
those  modes  of  death  which  are  totally  independent  of  the  existence 
of  congenital  disease  or  other  natural  causes.  In  most  cases  of 
alleged  child-murder,  the  body  of  the  child  bears  about  it  the  marks 
of  physical  injury,  such  as  those  which  are  indicative  of  strangula- 
tion, wounds,  burns,  and  fractures.  The  marks  of  violence  may  be 
such  as  to  leave  no  doubt  that  they  were  wilfully  inflicted. 

In  order  to  render  a  person  criminally  responsible,  it  must  be 
proved  that  the  injuries  were  unlawfully  inflicted  on  a  living  child, 
and  that  they  were  the  cause  of  death.  Assuming  that  the  altera- 
tions in  the  law  regarding  the  destruction  of  new-born  children  will 
be  carried  out  (p.  493),  cases  of  child-murder  will  include  all  those 
in  which  it  is  proved  that  the  violence  was  wilfully  inflicted  during 
or  after  birth,  and  that  it  was  subsequently  the  cause  of  death.  If 
the  child  has  died  after  birth,  from  violence  carelessly  or  ignorant ly 
inflicted  during  birth  or  afterwards,  this  will  constitute  a  case  of 
manslaughter.  A  question  of  medical  responsibility  may  be  raised 
under  these  circumstances,  as  where  a  medical  man  is  charged  with 
liaving  caused  the  death  of  a  child  by  gross  ignorance  and  careless- 
ness in  the  delivery  of  a  woman.  The  following  instance  is  reported 
by  Chitty  ("  Med.  Jur."  p.  416;  also  Archbold,  p.  345):  A  man  of 
the  name  of  Senior,  who,  it  appears,  was  an  unlicensed  medical  prac- 
titioner, was  tried  for  the  manslaughter  of  an  infant,  by  injuries  in- 
flicted on  it  at  its  birth.  The  prisoner  practised  midwifery,  and  was 
called  to  attend  the  prosecutrix,  who  was  taken  in  labor.  The  evi- 
dence showed  that  when  the  head  of  the  child  presented,  the  prisoner, 
by  some  mismanagement,  fractured,  and  otherwise  so  injured  the 
cranium,  that  the  child  died  immediately  after  it  was  born.  It  was 
argued,  in  defence,  that  as  the  child  was  not  born  {in  ventre  sa  n 
at  the  time  the  wounds  and  injuries  were  inflicted,  the  prisoner  could 
not  be  guilty  of  manslaughter.  The  judge,  however,  held  that  as 
the  child  was  born  alive  and  had  subsequently  died  from  the  vio- 
lence, the  case  might  be  one  of  manslaughter.  This  opinion  was 
afterwards  confirmed  by  the  other  judges,  and  the  prisoner  was  con- 
victed and  sentenced  to  imprisonment.     From  the  decision  in  this 


DEATH    FROM    SUFFOCATION.  511 

case,  it  will  be  seen  that  if  the  prisoner  had  effecutally  destroyed  the 
child  before  it  was  entirely  born,  he  would  not  have  been  guilty  of 
any  crime. 

Some  general  observations  have  been  elsewhere  made  on  the  mode 
in  which  the  dead  body  of  a  child  in  an  alleged  case  of  child-mur- 
der should  be  examined  (p.  470).  A  note  of  all  marks  of  physical 
injury,  however  slight  in  appearance,  may  be  of  importance  in  the 
case.  There  are  some  forms  of  child-murder  which  are  not  necessa- 
rily attended  with  marks  of  violence  ;  thus  a  child  may  be  criminally 
destroyed  by  suffocation,  drowning,  exposure  to  cold,  or  privation 
of  food.  It  may  die  under  these  circumstances,  and  its  body  may 
present  no  unusual  appearance.  These  modes  of  destroying  life  will 
therefore  first  require  consideration. 

1.  Suffocation. — This  is  a  common  cause  of  death  in  new-born 
children.  A  wet  cloth  may  be  placed  over  the  child's  mouth,  or 
thrust  into  this  cavity,  either  during  birth  or  afterwards,  and  before 
or  after  the  performance  of  respiration.  To  the  latter  case  only 
could  the  term  suffocation  be  strictly  applied.  A  child  may  be  thus 
destroyed  by  being  allowed  to  remain  closely  compressed  under  the 
bed-clothes  after  delivery,  or  by  its  head  being  thrust  into  straw, 
feathers,  ashes,  and  similar  substances.  The  appearances  in  the  body 
are  seldom  sufficient  to  excite  a  suspicion  of  the  cause  of  death, 
unless  undue  violence  has  been  employed.  There  is  commonly 
merely  lividity  about  the  head  and  face,  with  slight  congestion  of 
tie  lungs.  A  careful  examination  of  the  mouth  and  throat  should 
be  made,  as  foreign  substances  are  sometimes  found  in  this  situation, 
affording  circumstantial  evidence  of  the  mode  in  which  the  suffoca- 
tion has  taken  place.  Thus  wood,  straw,  feathers,  dust,  tow,  or  a 
hard  plug  of  linen  may  be,  and  in  some  cases  have  been,  found  block- 
ing up  the  mouth  and  throat,  drawn  into  these  parts  by  aspiration 
when  the  mouth  of  a  child  has  been  covered  with  such  substances. 
If  a  child  has  lived  sufficiently  long  to  be  fed,  it  may  be  accidentally 
suffocated  by  the  entrance  of  portions  of  solid  food,  such  as  the  curd 
of  milk,  into  the  windpipe  and  air-passages. 

A  new-born  child  may  be  suffocated  by  having  its  head  held  over 
noxious  vapors,  such  as  the  exhalations  of  a  privy  or  of  burning 
sulphur ;  and  it  is  here  necessary  to  remind  a  medical  jurist  that 
other  highly  poisonous  vapors,  e.  g.  chloroform,  may  be  used  by  a 
criminal  without  leaving  any  traces  upon  the  body — except,  possibly, 
for  a  short  time,  that  which  may  depend  upon  their  peculiar  odor. 
There  are  a  few  of  these  cases  of  suffocation  in  which  a  positive 
medical  opinion  of  the  causes  of  death  could  be  given,  unless  some 
circumstantial  evidence  were  produced,  and  the  witness  were  allowed 
to  say  whether  the  alleged  facts  were  or  were  not  sufficient  to  ac- 
count for  death.     ("  Annales  d'Hyg."  1832,  vol.  1,  p.  621.) 

On  the  other  hand,  if  it  be  even  clearly  proved  that  death  has 
been  caused  by  suffocation,  it  must  be  remembered  that  a  child  may 
be  accidentally  suffocated,  and  the  crime  of  murder  falsely  imputed. 
Dr.  J.  M.  Duncan,  quoting  the  observations  of  Dr.  Buhl,  states  that 
obstruction  of  the  air-passages  by  mucous  and  other  matters  is  a 


512  INFANTICIDE.      DEATH    FROM    SUFFOCATION. 

frequent  cause  of  death  in  new-born  children.  Among  twenty-seven 
children  dying  in  labor  or  shortly  after  birth,  eleven  died  from  ob- 
struction of  the  air-passages  with  foreign  matters.  Eight  were  born 
dead,  and  of  those  which  were  alive  at  birth,  none  survived  the  first 
day.  In  ten  of  these  cases  the  obstruction  was  produced  by  a  green- 
ish-brown slimy  mass  (meconium  and  mucus)  filling  the  larynx  and 
windpipe.  In  two  of  the  cases,  in  which  the  child  died  during  de- 
livery, air  was  found  in  the  lungs,  and  in  only  one  of  these  the  air 
had  been  derived  from  the  act  of  respiration  during  birth.  ("Edin. 
Monthly  Med.  Jour."  April,  1863,  p.  924;  also  "Med.  Times  and 
Gazette,"  August  3,  1861,  p.  117.)  In  Dr.  Hicks's  case  (p.  508)  the 
base  of  the  tongue  in  a  new-born  child  was  so  drawn  down  by  spas- 
modic action  as  to  close  the  glottis  by  pressing  backwards  the  epi- 
glottis. The  child  was  saved  by  simply  raising  the  epiglottis,  when 
air  rushed  in,  and  breathing  was  established;  but  many  children 
must  be  born  under  similar  conditions  when  no  assistance  is  at  hand. 
Cases  of  this  kind,  however,  rarely  give  rise  to  charges  of  child- 
murder,  as  no  air  is  found  in  the  lungs.  A  child  might  be  killed 
during  delivery  by  pressure  applied  to  the  chest ;  this  might  be  such 
as  not  to  produce  any  marks  of  violence.  If  the  child  had  not 
breathed,  there  would  be  nothing  to  indicate  the  mode  of  death  ;  if 
air  had  entered  the  lungs,  then  the  usual  appearances  would  be  found 
in  these  organs  (p.  475).  In  dealing  with  a  case  of  this  kind,  it 
should  be  remembered  that  a  child  with  its  head  born,  but  detained 
in  the  outlet  by  the  size  of  its  shoulders,  might  die  from  pressure 
exerted  on  the  chest  by  the  vagina.  It  might  have  breathed,  but 
be  born  dead  with  the  marks  of  suffocation  about  it.  There  is 
another  accidental  cause  of  the  death  of  a  new-born  child  during 
delivery.  The  membranes  or  caul  may  be  carried  forward  over  the 
head  and  face,  and  the  act  of  breathing  thus  mechanically  prevented. 
If  no  assistance  is  at  hand,  the  child,  although  born  living,  will  die 
soon  after  birth  in  consequence  of  the  prevention  of  respiration. 
If,  when  the  dead  body  is  found,  the  membranes  are  no  longer  there, 
the  cause  of  the  prevention  of  respiration  would  not  be  apparent. 
The  child,  although  born  living,  would  probably  be  pronounced  to 
have  been  born  dead.  ("Med.  Times  and  Gaz.,"  January,  1863,  p. 
126.)  The  delivery  of  a  child  with  a  mask  or  caul  around  its  head 
is  not  an  unfrequent  occurrence.  In  June,  1862,  Mr.  Blenkinsop,  of 
Warwick,  communicated  to  me  a  case  in  which  a  mature  and  healthy 
child  so  born  was  allowed  to  perish  by  those  who  had  access  to  it. 
The  caul  was  simply  not  removed,  so  that  breathing  could  not  be 
set  up.  The  lungs  contained  no  air.  There  was  congestion  of  the 
brain  and  lividity  of  the  body,  but  no  mark  of  violence.  There 
was  some  evidence  that  the  child  had  been  born  living,  and  that  the 
cause  of  death  was  the  prevention  of  respiration  by  omission  to  do 
that  which  was  necessary.  As  the  medical  evidence  showed  that 
the  child  had  not  breathed,  the  Coroner  held  that  it  had  never  had 
any  (legal)  existence,  and  that  there  was  no  ground  for  further  in- 
vestigation. Dr.  Hunter,  who  was  well  aware  of  the  risk  to  which 
a  woman  might  be  thus  exposed,  observes  in  relation  to  this  state 


DEATH    FROM    SUFFOCATION.  513 

of  things: — ""When  a  woman  is  delivered  by  herself,  a  strong  child 
may  be  born  perfectly  alive,  and  die  in  a  very  few  minutes  for  want 
of  breath,  either  by  being  on  its  face  in  a  pool  formed  by  the  natural 
discharges,  or  upon  wet  clothes :  or  by  the  wet  things  over  it  col- 
lapsing and  excluding  air,  or  drawn  close  to  its  mouth  and  nose  by 
the  suction  of  breathing.  An  unhappy  woman  delivered  by  herself, 
distracted  in  her  mind  and  exhausted  in  her  body,  will  not  have 
strength  or  recollection  enough  to  fly  instantly  to  the  relief  of  her 
child."  (Op.  cit.  p.  85.)  It  may  be  added  that  a  primiparous  woman 
may  faint  or  be  wholly  unconscious  of  her  situation  ;  or,  if  conscious, 
she  may  be  ignorant  of  the  necessity  of  removing  the  child,  and 
thus  it  may  be  suffocated  without  her  having  been  intentionally 
accessory  to  its  death.  In  such  cases,  however,  there  should  be  no 
marks  of  violence  on  the  body,  or,  if  present,  they  should  be  of  such 
a  nature  and  in  such  a  situation  as  to  be  readily  explicable  on  the 
supposition  of  an  accidental  origin. 

An  infant  is  easily  destroyed  by  suffocation.  If  the  mouth  and 
nostrils  are  kept  covered  for  a  few  minutes,  by  the  face  being  closely 
wrapped  in  clothes,  asphyxia  may  come  on  without  this  being  indi- 
cated by  convulsions  or  any  other  marked  symptoms  (see  p.  388). 
A  suspicion  of  murder  may  arise  in  such  cases ;  but  the  absence  of 
marks  of  violence,  with  an  explanation  of  the  circumstances  will 
rarely  allow  the  case  to  be  carried  beyond  an  inquest.  Sometimes 
the  body  is  found  maltreated,  with  severe  fractures  or  contusions  on 
the  skull,  and  marks  of  strangulation  on  the  neck ;  concealed  in  a 
feather-bed  or  privy,  or  cut  up  and  burnt.  This  kind  of  violence 
may  properly  excite  a  suspicion  of  murder,  and  lead  to  the  belief 
that  the  allegation  of  death  from  accidental  suffocation  is  a  mere 
pretence.  This,  however,  is  purely  a  question  for  a  jury,  and  not 
for  a  medical  witness.  Unless  the  case  be  of  a  glaring  nature,  the 
violence  is  considered  to  have  been  employed  for  the  purpose  rather 
of  concealing  the  birth  of  a  child  than  of  destroying  it.  In  the  present 
day  these  cases  of  death  from  accidental  suffocation,  when  properly- 
investigated,  can  never  involve  an  innocent  woman  in  a  charge  of 
murder,  although  the  facts  may  show  in  many  instances  that  the 
death  of  the  child  was  really  due  to  great  imprudence,  gross  neglect, 
or  culpable  indifference  on  her  part. 

The  appearances  in  the  body  in  cases  of  death  from  suffocation 
have  been  elsewhere  described,  in  reference  to  adults  (p.  878) ;  they 
are  similar  in  new-born  children,  provided  respiration  has  been  fully 
performed.  M.  Tardieu  attaches  great  importance  to  the  discovery 
of  subpleural  ecchymoses  in  the  lungs  of  children :  he  has  also 
noticed  small  effusions  of  blood  on  the  surface  and  in  the  substance 
of  the  thymus-gland.  ("Ann.  d'Hyg.,"  1855,  vol.  ii.  p.  379.)  If  the 
lungs  float  on  water,  as  the  result  of  breathing,  then  the  appearances 
described  will  be  met  with:  but  it  is  worthy  of  remark  that  in  three 
instances  M.  Tardieu  met  with  similar  appearances  in  children  whose 
lungs  had  not  received  air,  and  sank  when  placed  on  water.  They 
were  children  prematurely  born,  and  under  conditions  which  pre- 
vented full  vital  development.  One  born  in  the  Hospital  of  Riboi- 
33 


514  INFANTICIDE.      APPEARANCES 

sic  re  uttered  several  cries,  but^  in  spite  of  this,  the  lungs  contained 
no  air.  The  subpleural  ecchymoses  met  with  in  children  under  these 
circumstances,  are  ascribed  by  M.  Tardieu  to  the  efforts  made  to 
breathe  after  birth  (loc.  cit.).  Partial  emphysema  of  the  lungs  is 
occasionally  observed. 

2.  Drowning. — The  fact  of  drowning  cannot  be  verified  by  any 
appearances  on  the  body  of  a  child  which  has  not  breathed.  Thus, 
if  a  woman  caused  herself  to  be  delivered  in  a  bath,  and  the  child 
was  forcibly  retained  under  water  (a  case  which  is  said  to  have  oc- 
curred), it  would'of  course  die;  but  no  evidence  of  the  mode  of 
death  would  be  found  in  the  body.  After  respiration,  the  signs  of 
drowning  will  be  the  same  as  those  met  with  in  the  'adult.  (See  p. 
321.)  The  main  question  for  a  witness  to  decide  will  be,  whether 
the  child  was  put  into  the  water  living  or  dead.  Infanticide  by 
drowning  is  by  no  means  common ;  the  child  is  generally  suffocated, 
strangled,  or  destroyed  in  other  ways,  and  its  body  is  then  thrown 
into  water  in  order  to  conceal  the  real  manner  of  its  death.  The  fact 
of  the  dead  body  of  an  infant  being  found  in  water  must  not  allow  a 
witness  to  be  thrown  off  his  guard;  although  a  verdict  of  "found 
drowned"  is  so  commonly  returned  in  these  cases ;  the  body  should 
be  carefully  inspected  in  order  to  determine  what  was  really  the 
cause  of  death.  All  marks  of  violence  on  the  bodies  of  children 
that  have  died  by  drowning  should  be  such  as  to  have  resulted  from 
accidental  causes.  The  throat  and  air-passages  should  be  particularly 
examined. 

It  is  not  necessary  that  the  whole  of  the  body  of  a  child  should  be 
submerged,  in  order  that  it  may  be  destroyed  by  drowning :  the 
mere  immersion  of  the  head  in  water,  or  the  covering  of  the  mouth 
by  liquid,  will  suffice  to  produce  the  usual  effects  of  asphyxia.  The 
outlets  of  the  ears  and  the  air-passages  should  be  examined  for  foreign 
substances  which  may  be  deposited  in  them. 

New-born  children  may  be  drowned  or  suffocated  by  being  thrown 
into  mud,  or  into  the  soil  of  a  privy.  Sometimes  the  child  is  de- 
stroyed by  other  means,  and  its  body  is  thus  disposed  of  for  the  pur- 
pose of  concealment.  Should  there  be  a  large  quantity  of  liquid 
present,  the  phenomena  are  those  of  drowning.  The  liquid  portion 
of  the  soil  abounding  in  sulphide  of  ammonium  may  then  be  found, 
if  the  child  was  thrown  in  living,  in  the  air-passages,  gullet  or 
stomach.  The  mere  discovery  of  soil  in  the  mouth  would  not  suffice 
to  show  that  the  child  was  living  when  immersed ;  but  the  presence 
of  foreign  substances,  such  as  dirt,  straw,  or  ashes,  in  the  air-passages, 
gullet,  and  stomach,  has  usually  been  taken  as  a  medical  proof  that 
the  child  was  living  when  immersed  in  the  dirt,  &c,  and  that  the 
substances  had  been  drawn  into  the  passages  by  aspiration  or  by  the 
act  <>f  swallowing. 

On  these  occasions  the  defence  may  be:  1.  That  the  child  was 
born  dead,  and  that  the  body  was  thrown  in  for  concealment ;  but 
the  medical  evidence  may  show  that  it  had  breathed,  and  had  pro- 
bably been  born  living.  2.  It  may  be  alleged  that  the  child  breal  hod 
for  a  few  moments  after  birth,  had  then  died,  and  that  the  woman 


IN    DEATH    FROM    DROWNING.  515 

had  attempted  to  conceal  the  dead  body.  A  medical  witness  may  be 
here  asked,  whether  a  woman  could  have  had  power  to  convey  the 
body  to  the  place — a  point  which  must,  as  a  general  rule,  be  con- 
ceded. 3.  It  is  most  commonly  urged,  that  the  woman  being  com- 
pelled to  go  to  the  privy,  was  there  delivered  unconsciously  or  unex- 
pectedly ;  that  her  waters  had  broken  in  the  watercloset,  and  that 
she  had  no  idea  of  anything  more  having  happened;  or  that  the 
child  had  dropped  from  her,  and  was  either  suffocated  or  prevented 
from  breathing.  ("  Med.  Times  and  Gazette,"  Dec.  21,  1861,  p.  646.) 
All  these  circumstances  may  readily  occur,  but,  on  the  other  hand, 
the  explanation  may  be  inconsistent  with  some  of  the  medical  facts. 
(See  a  case  by  M.  Adelon  "  Ann.  d'Hyg."  1855,  vol.  2.  p.  453  ;  also 
Casper's  "Klinische  Novellen,"  1863,  p.  585.)  Thus,  the  head  or  the 
limbs  of  a  child  may  be  found  to  have  been  separated  or  divided  by 
some  cutting  instrument,  or  a  cord  or  other  ligature  may  be  found 
tightly  bound  round  its  neck,  or  there  may  be  a  tightly-fitting  plug  in 
the  throat.  Then,  again,  the  body  may  be  entire,  but  the  umbilical  cord 
may  be  cleanly  cut.  This  would  tend  to  set  aside  the  explanation  of 
the  child  having  accidentally  dropped  from  the  female :  because  in 
such  an  accident  the  cord  should  always  be  found  ruptured.  The 
practitioner  should  make  a  careful  examination  of  the  divided  ends 
of  the  cord  by  the  aid  of  a  lens,  or  a  rupture  may  be  mistaken  for 
a  section  with  a  sharp  instrument.  Mr.  Higginson  of  Liverpool,  has 
published  a  case  of  some  interest  in  this  point  of  view.  The  child 
fell  from  the  mother,  and  the  cord  broke  spontaneously.  "The torn 
ends  were,"  he  states,  "  nearly  as  sharp-edged  and  flat  as  if  cut." 
("  Med.  Gaz."  vol.  48,  p.  985.)  This  case  goes  to  prove  that  a  care- 
less or  hasty  examination  of  the  ends  of  the  cord  may  lead  to  a 
serious  mistake. 

When  the  cord  is  lacerated,  this  will  be,  cseteris  paribus,  in  favor 
of  the  woman's  statement  as  to  the  mode  in  which  her  delivery  oc- 
curred. Drowning  may  be  the  result  of  accident  from  sudden 
delivery.  A  woman  in  an  advanced  state  of  pregnancy,  while  sit- 
ting on  a  chamber- vessel,  was  suddenly  delivered.  The  child  fell 
into  the  fluids  in  the  vessel,  and  before  assistance  could  be  rendered, 
it  was  dead. 

Whether,  in  any  instance,  the  drowning  of  a  child  was  accidental 
or  criminal,  must  be  a  question  for  a  jury  to  determine  from  all  the 
facts  laid  before  them.  The  situation  in  which  the  body  of  an  infant 
is  found  may  plainly  contradict  the  supposition  of  accident.  On  the 
other  hand,  a  child  may  be  accidentally  drowned  by  its  mouth  fall- 
ing into  a  pool  of  the  discharges  during  delivery,  although  this  would 
be  rather  a  case  of  suffocation.  The  throat,  windpipe,  and  stomach 
of  the  child  should  always  be  examined  on  these  occasions,  as  mud, 
.-ticks,  straw,  weeds,  or  other  substances  may  be  found  in  these 
parts,  indicating,  according  to  circumstances,  that  the  child  had  been 
[tut  into  the  water  living,  and  that  it  had  been  drowned  in  a  par- 
ticular pond  or  vessel. 

3.  Cold. — A  new-born  child  maybe  easily  destroyed  by  simply 
exposing  it  uncovered,  or  but  slightly  covered,  to  a  cold  atmosphere 


516  DEATH    FROM    COLD    AXD    STARVATION". 

In  a  case  of  this  kind  there  may  he  no  marks  of  violence  on  the 
body,  or  these  may  be  slight  and  evidently  of  accidental  origin.  In 
death  from  cold  the  only  appearance  occasionally  met  with  has  been 
congestion  of  the  brain,  with  or  without  serous  effusions  in  the  ven- 
tricles. (See  Cold,  p.  410.)  The  evidence  in  these  cases  must  be 
purely  circumstantial.  The  medical  witness  may  have  to  consider 
how  far  the  situation  in  which  the  body  was  found ;  the  kind  of  ex- 
posure, and  the  temperature  of  the  air,  would  suffice  to  account  for 
death  from  the  alleged  cause.  There  is  no  doubt  that  a  new-born 
child  is  easily  affected  by  a  low  temperature,  and  that  warm  clothing 
is  required  for  the  preservation  of  its  life.  An  inspection  of  the 
body  should  never  be  omitted  on  these  occasions,  because  it  might 
turn  out  that  there  was  some  latent  cause  of  natural  death  which 
would  at  once  do  away  with  the  charge  of  murder.  Admitting  that 
the  child  died  from  cold,  it  becomes  necessary  to  inquire  whether  it 
was  exposed  with  a  malicious  intention  that  it  should  thus  perish. 
Unless  wilful  malice  be  made  out,  the  accused  cannot  be  convicted  of 
murder.  In  general,  females  do  not  expose  their  children  for  the 
purpose  of  destroying  them,  but  for  the  purpose  of  abandoning  them  ; 
hence  it  is  rare  to  hear  of  convictions  for  child-murder  where  cold 
was  the  cause  of  death,  although  some  medical  jurists  have  called 
this  infanticide  by  omission,  an  offence  which  does  not  appear  to  be 
recognized  by  the  English  law. 

4.  Starvation. — A  new-born  child  kept  long  without  food  will  die, 
and  no  evidence  of  the  fact  may  be  derivable  from  an  examination 
of  the  body.  There  may  be  no  marks  of  violence  externally,  nor 
any  pathological  changes  internally,  to  account  for  death.  This  is  a 
rare  form  of  murder,  except  as  it  may  be  accidentally  combined  with 
exposure  to  cold.  In  order  to  convict  the  mother,  it  is  necessary  to 
show  that  the  child  was  wilfully  kept  without  food,  with  the  crimi- 
nal design  of  destroying  it.  Mere  neglect  or  imprudence  will  not 
make  the  case  infanticide.  The  only  appearance  likely  to  be  found 
on  an  examination  of  the  body  would  be  complete  emptiness  of  the 
alimentary  canal.  Without  corroborative  circumstantial  evidence, 
this  would  not  suffice  to  establish  the  cause  of  death ;  a  medical  wit- 
ness could  only  form  a  probable  conjecture  on  the  point.  In  a  sus- 
pected case  of  this  kind,  the  contents  of  the  stomach  should  be 
tested  for  farinaceous  and  other  kinds  of  food. 

5.  Immaturity  in  Cases  of  Abortion. — From  the  case  of  Reg.  v. 
West  (Nottingham  Lent  Assizes,  1848),  it  would  appear  that  if  by 
the  perpetration  of  abortion,  or  the  criminal  inducement  of  prema- 
ture labor,  a  child  be  born  living  at  so  early  a  period  of  uterine  life 
that  it  dies  merely  from  immaturity,  the  person  causing  the  abortion, 
or  leading  to  the  premature  birth,  may  be  tried  on  a  charge  of  mur- 
der. A  midwife  was  alleged  to  have  perpetrated  abortion  on  a 
female  who  was  between  the  fifth  and  sixth  month  of  pregnancy. 
The  child  was  born  living,  but  died  five  hours  after  its  birth.  There 
was  no  violence  offered  to  it ;  and  its  death  appeared  to  be  due  en- 
tirely to  its  immaturity.  The  prisoner  was  acquitted,  apparently  on 
the  "'round  that  abortion  might  have  arisen  from  other  causes. 


INFANTICIDE    FROM    WOUNDS.  517 

Among  those  cases  of  violent  death  which  leave  on  the  bocly  of 
the  child  certain  marks  or  appearances  indicative  of  the  cause,  may- 
be mentioned  wounds,  strangulation,  and  poisoning. 

6.  Wounds. — Probably  this  is  one  of  the  most  frequent  causes  of 
death  in  cases  of  child-murder.  Wounds  may,  however,  be  found  on 
the  body  of  a  child  which  has  died  from  some  other  cause.  The 
principal  questions  which  a  medical  witness  has  to  answer  are:  1. 
Whether  the  wounds  were  inflicted  on  the  body  of  the  child  before  or 
after  death.  2.  Whether  they  were  sufficient  to  account  for  death ; 
and  3,  whether  they  resulted  from  accident  or  criminal  design.  The 
child  may  have  been  destroyed  by  burning,  and  evidence  must  then  be 
sought  for  by  an  examination  of  the  state  of  the  skin.  All  these  ques- 
tions have  been  fully  considered  in  treating  the  subject  of  Wounds, 
and  they  therefore  do  not  require  any  special  notice  in  this  place. 

Incised  wounds  found  on  the  bodies  of  children  may  be  referred 
to  the  use  of  a  knife  or  scissors  by  the  prisoner  in  attempting  to  sever 
the  navel-string,  and  they  may  therefore  be  due  to  accident.  This 
point  should  not  be  forgotten,  for  a  wound  even  of  a  severe  kind 
might  be  thus  accidentally  inflicted.  In  such  cases  we  should  always 
expect  to  find  the  navel-string  cut,  and  not  lacerated.  The  end  of  it 
may,  for  the  purpose  of  examination,  be  stretched  out  on  a  piece  of 
white  card.  This  will  in  general  suffice  to  show  whether  it  has  been 
cut  or  torn.  Wounds,  however  slight,  should  not  be  overlooked : 
minute  punctures  or  incisions  externally  may  correspond  to  deep- 
seated  injury  of  vital  organs.  The  spinal  marrow  is  said  to  have 
been  wounded  by  needles  or  stilettoes  introduced  between  the  verte- 
bras, the  skin  having  been  drawn  down  before  the  wound  was  in- 
flicted, in  order  to  give  it  a  valvular  character,  and  to  render  it  ap- 
parently superficial.  The  brain  is  also  said  to  have  been  wounded, 
by  similar  weapons,  either  through  the  nose  or  the  thinner  parts  of 
the  skull  (the  fontanelles). 

In  some  instances  the  body  of  a  child  is  found  cut  to  pieces,  and 
the  allegation  in  defence  may  be  that  the  child  was  still-born,  and 
the  body  thus  treated  merely  for  the  purpose  of  concealment.  Dr. 
Toulmouche  has  reported  a  case  of  this  kind,  which  was  the  subject 
of  a  trial  in  France  in  1852.  As  the  woman  had  not  destroyed  the 
lungs,  experiments  on  these  organs  gave  satisfactory  results  of  perfect 
respiration.  The  cavities  of  the  heart  and  great  vessels  were  empty ; 
the  body  was  generally  drained  of  blood,  and  the  skin  throughout  very 
pale.  This  led  to  the  inference  that  the  mutilations  must  have  been 
inflicted  while  the  child  was  living ;  and  as  all  the  parts  were  healthy 
and  no  natural  cause  of  death  apparent,  Dr.  Toulmouche  ascribed 
the  death  of  the  child  to  the  wounds.  The  woman  was  convicted, 
and  condemned  to  twenty  years'  confinement  in  the  galleys.  ("Ann. 
d'Hyg."  1853,  vol.  2,  p.  200.)  In  this  country  she  would  probably 
have  escaped  under  a  verdict  of  "concealment  of  birth,"  and  have 
been  sentenced  to  a  year's  imprisonment. 

Injuries  to  the  Head. — It  has  been  elsewhere  stated  that  during  a 
protracted  delivery  there  is  formed  on  the  head  of  a  child  a  tumor 
containing  either  serum,  blood,  or  a  mixture  of  the  two.     If  a  woman 


518  INFANTICIDE.      FRACTURES    OF    THE    SKULL. 

has  been  secretly  delivered,  non-professional  persons  may  ascribe 
a  tumor  of  this  kind  to  violence,  whereas  it  may  really  have  been 
produced  by  natural  causes.  The  tumor  is  generally  situated  on 
one  of  the  parietal  bones,  its  situation  depending  on  that  part  of  the 
head  which  presents  during  delivery.  After  the  discharge  of  the 
waters,  the  scalp  is  firmly  compressed  by  the  mouth  of  the  uterus, 
and  subsequently  by  the  os  externum.  This  pressure  interferes  with 
the  circulation  througn  the  skin,  and  causes  the  compressed  portion 
of  the  scalp  to  swell.  In  the  simplest  form  of  this  tumor  serum  only 
is  found  in  the  swollen  part ;  occasionally  this  is  mixed  with  blood, 
and  there  are  small  ecchymoses  of  the  scalp,  as  well  as  of  the  peri- 
cranium and  skull,  but  there  is  generally  no  injury  to  the  bones, 
nor  is  there  any  laceration  of  the  skin  externally.  In  other  cases 
blood  is  found  effused  in  the  tumor  either  under  the  scalp,  the  mem- 
brane covering  the  skull  (pericranium),  or  within  the  skull  itself. 
The  term  Cephalhematoma  or  Caput  succedaneum  is  applied  to  a  tumor 
which  has  this  natural  origin  (p.  506).  The  sanguineous,  is  more 
likely  to  be  confounded  with  the  effects  of  violence  than  the  serous 
tumor  :  but  it  may  be  identified  by  the  scalp  being  always  uninjured, 
although  it  may  present  redness  and  lividity.  Violence  from  blows 
or  falls  which  would  produce  bloody  effusions  beneath  the  scalp,  or 
within  the  skull,  would  in  general  be  indicated  by  injury  to  the  skin 
or  by  fracture  of  the  bones. 

The  only  injuries  to  the  head  which  require  to  be  specially  con- 
sidered in  relation  to  infanticide,  are  fractures  of  the  skull :  and  here 
the  question  to  which  we  may  chiefly  confine  our  attention  is, 
whether  the  fracture  arose  from  accident  or  criminal  violence.  The 
rules  for  determining  whether  these  injuries  were  inflicted  during  life 
or  after  death  have  been  elsewhere  considered.    (See  Wounds,  p.  210.) 

Although  it  has  been  a  matter  of  frequent  observation,  that  great 
violence  may  be  done  to  the  head  of  a  child  during  parturition  with- 
out necessarily  giving  rise  to  fracture,  yet  it  is  placed  beyond  all 
doubt  that  such  an  injury  may  occur  by  the  expulsive  efforts  of  the 
uterus  forcing  the  head  of  a  child  against  the  bones  of  the  pelvis. 
Even  the  violent  compression  which  the  head  sometimes  experiences 
in  passing  the  mouth  of  the  uterus,  may  suffice  for  the  production  of 
fracture.     (See  "  Edin.  Med.  and  Surg.  Jour.*'  vol.  26,  p.  75.) 

It  was  formerly  supposed  that  fractures  of  the  skull  in  new-born 
children  were  always  indicative  of  criminal  violence;  but  cases  which 
have  occurred  in  obstetric  practice  have  established  the  certainty  of 
their  accidental  occurrence.  These  accidental  fractures,  it  is  to  be 
observed,  are  generally  slight;  they  commonly  amount  merely  to 
fissures  in  the  bones,  beginning  at  the  sutures,  and  extending  down- 
wards for  about  an  inch  or  less  into  the  body  of  the  bone.  Accord- 
ing to  Dr.  Weber,  the  frontal  and  parietal  bones  are  the  only  bones 
liable  to  be  fissured  or  fractured  by  the  action  of  the  uterus  during 
delivery :  and  in  the  greater  number  of  cases  reported,  the  parietal 
bones  only  have  presented  marks  of  fracture. 

The  possible  occurrence  of  an  injury  of  this  kind  as  the  result  of 
uterine  action  has  been  strained  in  several  cases  of  child-murder,  to 


FRACTURES    FROM    UTERINE    ACTION.  519 

explain  the  origin  of  fractures  which  could  not  fairly  or  reasonably 
be  assigned  to  such  an  accident.  A  case  was  tried  at  Glasgow,  in 
April,  1852  (case  of  Ann  Irwin),  in  which  there  was  no  doubt,  from 
the  state  of  the  lungs,  that  the  child  had  fully  breathed,  and  there 
was  violence  to  the  head  which  satisfactorily  accounted  for  its  death. 
The  whole  of  the  right  side  of  the  head  was  deeply  ecchymosed,  and 
there  was  a  large  quantity  of  coagulated  blood  lying  beneath  the 
scalp.  In  the  centre  of  the  right  parietal  bone  there  was  a  fracture 
extending  across  the  vertex  for  fully  four  inches,  and  involving 
a  part  of  the  parietal  bone  on  the  opposite  side  ;  it  was  in  a  contin- 
uous even  line,  not  radiated  and  not  depressed.  The  pericranium, 
bones,  and  soft  parts  in  the  track  of  the  fracture  were  deeply  ecchy- 
mosed, while  on  the  surface  of  the  brain,  particularly  on  the  right 
side,  there  was  a  copious  effusion  of  clotted  blood.  It  was  impossi- 
ble to  refer  severe  injuries  of  this  kind  to  the  action  of  the  uterus 
in  delivery,  or  to  violence  applied  after  death.  The  prisoner  alleged 
that  the  child  was  still-born.  (See  "  Edin.  Monthly  Jour.,"  June, 
1852.) 

Accidental  fractures  and  effusions  of  blood  which  are  caused  by 
uterine  action  may  be  in  general  recognized  by  their  slight  extent. 
In  cases  of  murder  by  violence  to  the  head,  the  injuries  are  com- 
monly much  more  severe :  the  bones  are  driven  in,  the  brain  pro- 
trudes, and  the  scalp  is  extensively  lacerated.  Such  severe  injuries 
as  these  cannot  be  ascribed  to  the  action  of  the  uterus  in  parturition. 
Here,  however,  it  may  be  fairly  urged,  that  the  woman  was  unex- 
pectedly seized  with  labor,  that  the  child  was  expelled  suddenly  by 
the  violent  efforts  of  the  uterus,  and  that  the  injuries  might  have 
arisen  from  its  head  coming  in  contact  with  some  hard  surface — as  a 
floor  or  pavement.  It  must  be  admitted  that  a  woman  may  be  thus 
suddenly  and  unexpectedly  delivered  while  in  the  erect  posture, 
although  this  is  not  common  among  primiparous  women ;  and  that 
injuries  may  be  thus  accidentally  produced  on  the  head  of  a  child. 

A  woman  is  often  unable  to  distinguish  the  sense  of  fulness,  pro- 
duced by  the  descent  of  a  child,  from  the  feeling  which  leads  her  to 
suppose  that  she  is  about  to  have  an  evacuation :  and  thus  it  is 
dangerous,  when  a  labor  has  advanced,  to  allow  a  woman  to  yield  to 
this  feeling,  for  there  is  nothing  more  probable  than  that  the  child 
will  be  suddenly  born.  Mr.  Rankin,  of  Carluke,  has  reported  two 
cases  of  this  description,  where  there  could  not  be  the  slightest  sus- 
picion of  criminality.  In  one,  a  primipara,  the  child  was  actually 
born  under  these  circumstances,  but  its  life  was  fortunately  saved ; 
had  there  been  no  other  convenience  than  a  privy  it  must  have  been 
inevitably  lost.  In  the  second,  although  a  case  of  third  pregnancy, 
the  female  was  equally  deceived  by  her  sensations.  ("  Edin.  Month. 
Jour.,"  Jan.  1846,  p.  11.)  It  is  true  that  this  alleged  mistaken  sen- 
sation forms  a  frequent  and  specious  defence  on  charges  of  child- 
murder  ;  but  still  a  medical  jurist  is  bound  to  admit,  that  an  accident 
which  occurs  to  Avomen  of  the  middle,  class,  may  also  occur  to  the 
poor  without  necessarily  implying  guilt. 

The  following;  case  shows  that  a  fracture  of  the  skull  of  a  child 


520         INFANTICIDE.   FRACTURES  OF  THE 

may  occur  when  a  woman  is  delivered  in  the  erect  posture.  In  this 
instance  there  was  merely  the  appearance  of  a  bruise  on  the  head, 
and  the  navel-string  was  ruptured  (not  cut)  three  inches  from  the 
navel.  The  child  did  not  suffer  from  the  fall,  and  continued  well 
until  six  davs  after  its  birth,  when  it  was  seized  with  convulsions 
and  died.  A  fissure  of  about  an  inch  and  a  half  in  length  was 
found  in  the  upper  part  of  the  left  parietal  bone.  A  clot  of  blood 
was  found  in  this  situation  between  the  dura  mater  and  bone,  and 
there  was  congestion  of  the  vessels  of  the  membranes  ;  with  this 
exception  there  was  no  morbid  appearance  in  the  body.  ("  Associa- 
tion Journal,"  Oct.  14,  1853,  p.  901.)  Dr.  Porter  Smith,  of  Bath, 
communicated  to  me  a  case,  which  occurred  in  November,  1856,  in 
which  the  facts  were  similar  to  those  above  related.  In  consequence 
of  the  concealment  of  the  body,  however,  the  mother  was  charged 
with  murder.  The  right  parietal  bone  was  fractured,  and  there  was 
effusion  of  blood  internally,  but  there  was  no  mark  of  external  vio- 
lence. The  cord  had  been  ruptured  at  a  distance  of  two-and-a-half 
inches  from  the  navel.  The  stomach  of  the  child  contained  the 
usual  albuminous  and  mucous  matters  of  the  foetal  state,  without 
any  appearance  of  food.  The  lungs  contained  air,  and  were  highly 
crepitant ;  the  foramen  ovale  and  the  ductus  arteriosus  were  in  their 
foetal  condition.  The  child  had  probably  been  drowned  in  the  dis- 
charges from  want  of  assistance  at  the  time  of  birth.  The  woman, 
who  admitted  that  the  child  fell  from  her  suddenly,  was  acquitted. 
Dr.  Olshausen  has  published  four  cases  of  sudden  delivery,  in  each 
of  which  the  child  dropped  from  the  woman,  and  in  two  of  them 
there  were  fissures  in  the  parietal  bones.  The  children  recovered 
from  the  effects  of  the  accidents.  ("  Med.  Times  and  Gazette,"  Scot. 
1860;  "Am.  Jour.  Med.  Sci.,"  Jan.  1861,  p.  279.)  Other  cases  of 
rapid  delivery  in  the  erect  posture  are  reported  in  the  "  Lancet" 
(Jan.  5,  1861,  p.  13).  In  these  there  was  no  injury  to  the  child, 
although  in  one  case  the  delivery  took  place  on  the  deck  of  a  vessel. 

A  medical  witness  would  find  no  difficulty  in  determining  the  pro- 
bability  of  this  explanation  of  the  accidental  origin  of  such  fractures, 
if  he  were  made  acquainted  with  all  the  facts  connected  with  the 
delivery.  But  the  acquisition  of  this  knowledge  must  be  accidental; 
and  it  will  in  general  be  out  of  his  power  to  obtain  it.  When  the  frac- 
tures are  accompanied  by  cuts,  punctures,  or  laceration  of  the  scalp 
or  face,  although  their  production  might  be  accounted  for  by  an 
alleged  fall  during  parturition,  the  cause  of  these  wounds  would  still 
remain  to  be  explained. 

In  fractures  of  the  bones  of  the  head  in  new-born  children,  the 
presence  of  effusions  of  blood  on  the  outside  of  the  skull,  or  on  the 
membranes  within,  is  one  of  the  most  common  appearances.  Effusions 
of  blood  beneath  the  skin  of  the  scalp  are  by  no  means  uncommon 
in  new-born  children,  and  are  not  necessarily  indicative  of  criminal 
violence.  Each  case,  however,  must  be  decided  by  the  circumstances 
attending  it.  Effusions  on  the  membranes  and  in  the  substance  of 
the  brain  are  generally  the  results  of  great  violence  to  the  head. 

Twisting  of  the  Neck. — Children  are  sometimes  destroyed  in  the  act 


BONES  OF  THE  HEAD  FROM  FALLS.         521 

of  birth  by  the  neck  being  forcibly  twisted,  whereby  a  displacement 
of  the  cervical  vertebras,  with  injury  to  the  spinal  marrow,  may  occur, 
and  destroy  life.  Such  injuries  are  immediately  discovered  by  an 
examination  of  the  body.  It  should  be  remembered  that  the  neck 
of  a  child  is  very  short,  and  that  it  always  possesses  considerable 
mobility. 

Violence  in  Self -Delivery. — When  the  marks  of  violence  found  on 
the  head,  neck,  or  body  of  a  child  cannot  be  easily  referred  to  uterine 
action  or  to  an  accidental  fall,  it  is  common  to  ascribe  them  to  the 
efforts  made  by  a  woman  in  her  attempts  to  deliver  herself — the 
destruction  of  the  child  being  an  accidental  result  of  these  efforts. 
A  medical  opinion  in  such  cases  must  depend  upon  the  nature,  situ- 
ation and  extent  of  the  injuries;  and  each  case  must  be  therefore 
decided  by  the  circumstances  attending  it.  A  medical  witness, 
however,  should  always  be  prepared  to  allow  that  a  woman  at 
the  time  of  her  delivery,  owing  to  pain  and  anxiety  may  be  de- 
prived of  all  judgment,  and  may  destroy  her  offspring  without  being 
conscious  of  what  she  is  doing.  It  is  therefore  a  sound  principle  of 
law  that  mere  appearances  of  violence  on  a  child's  body  are  not  per 
se  sufficient,  unless  there  is  some  evidence  to  show  that  the  violence 
was  knowingly  and  intentionally  inflicted  or  the  appearances  are  of 
such  a  kind  as  of  themselves  to  indicate  intentional  murder.  (Alison.) 
But,  judging  from  cases  which  have  hitherto  occurred,  it  would  be 
difficult  to  suggest  any  appearances  which  would  be  considered  by 
a  jury  to  indicate  murderous  violence. 

Power  of  Exertion  in  Recently-delivered  Women. — On  these  occasions, 
a  witness  will  often  find  himself  questioned  respecting  the  strength  or 
capability  for  exertion  evinced  by  the  lower  class  of  women  shortly 
after  childbirth.  Dr.  Alison  remarks  that  many  respectable  medical 
practitioners,  judging  only  from  what  they  have  observed  among  the 
higher  ranks,  are  liable  to  be  led  into  an  erroneous  opinion,  which 
may  affect  their  evidence.  He  mentions  a  case,  in  which  a  woman 
accused  of  child-murder  walked  a  distance  of  twenty-eight  miles  in 
a  single  day,  with  her  child  on  her  back,  two  or  three  days  after 
her  delivery.  (Case  of  Anderson,  Aberdeen  Spring  Circular,  1829.) 
Instances  have  even  occurred  in  which  women  have  walked  six  and 
eight  miles,  on  the  very  day  of  their  delivery,  without  sensible  in- 
convenience. ("Criminal  Law,"  p.  161.)  In  one  case  [Smith,  Ayr 
Spring  Circ.  1824),  the  woman  was  engaged  in  reaping — she  retired 
to  a  little  distance,  effected  her  delivery  by  herself,  and  went  on  with 
her  work  for  the  remainder  of  the  day,  appearing  only  a  little  thinner 
and  paler  than  usual.  In  Reg.  v.  Stowler  (Wells  Aut.  Ass.  1865), 
two  witnesses  proved  that  the  prisoner,  who  was  tried  for  the  murder  of 
her  child,  was  at  work  with  them  in  a  field  about  800  yards  from  a 
pond  in  which  the  body  was  afterwards  found.  They  left  the  prisoner 
weeding,  returned  in  about  an  hour,  and  she  was  not  then  in  the  field. 
After  a  time  she  returned,  sat  on  a  bank,  and  then  resumed  her  work. 
The  witnesses  noticed  that  on  her  return  there  was  a  great  difference 
in  hci'  appearance.  In  the  short  interval  she  had  been  delivered, 
had  disposed  of  the  body  of  the  child,  and  resumed  her  work,  as  if 


522  DEATH    FROM    STRANGULATION. 

nothing  had  happened.  A  firm  resolution,  with  a  desire  to  conceal 
her  shame,  may  enable  a  woman,  immediately  after  her  delivery,  to 
perform  acts  connected  with  the  disposal  of  the  body  of  her  child 
which,  from  ordinary  experience,  might  appear  to  be  far  beyond  her 
strength. 

Conclusions. — The  conclusions  to  be  derived  from  the  contents  of 
this  chapter  are  : — 

1.  That  a  new-born  child  may  die  from  violent  causes  of  an  acci- 
dental nature. 

2.  That  some  forms  of  violent  death  are  not  necessarily  attended 
with  external  signs  indicative  of  violence. 

3.  That  a  child  may  be  accidentally  suffocated  during  delivery. 

4.  That  the  usual  marks  of  death  from  suffocation  or  drowning  are 
not  apparent,  except  in  the  bodies  of  children  which  have  breathed. 

5.  That  the  state  of  the  umbilical  cord  may  often  furnish  important 
evidence. 

6.  That  some  females  recently  delivered  may  have  strength  to  exert 
themselves  and  walk  a  great  distance. 

7.  That  a  new-born  child  may  speedily  die  from  exposure  to  cold 
or  from  want  of  food. 

8.  That  slight  fractures  of  the  bones  of  the  cranium  may  arise 
from  the  action  of  the  uterus  on  the  head  of  the  child  during 
delivery. 

9.  That  women  may  be  unexpectedly  delivered  while  in  an  erect 
posture ;  the  umbilical  cord  is  under  these  circumstances  sometimes 
ruptured,  and  the  child  may  sustain  injury  by  the  fall. 

10.  That  the  violence  found  on  the  body  of  a  child  may  be  some- 
times referred  to  attempts  innocently  made  by  a  female  to  aid  her 
delivery. 


CHAPTER    LI. 

Death  of  the  child  from  strangulation. — strangulation  by 
the  navel-string. — accidental  marks  resembling  those  of 
strangulation. — constriction  before  and  after  death. — 
before  and  after  breathing. before  and  after  the  sever- 
ance of  the  navel-string. examination  of  the  mother. 

Among  the  forms  of  violent  death  which  are  generally  attended 
with  appearances  indicative  of  criminal  design  are  the  following : — 

7.  Strangulation. — The  destruction  of  a  new-born  child  by  stran- 
gulation is  not  an  unfrequent  form  of  child-murder;  and  here  a 
medical  jurist  has  to  encounter  the  difficulty,  that  the  strangulation 
may  have  been  accidentally  produced  by  the  twisting  of  the  umbilical 
cord  round  the  neck  during  delivery.  We  must  not  hastily  conclude, 
from  the  red  and  swollen  appearance  of  the  head  and  face  of  a  child 
when  found  dead,  that  it  has    been    destroyed   hy  strangulation. 


STRANGULATION    BY    THE    UMBILICAL    CORD.  523 

There  is  no  doubt  that  errors  were  formerly  made  with  respect  to 
this  appearance;  for  Dr.  Hunter  observes: — "When  a  child's  head 
or  face  looks  swollen,  and  is  very  red  or  black,  the  vulgar,  because 
hanged  people  look  so,  are  apt  to  conclude  that  it  must  have  been 
strangled.  But  those  who  are  in  the  practice  of  midwifery  know 
that  there  is  nothing  more  common  in  natural  births,  and  that 
the  swelling  and  deep  color  go  gradually  off  if  the  child  lives  but 
a  few  days.  This  appearance  is  particularly  observable  in  those 
cases  where  the  navel-string  happens  to  gird  the  child's  neck,  and 
where  its  head  happens  to  be  born  some  time  before  its  body.  (Op. 
cit.  p.  27.) 

Strangulation  by  the  navel-string  can  of  course  refer  to  those  cases 
only  in  which  it  becomes  firmly  twisted  round  the  neck  after  the 
child  has  breathed.  This  is  rather  a  rare  occurrence,  because  under 
these  circumstances  death  more  commonly  takes  place  by  compres- 
sion of  the  cord,  and  by  the  consequent  arrest  of  circulation  before 
the  act  of  breathing  is  performed.  The  only  internal  appearance 
met  with  in  death  from  this  cause  is  a  congested  state  of  the  cere- 
bral vessels.  The  presence  of  ecchymosis  on  the  scalp,  as  well  as 
of  lividity  of  the  face,  is  very  common  in  new-born  children  when 
the  labor  has  been  tedious  and  difficult ;  and  therefore,  unless  there 
were  some  distinct  marks  of  pressure  about  the  neck,  with  a  pro- 
trusion of  the  tongue,  such  appearances  would  not  justify  any  sus- 
picion of  death  from  strangulation. 

It  has  been  supposed,  that  the  strangulation  produced  by  the  wil- 
ful application  of  any  extraneous  constricting  force  to  the  neck, 
would  be  known  from  the  accidental  strangulation  caused  by  the 
cord,  by  the  fact  that  in  the  former  case  there  would  be  a  livid  or 
ecchymosed  mark  or  depression  on  the  neck,  while  in  the  latter 
there  would  not.  Severe  violence  to  the  neck  of  a  new-born  child 
may  produce  in  the  seat  of  constriction  not  only  ecchymosis  but  a 
laceration  of  the  skin,  muscles,  and  windpipe ;  but  these  appear- 
ances are  not  always  present  in  homicidal  strangulation.  In  April, 
1861,  Dr.  Evans,  of  Sunderland,  communicated  to  me  the  particulars 
of  the  case  of  a  new-born  child  which  had  been  destroyed  by  stran- 
gulation. Great  violence  had  been  used,  but  there  was  no  trace  of 
discoloration  in  the  course  of  the  ligature,  or  of  ecchymosis  in  the 
tissues  beneath.  The  muscles  compressed  were  very  dark  in  color. 
In  most  cases  when  a  ligature  is  applied  to  the  neck  during  life  the 
skin  above  and  below  it  becomes  much  swollen,  and  presents  an 
oedematous  character.  This  indicates  an  application  of  violence 
when  there  is  still  some  vital  power  in  the  body  of  the  child.  The 
navel-string  itself  may  be  used  as  a  means  of  constriction,  and  the 
mark  or  depression  may  sometimes  present  an  appearance  of  ecchy- 
mosis. Among  various  cases  which  might  be  quoted  in  support  of 
this  statement,  is  the  following,  reported  by  Mr.  Foster.  In  April, 
1846,  he  was  summoned  to  attend  a  lady  in  labor  with  her  first  child. 
The  labor  was  of  a  lingering  kind,  owing  to  the  size  of  the  head; 
and  the  child  came  into  the  world  dead.  The  navel-string  was 
found  coiled  three  times  round  the  neck,  passing  under  the  right 


524  STRANGULATION    BY    THE    UMBILICAL    CORD. 

armpit :  and  upon  removing  it  three  parallel  discolored  depressions  were 
distinctly  evident.  These  extended  completely  round  the  neck,  and 
corresponded  to  the  course  taken  by  the  coils.  The  child  appeared 
as  if  it  had  been  strangled.  ("Med.  Gaz."  vol.  37,  p.  485.)  Had 
this  child  been  born  secretly,  this  state  of  the  neck  might  have 
created  a  strong  suspicion  of  homicidal  violence.  Strangulation 
after  birth  could  not,  however,  have  been  alleged,  because  there 
would  have  been  no  proof  of  respiration.  When  a  blue  mark  is 
found  on  the  neck  of  a  child  whose  lungs  retain  their  foetal  charac- 
ters, it  is  fair  to  presume,  casteris  paribus,  that  it  has  been  accident- 
ally occasioned  by  the  twisting  of  the  umbilical  cord  during  delivery. 
Mr.  Price  has  communicated  to  the  same  journal  the  account  of  a 
case  in  which  the  cord,  which  was  short,  was  so  tightly  twisted 
around  the  neck  of  a  child,  that  he  was  compelled  to  divide  it  be- 
fore delivery  could  be  accomplished.  There  was  in  this  instance  a 
deep  groove  formed  on  the  neck,  conveying  the  impression  to  him- 
self and  a  medical  friend  that,  in  the  absence  of  any  knowledge  of 
the  tacts,  they  would  have  been  prepared  to  say  that  the  child  had 
been  wilfully  strangled  by  a  rope.  ("Med.  Gaz."  vol.  38,  p.  40;) 
A  diagnosis  might  have  been  formed,  as  in  the  preceding  case,  by 
examining  the  state  of  the  lungs.  Dr.  Mutter  met  with  a  case  in 
which  a  child  was  born  dead,  and  the  cord  was  tightly  twisted  round 
its  neck ;  when  removed,  the  neck  exhibited  a  livid  circle  of  a  fin- 
ger's breadth,  smooth  and  shining:  but  on  cutting  into  this  mark, 
no  ecchymosis  was  found.     ("North.  Jour.  Med."  Jan.  1845,  p.  190.) 

Dr.  AYilliamson,  of  Leith,  has  directed  attention  to  an  important 
fact  connected  Avith  the  state  of  the  lungs  in  a  new-born  child,  and 
the  medical  opinions  which  may  be  expressed  from  their  condition  as 
furnishing  evideuce'  of  live  birth.  Eeferring  to  Mr.  Price's  case,  in 
which  the  cord  was  tightly  twisted  round  the  neck  of  the  child,  he 
states  that  in  similar  cases  which  have  occurred  to  himself,  the  child 
has  breathed  immediately  on  the  birth  of  the  head ;  but,  owing  to 
the  shortness  of  the  cord,  the  child  would  have  been  strangled  and 
born  dead  unless  he  had  divided  it.  Thus,  then,  a  child  might  die 
apparently  strangled,  and  not  be  born  alive,  although  it  might  have 
so  breathed  during  birth  that  the  lungs  would  present  all  the  char- 
acters of  respiration.  If  the  circumstances  were  not  known,  a  medi- 
cal man  might  be  led  to  say  that  the  child  had  been  born  alive,  and 
had  been  destroyed  by  strangulation.  ("  Edin.  Med.  Jour."  Feb. 
1858,  p.  714.)  The  proof  of  respiration,  as  it  has  been  elsewhere 
stated,  is,  however,  not  necessarily  a  proof  of  live  birth. 

From  these  cases  it  will  be  perceived  that  ecchymosis  in  the  de- 
pression on  the  neck  furnishes  no  distinction  between  constriction 
produced  by  criminal  means,  and  that  which  may  result  accidentally 
from  the  navel-string.  In  the  following  case  ("  Ann.  d'Hyg."  1841, 
vol.  1,  p.  127),  a  woman  charged  with  the  murder  of  her  child  by 
strangulation  appears  to  have  been  unjustly  condemned.  The  child 
had  fully  and  perfectly  breathed ;  the  lungs  weighed  one  thousand 
grains,  and  when  divided,  every  portion  floated  on  water,  even  after 
firm  compression.     There  was   a   circular  depression  on  the  neck, 


DEATH    FROM    STEANGULATION.  525 

which  was  superficially  ecchymosed  in  some  parts.  From  an  inves- 
tigation of  the  facts,  this  appeared  to  have  been  a  case  in  which  a 
mark  on  the  neck  was  accidentally  produced  by  the  umbilical 
cord,  during  attempts  at  self-delivery  on  the  part  of  the  woman  ; 
she  was  nevertheless  convicted  and  condemned  to  a  severe  punish- 
ment, chiefly  from  the  opinion  expressed  by  two  medical  witnesses, 
that  a  soft  and  yielding  substance  like  the  umbilical  cord  could  not 
produce  a  depression  and  ecchymosis  on  the  neck  of  a  child  during 
birth.  They  attributed  the  mark  to  the  wilful  application  of  a  liga- 
ture like  a  garter ;  but  the  experiments  of  Dr.  Negrier  clearly  show 
that  the  umbilical  cord  has  sufficient  strength  to  produce  fatal  con- 
striction. 

In  the  same  volume  of  the  "  Annales  d'Hygiene,"  (at  p.  428,)  will 
be  found  the  report  of  another  case,  suggesting  many  important  re- 
flections in  regard  to  the  medical  jurisprudence  of  infanticide.  In 
this  instance  the  navel-string  and  the  membranes  were  actually  used 
by  the  female  as  a  means  of  strangulation ;  the  child  had  not  breathed, 
but  was  thereby  prevented  from  breathing.  There  was  superficial 
ecchymosis  on  each  side  over  the  muscles  of  the  neck.  The  defence 
was,  that  the  child  was  born  with  the  cord  around  its  neck,  and  that 
it  was  from  this  circumstance  accidentally  strangled ;  but  the  medi- 
cal evidence  tended  to  show  that  the  cord  had  been  violently  stretched 
and  employed  as  a  means  of  strangulation.  The  child  had  not 
breathed,  and  the  medical  witnesses  considered  that  it  had  been  born 
dead,  owing  to  the  violence  used  by  the  woman.  The  cause  of  death 
here  was  certainly  not  strangulation,  but  arrested  circulation.  In 
the  meantime,  the  case  proves  that  ecchymosis  (a  blue  mark)  may  be 
the  result  of  violent  constriction  produced  by  the  navel-string.  A 
case  occurred  to  Mr.  M'Cann,  in  September,  1838,  in  which  the  navel- 
string,  which  was  of  its  full  length,  had  been  used  as  the  means  of 
strangulation.  It  was  twisted  once  round  the  neck,  passed  under  the 
left  arm,  over  the  shoulders,  and  round  the  neck  again,  forming  a 
noose  or  knot,  which,  pressing  upon  the  throat,  must  have  caused 
strangulation,  as  the  tongue  was  protruded,  and  there  were  other 
clear  indications  of  the  child  having  been  strangled.  The  hydro- 
static test  applied  to  the  lungs  proved  that  respiration  had  been  per- 
formed. 

When  the  mark  on  the  neck  is  deep,  broad,  much  ecchymosed,  and 
there  is  extravasation  of  blood  beneath,  with  injury  to  the  muscles 
or  trachea,  and  ruffling  or  laceration  of  the  skin,  it  is  impossible  to 
attribute  these  appearances  to  accidental  compression  by  the  navel- 
string.  The  lividity  produced  by  it  in  the  cases  hitherto  observed 
has  been  only  slight  and  partial,  and  unaccompanied  by  laceration 
of  the  skin,  or  injury  to  deep  seated  parts.  On  the  other  hand,  in 
homicidal  strangulation,  as  much  more  violence  is  commonly  used 
than  is  necessary  for  destroying  life,  we  may  expect  to  find  great 
ecchymosis  and  extensive  injury  to  the  surrounding  soft  parts.  On 
some  occasions  all  difficulty  is  removed  by  the  discovery  of  a  rope, 
tape,  or  ligature,  tied  tightly  round  the  neck  ;  or,  if  this  be  not  found, 
the  proofs  of  some  ligature  having  been  used  will  be  discovered  in 


526  DEATH    FROM    STR ANGULATION. 

the  indentations  or  irregularly- eccliymosecl  spots  left  on  the  skin ; 
the  depressed  portions  of  skin  being  generally  white,  and  the  raised 
edges  livid  or  oedematous. 

It  has  been  doubted  whether  a  child  can  be  born  with  the  navel- 
string  so  tightly  round  the  neck  as  to  produce  great  depression  of 
the  skin  and  ecchyruosis,  i.  e.,  to  simulate  homicidal  strangulation, 
and  at  the  same  time  perform  the  act  of  respiration  fully  and  com- 
pletely. It  is  important,  therefore,  when  this  hypothesis  is  raised  in 
order  to  account  for  a  suspicious  mark  on  the  neck,  to  examine 
closely  the  state  of  the  lungs.  Unless  the  cord  be  designedly  put 
round  the  neck  of  the  child  after  the  head  has  protruded,  the  effect 
of  the  expulsive  efforts  of  the  uterus,  when  a  coil  has  become  acci- 
dentally twisted  round  the  neck,  would  be  to  tighten  the  cord,  com- 
press the  vessels,  and  kill  the  child  by  arresting  the  maternal 
circulation,  at  the  same  time  that  this  pressure  would  effectually  pre- 
vent the  act  of  breathing.  Hence  the  lungs  usually  present  the 
appearances  met  with  in  still-born  children  generally ;  but  the  case 
which  occurred  to  Dr.  Williamson  (p.  524)  shows  that  this  state  of 
things  may  sometimes  occur,  and  that  a  child  may  breathe,  and  die 
strangled  by  the  umbilical  cord  before  its  body  is  entirely  born. 
Medical  witnesses,  however,  should  not  be  too  ready  to  accept  such  a 
suggestion;  a  careful  examination  of  the  neck  will  show  whether  a 
ligature  has  or  has  not  been  wilfully  applied  after  birth.  In  Reg.  v. 
Robinson  (Lewes  Summer  Assizes,  1853),  there  was  around  the  neck, 
the  mark  of  a  ligature  which  had  been  tied  very  tightly.  The  child 
had  fully  breathed,  and  according  to  the  medical  evidence  it  had 
died  from  strangulation,  owing  to  an  accidental  twisting  of  the  cord 
during  delivery.  In  examining  a  suspicious  mark  on  the  neck  of  a 
new-born  infant,  it  is  proper  to  notice  whether  it  does  not,  by  its 
form  or  course,  present  some  peculiar  indentations  which  may  ren- 
der it  certain  that  a  ligature  has  been  wilfully  employed  after  birth. 
When  it  is  found  that  a  child  has  fully  breathed,  the  presence  of  a 
deeply-ecchymosed  or  an  oedematous  mark  on  the  neck  with  injury 
to  the  skin  and  muscles  is,  casteris  paribus,  presumptive  of  homici- 
dal strangulation.  Death  from  accidental  constriction  of  the  cord 
during  delivery  should,  as  a  general  rule,  leave  the  lungs  in  their 
foetal  condition. 

Murks  on  the  neck  of  a  child  may  be  accidentally  produced  by  the 
navel-string  without  necessarily  destroying  the  child's  life.  Two 
cases  of  this  kind  are  reported  by  Professor  Busch  ("Brit,  and  For. 
Med.  Eev."  vol.  10,  p.  579):  and  a  child  may  be  destroyed  without 
ecchymosis  being  a  necessary  consequence  of  the  constriction  pro- 
duced by  it.  There  is  much  less  risk  of  strangulation  from  twisting 
of  the  cord  during  birth  than  is  commonly  believed.  Out  of  190 
cases  Dr.  Churchill  found  the  cord  round  the  neck  in  fifty-two  chil- 
dren, and  the  shortest  cord  so  disposed  was  eighteen  inches  long; 
Dr.  Negrier  found  it  round  the  neck  in  twenty  cases  out  of  160  na- 
tural labors.     ("Ann.  dllyg."  1811,  vol.  1,  p.  137.) 

The  appearances  met  with  in  the  body  in  death  from  strangulation 
have  been  elsewhere  fully  considered  ^p.  351.)     The  facts  of  a  case 


APPEARANCES    RESEMBLING    STRANGULATION.         527 

communicated  to  me,  in  March,  1865,  by  Mr.  Cann  of  Dawlisli  will, 
however,  serve  to  show  the  appearances  as  they  may  present  them- 
selves in  a  new-born  child.  A  maid-servant  in  a  family  was  secretly 
delivered  of  a  child.  When  the  body  was  found,  it  was  observed 
to  be  full-grown,  and  there  was  a  piece  of  tape  twice  round  the  neck, 
which  had  been  tied  tightly  in  a  bow.  The  tongue  protruded  be- 
tween the  lips;  two  deep  furrows  were  found  round  the  neck  after 
the  removal  of  the  tape;  there  was  great  oedema  with  swelling  of 
the  skin  between  and  above  them,  and  the  right  hand  was  clenched. 
The  lungs  were  of  a  light-red  color;  they  filled  the  chest,  were 
highly  crepitant,  and  floated  readily  on  water,  even  when  divided 
into  sixteen  pieces,  and  these  had  been  submitted  to  strong  pressure. 
They  weighed,  however,  only  626  grains.  The  heart  was  healthy: 
the  right  side  contained  some  coagula  of  blood — -the  left  side  was 
empty;  the  foramen  ovale  was  open.  The  scalp  was  much  con- 
gested, the  congestions  almost  amounting  to  small  effusions  of  blood; 
the  pia  mater  was  also  congested.  The  inferences  drawn  from  these 
facts  were,  that  the  child  had  been  born  alive,  and  that  it  had  died  from 
strangulation.  The  lungs  were  as  light  as  they  usually  are  in  the 
foetal  state,  showing  that,  although  they  had  received  air,  the  pul- 
monary circulation  had  not  been  perfectly  established. 

Accidental  Marks  resembling  those  of  Strangulation. — In  the  fore  part 
of  the  neck  of  a  child  a  mark  or  depression  is  sometimes  accidentally 
produced  by  forcibly  bending  the  head  forwards  on  the  chest,  espe- 
cially when  this  has  been  done  repeatedly  and  recently  after  death, 
while  the  body  is  warm.  It  may  occur,  also,  as  an  accident  during 
labor.  Such  a  mark  must  not  be  mistaken  for  the  effect  of  homi- 
cidal violence.  It  has  been  a  question  whether,  independently  of 
the  constriction  produced  by  the  umbilical  cord,  the  neck  of  the 
uterus  might  not  cause,  daring  its  contractions,  an  ecchymosed  mark 
on  the  neck.  I  am  not  aware  that  there  is  any  case  reported  which 
bears  out  this  view;  and  it  seems  highly  improbable  that  any  such 
result  should  follow. 

The  discoloration  may  be  in  detached  spots  or  patches — situated 
in  the  fore  part  of  the  neck,  and  evidently  not  arising  from  the  em- 
ployment of  any  ligature.  These  marks  may  depend  on  the  forcible 
application  of  the  fingers  to  the  fore  part  of  the  neck  of  the  child, 
and  the  indentations  have  been  known  to  correspond — a  fact  which 
has  at  once  led  to  a  suspicion  of  the  cause  of  pressure  and  the  mode 
of  death.  At  the  same  time  it  should  be  born  in  mind  that  a  super- 
ficial mottling  of  the  skin  occurs  after  death  in  new-born  infants,  in 
parts  where  moderate  pressure  only  may  have  been  accidentally 
produced.  This  would  not  be  attended  with  ecchymosis,  and  its 
true  nature  would  be  at  once  determined  by  comparing  the  discol- 
ored spots  with  the  surrounding  skin.  It  may  be  alleged,  in  defence, 
that  such  marks  might  have  been  accidentally  produced:  1.  By  the 
forcible  pressure  produced  by  the  child's  head  during  labor.  2. 
They  will  be  more  commonly  referred  to  violent  attempts  made  by 
a  woman  at  self-delivery,  during  a  paroxysm  of  pain.  This  expla- 
nation is  admissible,  so  long  as  it  is  confined  to  injuries  which,  by 


528         APPEARANCES    RESEMBLING    STRANGULATION. 

any  reasonable  construction,  might  be  caused  during  labor;  but 
supposing  the  marks  to  have  been  certainly  produced  after  the  com- 
plete birth  of  the  bod}^  it  will  not  of  course  apply. 

Among  marks  simulating  violence,  which  are  sometimes  found  on 
the  necks  of  new-born  children,  Mr.  Harvey  has  pointed  out  one  of 
a  singular  kind.  In  February,  1846,  he  was  present  at  a  delivery  in 
which  a  child  was  expelled  rather  suddenly  ;  and  after  making  two 
or  three  convulsive  gasps,  it  died.  Whilst  endeavoring  to  restore 
animation,  he  observed  a  bright-red  mark  extending  completely 
across  the  upper  and  fore  part  of  the  neck,  from  one  angle  of  the 
lower  jaw  to  the  Other,  as  though  it  had  been  produced  by  strangu- 
lation with  a  cord,  except  that  the  mark  was  not  continued  round  to 
the  back  of  the  neck.  It  was  of  a  vivid  red  color,  and  not  like  a 
bruise  or  ecchymosis,  but  it  had  very  much  the  appearance  of  a  re- 
cent excoriation.  It  was  most  clearly  defined  in  front,  where  it  was 
about  a  quarter  of  an  inch  in  breadth,  and  it  became  diffused  at  the  sides. 
The  face  was  not  swollen,  and  there  was  no  fulness  of  the  veins. 
("Med.  Graz."  vol.  39,  p.  379.)  A  distinction  in  this  instance  might 
nave  been  based  upon  the  color  of  the  mark,  the  uninjured  state  of 
the  cuticle,  and  the  absence  of  congestion  of  the  face  and  venous 
system.  Nevertheless,  the  fact  is  of  some  importance,  and  should 
be  borne  in  mind  during  the  examination  of  the  body  of  a  new-born 
child  alleged  to  have  been  strangled.  Another  case,  which  was  the 
subject  of  a  coroner's  inquest,  was  published  by  Mr.  Kose  in  the 
same  journal  (vol.  37,  p.  530),  in  which  red  marks  on  each  side  of 
the  nose  of  a  new-born  child  were  mistaken  for  the  effects  of  violence 
applied  to  the  nostrils  during  a  supposed  attempt  at  suffocation.  Mr. 
Kose  examined  them  closely,  and  considered  that  they  were  nsevi 
(mother's  marks),  and  had  nothing  to  do  with  the  death  of  the  in- 
fant. 

A  medical  witness  may  be  asked  on  these  occasions,  whether  he 
will  undertake  to  swear  that  the  ligature  or  the  fingers  had  been 
applied  to  the  neck  of  a  child  before  or  after  its  death,  or  before  or 
after  it  had  breathed.  It  is  proper  to  observe  that,  so  far  as  external 
marks  of  strangulation  are  concerned,  there  is  no  difference  in  the 
appearances,  whether  the  constriction  takes  place  during  life,  or  im- 
mediately after  death  while  the  body  is  warm.  Casper's  experiments 
render  it  highly  probable,  that  when  a  constricting  force  is  applied 
to  the  neck  of  a  dead  child,  at  any  time  within  an  //our  after  death, 
the  marks  cannot  with  certainty  be  distinguished  by  any  appearance 
from  those  made  on  a  living  body.  ("  Wochenschrift,"  Jan.  1837; 
see  also  p.  344,  ante.)  With  regard  to  the  second  point,  it  may  be 
stated,  that  whether  the  child  has  breathed  or  not,  provided  it  be 
living  and  the  blood  circulating,  marks  of  violence  on  the  neck  will 
present  precisely  the  same  characters. 

In  the  absence  of  any  visible  discoloration  of  the  skin,  it  may  be  a 
question  whether  this  should  be  taken  as  evidence  of  the  means  of 
constriction  not  having  been  applied  during  life.  What  we  are  en- 
titled to  say  from  observed  facts  is,  that  ecchymosis  from  the  liga- 
ture is  not  a  necessary  consequence  of  constriction  either  in  a  living 


STRANGULATION.  529 

or  a  recently  dead  child ;  although  Ave  might  expect  that  there  would 
be  few  cases  of  deliberate  child-murder  in  which  when  strangulation 
was  resorted  to,  there  would  not  be  some  ecchymosed  mark  or  dis- 
coloration, chiefly  from  the  presumption  that  great  and  unnecessary 
force  is  suddenly  applied.  Besides,  it  is  not  improbable  that  a 
slighter  force  would  cause  ecchymosis  on  the  skin  of  a  new-born 
infant  than  would  be  required  to  produce  such  an  appearance  on 
that  of  an  adult. 

Another  question  has  been  put  which  the  proposed  change  in  the 
statute  law  will  hereafter  exclude — namely,  whether  a  medical  wit- 
ness will  undertake  to  say  that  the  constricting  force  had  not  been 
applied  to  the  neck  of  the  child  until  after  its  body  had  been  entirely 
born.  This,  of  course,  must  be  a  pure  matter  of  speculation.  The 
appearance  caused  by  a  ligature  applied  to  the  neck  of  a  living  child 
would  not  be  different  whether  the  child  was  partially  or  entirely 
born.  If  the  child  has  actually  breathed,  the  appearances  in  the 
body  would  be  the  same,  and  there  are  no  medical  facts  by  which  it 
could  be  determined  whether  the  act  of  strangulation  proved  fatal  dur- 
ing birth  or  afterwards.  A  medical  witness  has  also  had  this  question 
put  to  him  :  Whether  the  strangulation  occurred  before  or  after  the 
navel-string  was  severed.  It  would  appear  that  the  severance  of  the 
cord  has  been  sometimes  regarded  in  law  as  a  test  of  an  independent 
circulation  being  established  in  the  child;  but  this  is  obviously  an 
error,  depending  on  the  want  of  proper  information  respecting  the 
phenomena  which  accompany  birth.  Respiration,  and  therefore  an 
independent  circulation,  may  take  place  before  the  cord  is  divided ; 
and  its  severance,  which  is  never  likely  to  occur  until  after  entire 
birth,  cannot  consequently  be  considered  as  a  boundary  between  a 
child  which  is  really  born  alive,  and  one  which  is  born  dead.  A 
premature  severance  might  possibly  endanger  the  life  of  a  child,  in- 
stead of  giving  it  an  independent  existence.  A  healthy  and  vigorous 
child  may  continue  to  live,  and  breathe  independently  of  the  mother, 
before  the  division  of  the  cord,  and  the  time  at  which  the  severance 
is  made  depends  on  mere  accident.  Hence  the  marks  of  strangula- 
tion on  the  neck  of  a  living  and  breathing  child  must  be  the  same 
whether  the  cord  has  been  divided  or  not.  The  entire  birth  of  the 
body  is,  however,  now  considered  to  be  complete  although  the  navel- 
string  has  not  been  divided. 

8.  Poisoning. — This  is  placed  among  the  possible  means  of  perpe- 
trating child-murder,  but  Ave  rarely  hear  of  new-born  children  being 
thus  destroyed.  The  earliest  age  at  which  I  have  known  a  trial  to 
take  place  for  the  murder  of  a  child  by  poison  was  two  months. 
{Rex  v.  South,  Norf.  Aut.  Circ,  1884.)  A  quantity  of  arsenic  was 
given  to  an  infant,  and  it  died  in  three  hours  and  a  quarter  after 
the  administration  of  the  poison.  At  this  age  the  case  can  scarcely 
be  called  one  of  infanticide  in  a  medico-legal  signification,  because 
all  that  it  would  be  necessary  to  prove  would  be  the  cause  of  death  ; 
the  question  of  life  or  live  birth  would  not  require  to  be  entered 
into.  If,  in  a  case  of  child-murder,  death  from  poison  should  be 
suspected,  it  must  be  sought  for  in  the  usual  way.  Some  cases  have 
34 


530  DEATH    FROM    POISON. 

occurred,  in  which  children  have  been  wilfully  destroyed  a  week  or 
two  after  birth,  by  the  administration  of  opium  or  excessive  doses 
of  purgative  medicine.     Oil  of  vitriol  has  been  also  used. 

In  cases  in  which  infants  are  destroyed  by  poison,  there  is  gen- 
erally great  difficulty  in  tracing  the  act  of  administration  to  the 
guilty  person.  The  fluid  food  given  to  them  renders  the  admixture 
of  poison  easy,  and  as  many  persons  may  have  access  to  this  food, 
it  is  often  impossible  to  fix  upon  the  criminal.  In  one  instance 
which  came  to  my  knowledge,  an  illegitimate  child  had  been  placed 
out  to  nurse  by  its  mother,  a  woman  in  good  social  position.  It  was 
noticed  that  after  each  visit  paid  by  the  mother  the  child  was  sick, 
and  after  repeated  attacks  of  illness,  the  child  died.  On  inspection 
arsenic  was  found  in  the  body,  and  this  was  beyond  doubt  the  cause 
of  death.  There  was  no  suspicion  against  the  nurse;  but  a  strong 
suspicion  fell  on  the  mother,  from  the  circumstances  above  mentioned. 
There  was  evidence,  however,  that  the  child  was  not  at  any  time  fed 
by  the  mother  when  she  visited  it,  and  that  the  mother  had  no  access 
to  the  child's  food.  No  poison  could  be  traced  to  her  possession, 
and  she  was  not  seen  by  the  nurse,  who  was  present,  to  give  any- 
thing to  the  infant.  The  only  fact  that  transpired  was  that,  at  each 
visit,  she  took  it  in  her  arms  and  was  observed  to  rub  its  gums  with 
her  fingers,  and  soon  after  her  visits,  sickness  followed.  There  was 
reason  to  believe  that  she  had  concealed  small  quantities  of  arsenic 
under  her  finger-nails,  and  that  she  had  administered  the  poison 
while  rubbing  the  gums  of  the  child! 

Examination  of  the  Mother. — The  duties  of  a  medical  practitioner, 
so  far  as  they  relate  to  the  mother  of  the  child,  generally  the  accused 
party,  are  slight.  He  may  be  required  to  prove,  by  an  examination 
made  under  an  order  from  proper  authority,  whether  a  woman  has 
or  has  not  been  recently  delivered  of  a  child,  and  to  state  the  prob- 
able period  at  which  the  delivery  took  place.  (See  Delivery,  p. 
431.)  This  examination  may  be  necessary  in  order  to  connect  her 
delivery  with  the  period  which  may  have  elapsed  since  the  birth  and 
death  of  the  child.  Unless  the  examination  of  the  woman  be  made 
within  twelve  or  fifteen  days,  no  satisfactory  evidence  can  in  general  be 
obtained.  It  has  happened,  on  more  than  one  occasion,  that  medical 
men  have  assumed  to  themselves  the  right  of  enforcing  an  examina- 
tion of  a  suspected  woman,  and,  by  threats  or  otherwise,  have  com- 
pelled her  to  undergo  this.  Such  a  course  of  conduct  is  in  the 
highest  degree  indecent  and  improper:  if  a  woman  willingly  con- 
sents to  an  examination,  or  an  order  be  obtained  from  a  magistrate 
or  other  official  person,  the  case  is  different.  In  taking  this  au- 
thority upon  himself,  a  medical  man  is  forcibly  compelling  an  accused 
party  to  produce  positive  proof  of  her  guilt — a  principle  which  is 
entirely  opposed  to  the  spirit  and  practice  of  English  jurisprudence. 
The  mischievous  results  of  such  officiousness  on  the  part  of  a 
medical  practitioner  are  well  illustrated  by  the  case  of  Weir  and  wife 
v.  Hodgson  (Liverpool  Winter  Assizes,  1861).  The  dead  body  of  a 
child  had  been  found  near  the  house  of  the  plaintiff.  The  defend- 
ant, a  surgeon,  went  with  the  inspectors  of  police  to  see  Mrs.  "Weir; 


BIRTH.      INHERITANCE.  531 

and,  having  informed  her  that  she  was  suspected  of  having  had  a 
child,  told  her  that  he  had  come  to  examine  her  by  the  authority  of 
the  law,  and  that  she  must  submit.  She  refused  at  first,  and  proposed 
to  send  for  a  medical  man  whom  she  knew.  In  the  end  the  defend- 
ant examined  her,  and  there  was  no  ground  for  the  charge.  The 
jury  returned  a  verdict  of  200 1,  damages  for  the  assault.  The  police 
can  give  no  legal  power  to  a  medical  man  to  make  such  an  examina- 
tion in  a  suspected  case,  and  the  ultimate  consent  of  the  woman,  if 
extorted  by  threats  or  intimidation,  will  be  no  answer  to  a  charge  of 
assault. 

Conclusions. — The  following  conclusions  may  be  drawn  from  the 
preceding  remarks: — 

1.  That  congestion  of  the  face  and  head  in  a  new-born  child  is  not 
a  proof  of  death  from  strangulation. 

2.  That  strangulation  can  take  place  only  in  children  which  have 
breathed. 

3.  That  a  child  may  be  strangled  during  birth  by  the  accidental 
twisting  of  the  navel-string  round  its  neck. 

4.  That  the  navel-string  may  produce  a  livid  or  ecchymosed  de- 
pression on  the  neck,  like  any  other  ligature. 

5.  The  marks  on  the  neck,  arising  from  accidental  causes,  may  re- 
semble those  which  arise  from  strangulation. 

6.  That  the  effect  of  constriction  on  the  neck,  either  by  the  navel- 
string  or  any  other  ligature,  is  the  same  if  the  child  be  living, 
whether  it  has  or  has  not  breathed. 

7.  That  the  effect  is  the  same  whether  the  child  has  been  partially 
or  entirely  born. 

8.  That  the  effect  of  a  ligature  on  the  neck  of  a  living  child  is  the 
same,  whether  the  navel-string  has  or  has  not  been  severed. 

9.  That  a  new-born  child  may  die  from  strangulation,  without 
this  fact  being  necessarily  indicated  by  ecchymosis  on  the  neck. 
This  depends  on  the  nature  of  the  ligature,  and  the  amount  of  force 
used. 


BIRTH.   INHERITANCE. 


CHAPTER   LII. 

Live  birth  in  civil  cases. — date  op  birth. — signs  of  live  birth 
independently  of  respiration  orcrying. — vagitus  uterinus. 
— tenancy  by  courtesy. — legal  birth. — post-mortem  births. 
—  minority  and  majority. — plural  and  monstrous  births. 

Date  of  Birth. — Medical  evidence  has  occasionally  been  demanded 
in  courts  of  law  respecting  the  actual  date  of  birth  in  those  cases  in 
which  a  period  of  a  few  days,  hours,  or  even  minutes  was  required 


532  LEGAL  PROOFS  OF  BIRTH. 

to  prove  the  att'ainment  of  majority — and  therefore  a  legal  respon- 
sibility for  the  performance  of  civil  contracts  into  which  the  parties 
had  entered,  either  knowingly  or  ignorantly,  when  minors.  Some 
such  cases  have  been  decided  by  the  evidence  of  the  accoucheur 
himself — others,  when  the  accoucheur  was  dead,  by  the  production 
of  his  case-books ;  and  it  is  worthy  of  notice  that  the  strictness  and 
punctuality  of  some  medical  practitioners,  in  making  written  mem- 
oranda of  cases  attended  by  them,  have  in  more  than  one  instance 
led  to  a  satisfactory  settlement  of  such  suits,  and  the  avoidance  of 
further  litigation.  The  proof  of  the  exact  date  of  birth  is  also  of 
considerable  importance  in  certain  cases  of  contested  legitimacy. 

The  medico-legal  questions  connected  with  this  subject  are  those 
which  arise  in  contested  suits  relative  to  succession  or  the  inheri- 
tance of  property.  A  child  that  is  born  alive,  or  has  come  entirely 
into  the  world  in  a  living  state,  may  by  the  English  law  inherit  and 
transmit  property  to  its  heirs,  even  although  its  death  has  immedi- 
ately, and  perhaps  from  morbid  causes  necessarily,  followed  its  birth. 
Should  the  child  be  born  dead,  whether  it  died  in  the  womb  or  dur- 
ing the  act  of  birth,  it  does  not  acquire  any  civil  rights;  for  it  is 
not  regarded  as  a  life  in  being,  unless  it  manifests  some  sign  of  life 
after  it  is  entirely  born  and  separated  from  the  mother.  Some  have 
considered  that  'partial  birth,  provided  a  child  is  living,  should  suf- 
fice to  confer  the  same  rights  on  the  offspring  as  the  proof  of  entire 
birth;  but  great  difficulty  might  arise  in  civil  cases,  if  the  bare  ex- 
trusion of  a  part  of  the  body  sufficed  for  all  the  legal  purposes  of 
entire  birth.  It  might  become  a  casuistical  question,  as  to  how  much 
of  the  body  should  be  in  the  world  in  order  to  constitute  legal  birth  ; 
for  there  is  no  reason  why,  in  a  medical  view,  the  extrusion  of  the 
head  and  shoulders  should  constitute  birth  any  more  than  the  extru- 
sion of  a  hand  or  a  foot.  If  it  be  said  that  the  act  of  breathing 
should  be  combined  with  a  partial  extrusion  of  the  body,  this  would 
be  unjust ;  because  a  child  is  alive — its  heart  is  evidently  pulsating, 
and  its  blood  circulating,  as  freely  before  the  act  of  breathing  as 
afterwards.  Besides,  it  is  admitted  that  children  may  be  born  alive, 
and  live  for  some  time  without  respiring;  and  this  want  of  respira- 
tion is  no  objection  to  these  children  being  considered  living  in  law. 
In  a  case  referred  to  hereafter,  a  child  was  pronounced  to  have  been 
legally  born  alive,  although  it  had  certainly  not  respired ;  and  that 
a  child  may  manifest  life  for  a  certain  time  without  leaving  in  its 
body  any  evidence  of  respiration  is  clear  from  numerous  reported 
<ases  (p.  476).  If,  then,  proof  of  respiration  be  not  demanded  in 
cases  of  entire,  it  could  scarcely  be  required  in  cases  of  partial  birth. 
In  the  event  of  partial  being  treated  as  synonymous  with  entire 
birth,  there  would  be  no  end  to  litigation;  and  medical  opinions 
would  vary  in  every  case.  It  is  doubtful  whether,  under  such  cir- 
cumstances, the  law  could  be  administered  with  any  degree  of  cer- 
tainty or  impartiality.  Admitting,  then,  that  a  child  must  be  entirely 
born  in  order  that  it  should  acquire  civil  rights,  it  will  next  be 
necessary  to  examine  the  proofs  required  to  show  that  it  has  been 
born  alive  in  a  legal  sense.     The  question  here  is  different  from  that 


PROOFS    OF    LIFE    AFTER    BIRTH.  533 

of  live  birth  in  reference  to  child-murder.  We  must  presume  that 
a  practitioner  is  present  at  a  delivery  in  which  a  child  is  born  in  a 
doubtful  state,  or  where  its  death  speedily  follows  its  birth.  The 
civil  rights  of  the  child  and  its  heirs  will  depend  upon  the  careful 
observation,  made  by  a  practitioner,  of  the  circumstances  attending 
the  delivery.  It  is  proper  that  he  should  note  when  the  birth  is 
completed,  by  the  body  of  the  child  being  entirely  out  of  the  body 
of  the  mother.  Children  born  at  or  about  midnight  are  liable  to 
have  the  date  of  birth  wrongly  registered ;  and  the  legal  difference 
of  twenty-four  hours,  which  a  few  seconds  or  minutes  may  make, 
may  hereafter  affect  their  own  rights  if  they  survive,  or  those  of 
others  if  they  die. 

Signs  of  Live  Birth  Independently  of  Respiration  or  Crying. — -The 
visible  respiration  of  a  child  after  its  birth,  or  as  it  may  be  mani- 
fested by  its  crying,  is  an  undoubted  sign  of  its  having  been  born 
alive ;  but,  as  it  has  just  been  stated,  a  child  may  acquire  its  civil 
rights,  although  it  may  be  neither  seen  to  breathe  nor  heard  to  cry. 
The  pulsation  of  a  child's  heart,  or  even  the  spasmodic  twitching  of 
any  of  the  muscles  of  the  body,  has  been  regarded  as  a  satisfactory 
proof  of  live  birth.  The  latter  sign  has  been  judicially  so  pro- 
nounced— a  fortiori,  therefore,  the  motion  of  a  limb  will  be  consid- 
ered sufficient  legal  evidence,  in  an  English  court  of  law,  of  life 
after  birth.  It  is  to  be  observed  that  the  length  of  time  during 
which  these  signs  of  life  continue  after  a  child  is  born  is  wholly  im- 
material ;  all  that  is  required  to  be  established  is,  that  they  were 
positively  manifested.  A  child  which  survives  entire  birth  for  a 
single  instant  acquires  the  same  civil  rights  as  if  it  had  continued  to 
live  for  a  month  or  longer. 

A  late  eminent  Scotch  judge  informed  me  that  in  Scotland  the 
husband's  right  of  courtesy,  or  life-rent  in  his  wife's  estate,  depends 
on  there  having  been  a  child  of  the  marriage  born  alive ;  and  for 
the  proof  of  live  birth  it  is  required  to  be  shown,  not  merely  that 
it  had  breathed,  but  that  the  child  had  cried  after  it  was  born. 
(Case  of  Dobie  v.  Richardson,  Court  of  Sessions,  1765.)  The  last 
case  of  this  kind  came  before  the  courts  in  1833,  and  by  a  majority 
their  lordships  adhered  to  the  old  dicta  of  the  law,  and  decided  that 
the  only  receivable  proof  of  life  in  such  a  case  was  that  the  cliild 
had  cried.  The  fact  that  the  child  was  capable  of  motion,  and  that 
it  had  breathed  for  three-quarters  of  an  hour,  was  held  not  to  be  a 
sufficient  proof  to  establish  life  unless  it  had  cried !  There  is  rea- 
son to  believe  that,  in  any  future  case,  this  will  not  be  taken  as  a 
precedent.  The  attainment  of  greater  knowledge  on  the  nature  and 
the  proofs  of  life  from  the  results  of  medical  experience  and  obser- 
vation, and  the  fact  that  these  questions  have  become  more  gene- 
rally known  and  better  understood,  will  probably  lead  to  a  different 
decision.  That  there  should  not  be  a  power  of  proving  life  (when 
the  death  of  a  child  takes  place  speedily  after  birth),  except  by 
direct  evidence  that  the  child  has  cried,  is  in  truth  a  view  of  the 
matter  wholly  indefensible.  The  crying  of  a  child  is  not  necessarily 
a  sign  of  live  birth,  for  it  may  cry  during  the  act  of  birth,  and  die 


534  LEGAL    AND    PHYSIOLOGICAL    LIFE. 

before  its  body  is  born ;  while  the  fact  that  it  breathes  and  moves 
after  birth,  although  from  accidental  circumstances  it  may  not  cry, 
is  unexceptionable  evidence  of  its  having  been  born  alive. 

In  Brock  v.  Kellock  (April,  1861,)  involving  a  claim  by  the  widow 
to  the  estate  of  her  husband,  on  the  ground  that  a  child  born  twenty 
years  before  had  been  born  living,  although  it  was  at  first  supposed 
to  have  been  still-born,  Stuart,  Y.  C,  decided  that  proof  of  breath- 
ing was  not  necessary,  and  held  that  there  was  sufficient  legal  evi- 
dence of  life  after  birth  in  the  pulsations  observed  by  the  accoucheur. 
This  decision  is  in  accordance  with  law  and  common-sense.  Pulsa- 
tions indicate  an  independent  action  of  the  foetal  heart,  as  much  as 
a  motion  of  the  chest  indicates  an  action  of  the  intercostal  muscles. 
Why  it  should  be  maintained  that  there  is  life  with  contractility  of 
the  intercostal  muscles,  but  not  with  a  contractile  power  of  the 
heart,  is  not  apparent ;  that  this  view  is  not  in  accordance  with 
facts,  is  however  proved  by  several  cases  which  are  described  under 
Infanticide,    (p.  476.) 

There  is  no  doubt  that  the  best  test  to  apply  to  such  cases  for  the 
determination  of  physiological  life  is  auscultation.  The  beating  of 
the  heart,  as  determined  by  the  ear  or  the  stethoscope,  applied  even 
for  five  consecutive  minutes,  is  an  undoubted  sign  of  life,  in  a 
physiological  sense,  whether  the  child  breathes,  cries,  or  moves. 
M.  Bouchut  noticed,  on  one  occasion,  that  this  kind  of  passive  life 
continued  in  an  infant  for  twenty-three  hours  after  its  birth.  Feeble 
but  distinct  pulsations  were  heard  at  long  intervals,  but  there  was 
no  motion  of  the  ribs.  Attempts  at  resuscitation  were  made,  but 
the  motions  of  the  heart  became  more  and  more  feeble,  until  they 
entirely  ceased.  An  examination  showed  that  the  lungs  had  not 
received  air.  As  we  take  the  cessation  of  the  heart's  action  to  be 
the  only  certain  evidence  of  death,  so  the  existence  of  pulsations  in 
the  heart  or  arteries,  when  clearly  perceived  by  the  ear,  stethoscope, 
or  finger,  is  positive  evidence  of  life  in  a  physiological  sense.  Is 
this  legal  life  ?  Would  the  wilful  destruction  of  such  a  child  con- 
stitute murder  ?  Would  this  proof  of  pulsation  without  muscular 
motion,  respiration,  crying,  or  any  other  sign  of  active  life  confer 
tenancy  by  courtesy,  or  transfer  an  estate  by  inheritance  or  sur- 
vivorship? M.  Bouchut  justly  observes  that  apparent  death  suc- 
ceeding to  birth,  and  characterized  by  the  presence  of  a  beating  of 
the  heart  and  an  absence  of  respiration,  is  only  a  diseased  condition 
of  the  new-born  child  (see  "Atelectasis,"  p.  480);  and,  whether  it 
is  cured  of  this  or  dies,  it  is  living,  although  it  has  not  breathed — 
or,  as  a  German  jurist  remarks,  "Scheintod  ist  Scheinleben.'1'1  By 
taking  away  its  rights  of  succession,  the  law  punishes  the  child  and 
its  heirs  for  a  malady  with  which  it  is  born  ("Gaz.  des  Hop."  1855, 
No.  124;  and  "Med.  Times  and  Gaz."  Aug.  19,  1856.)  They  who 
contend  that  crying  or  breathing  alone  should  be  taken  as  a  sign  of 
life  after  birth,  would  of  course  pronounce  such  a  child  to  have 
been  born  dead,  even  at  the  time  that  they  might  be  listening  to  the 
pulsations  of  its  heart!  (Casper  "Klinische  Novellcn,"  1863,  p. 
564).  Such  pulsations  would  probably  be  referred  by  them  to  the 
remains  of  uterine  life  of  which  the  law  takes  no  cognizance. 


TENANCY    BY    COURTESY.  535 

Vagitus  Uterinus. — Let  us  suppose  that  the  evidence  of  a  child 
having  been  born  alive  is  stated  to  be  that  it  was  heard  to  cry — it 
may  be  a  question  for  a  medical  witness,  in  cross-examination, 
whether  this  is  to  be  taken  as  an  absolute  proof  of  live  birth.  The 
answer  must  be  in  the  negative,  because  a  child  may  cry  before  its 
body  is  entirely  born ;  or  there  may  have  been  what  is  called  vagitus 
uterinus — a  uterine  cry  after  the  rupture  of  the  membranes.  (See 
Infanticide.)  It  is  quite  certain  that  a  child  may  breathe  without 
crying,  but  it  cannot  cry  without  breathing ;  yet  neither  the  crying 
nor  the  breathing  is  a  necessary  proof  that  the  child  was  actually 
born  alive.  "  As  in  all  cases  of  this  description  there  must  be  eye- 
witnesses, either  professional  or  not — the  evidence  will  not  rest 
solely  upon  a  mere  medical  possibility  of  the  occurrence  of  such  a 
cry  before  birth ;  and  proof  will  then  be  required  of  the  crying  of 
the  child  after  it  was  born.  The  determination  of  the  momentary 
existence  of  children  after  birth  is  of  importance  in  a  legal  point  of 
view  in  reference  to  the  subject  of  Tenancy  by  Courtesy. 

Tenancy  by  Courtesy. — This  signifies,  according  to  Blackstone 
("  Com."  vol.  2,  p.  426),  a  tenant  by  the  courts  of  England.  If  a 
married  woman  possessed  of  estate  die,  the  estate  passes  from  her 
husband  to  her  heir-at-law,  unless  there  has  been  a  child  born  living 
of  the  marriage,  [capable  of  inheriting  the  estate]  in  which  case  the 
husband  acquires  a  life-interest  in  the  property.  The  only  defence 
of  this  singular  custom  is,  that  it  is  of  great  antiquity.  An  unsuc- 
cessful attempt  was  made  a  few  years  since  to  substitute  for  it  the 
reasonable  provision,  that  the  marriage  should  entitle  the  husband 
to  a  right,  which  he  can  now  only  acquire  by  the  fulfilment  of  cer- 
tain accidental  conditions.  Incurable  sterility,  a  protracted  labor, 
deformity  in  the  pelvis  of  the  wife,  or  the  necessary  performance  of 
craniotomy  on  a  healthy  well-formed  child,  may,  under  this  custom, 
lead  to  an  aversion  of  the  inheritance.  The  tenancy,  in  contested 
cases,  is  generally  established  or  disproved  by  medical  evidence ;  and 
the  following  are  the  conditions  which  the  law  requires  in  order  that 
the  right  should  exist : 

1.  The  child  must  be  born  alive.  Cases  have  been  already  re- 
ferred to  in  which  the  motion  of  a  lip  and  the  pulsations  of  the  um- 
bilical cord  were  held  to  be  sufficient  legal  proofs  of  live  birth. 
Some  physiologists  have  objected  to  these  as  inadequate  proofs  of 
life  in  a  medical  sense ;  and  if  the  question  were  one  of  pure  physi- 
ology, and  not  of  law,  there  might  be  some  ground  for  the  objection. 
In  truth,  however,  the  law  does  not  require  proof  of  active  life  in  a 
child,  but  merely  some  evidence,  however  slight,  that  it  has  been 
born  living ;  and  the  amount  of  proof  to  satisfy  the  purposes  of  jus- 
tice, must  of  course  rest  not  with  physiologists,  but  with  the  expound- 
ers of  the  law. 

The  crying  of  a  child,  properly  attested  by  disinterested  witnesses, 
has  been  held  in  cases  of  disputed  tenancy  to  be  sufficient  evidence 
of  live  birth ;  this  is,  in  fact,  one  of  the  tests  given  by  Lord  Coke. 
At  page  480,  some  cases  are  related  in  which  new-born  children  sur- 
vived birth  several  hours,  but  manifested  no  sign  of  active  life  either 


536  CESAREAN    EXTRACTION. 

by  crying  or  in  any  other  mode,  and  after  death  there  was  no  air  in 
the  lungs.  As  in  cases  of  infanticide,  if  the  evidence  of  live  birth 
rests  entirely  on  an  examination  after  death,  the  absence  of  air  from 
the  lungs  will  not  necessarily  show  that  a  child  has  come  into  the 
world  dead,  nor  will  the  presence  of  air  in  these  organs  prove  that 
it  has  been  born  alive,  because  it  may  have  breathed  and  died  be- 
fore birth.  The  child  must  be  heard  to  cry,  or  be  seen  to  breathe  or 
move  after  birth.  The  fact  that  the  lungs  are  not  distended  with  air, 
and  that  they  immediately  sink  in  water,  either  when  entire  or  when 
divided  into  small  pieces,  is  no  proof  that  a  child  has  not  breathed 
and  cried  during  birth  and  afterwards.  In  a  case  which  occurred  to 
Dr.  Yernon  (p.  481),  the  child  had  only  reached  the  sixth  month, 
but  it  was  strong  enough  to  cry ;  and  yet,  probably,  had  its  history 
been  unknown,  a  medical  witness  would  have  been  prepared  to  state, 
from  an  examination  of  the.  lungs,  which  contained  no  air,  and  sank 
in  water,  that  it  must  have  been  born  dead,  and  certainly  could  not 
have  had  the  power  of  uttering  a  cry !  A  child  born  at  the  fifth 
month  has  been  known  to  cry ;  but  the  state  of  its  lungs  is  not  re- 
corded. In  the  case  of  Gardner  v.  Llewellyn  (1856),  a  medical  wit- 
ness who  appeared  for  the  plaintiff  stated  as  his  belief  that  a  child 
born  at  the  fifth  month  could  not  resjnre,  and  if  it  could  not  breathe 
(so  as  to  fill  the  lungs)  it  could  not  cry !  This  may  have  been  con- 
sistent with  his  experience,  but  it  is  not  consistent  with  facts  observed 
by  others.  One  of  the  greatest  difficulties  that  lawyers  have  to  con- 
tend with  in  getting  at  medical  truth,  is  this  strong  disposition  on 
the  part  of  witnesses  to  act  upon  a  foregone  conclusion,  and  to  "fix" 
all  natural  events  by  an  exclusive  reference  to  their  individual  ex- 
perience. 

2.  The  child  must  be  born  while  the  mother  is  living.  From  this 
it  appears  that  if  a  living  child  were  removed  from  the  outlet,  or 
extracted  from  the  uterus  by  the  Ccesarean  operation  after  the  death 
of  the  mother,  the  husband  would  not  become  entitled  to  enjoy  his 
wife's  estate ;  although  the  child  might  survive  its  removal  or  ex- 
traction, and  succeed  to  the  estate  on  attaining  its  majority  !  How 
such  a  case  would  be  decided  in  the  present  day  it  is  difficult  to  de- 
termine ;  but  one  instance  is  quoted  by  most  medico-legal  writers 
from  Lord  Coke,  in  which,  about  three  centuries  since,  the  decision 
went  against  the  husband  in  consequence  of  the  child  having  been 
removed  from  the  uterus  by  the  Ccesarean  section  after  the  death  of 
the  wife.  (For  a  singular  case  involving  this  question  in  France, 
see  "  Ann.  d'Hyg."  1838,  vol.  1,  p.  98.)  In  the  case  of  Llewellyn 
(supra)  the  late  Baron  Alderson  ruled  that  the  husband  could  not 
take  the  estate  unless  the  child  was  proved  to  have  been  born  during 
the  marriage,  i.  e.,  during  the  life  of  the  woman. 

Gsesarean  Extraction. — The  Cesarean  operation  has  rarely  been 
performed  in  England  except  when  a  woman  was  actually  dying  or 
dead.  A  medical  man  wishing  to  perform  it  may  find  that  the  hus- 
band or  representative  of  the  deceased  parturient  woman  will  object 
to  its  performance,  although  the  child  ma;  be  living  in  the  womb, 
and  there  may  be  a  reasonable  hope,  by  an  immediate  operation,  of 


AND    LEGAL    BIRTH.  537 

extracting  it  living.  The  late  Dr.  Lever  informed  me  that  on  two 
occasions  in  1858,  the  husbands  thus  refused  to  allow  him  to  operate 
on  the  dead  body  of  the  wife.  I  apprehend  that  no  medical  man 
would  proceed  to  operate  by  force,  or  against  the  will  of  the  hus- 
band ;  at  the  same  time,  in  refusing  his  permission,  the  husband  is 
not  guilty  of  any  legal  offence.  The  practice  on  the  Continent  has 
been  to  undertake  it  while  the  woman  was  living,  and  the  result  has 
shown  that  it  may  be  performed  successfully  both  with  regard  to 
mother  and  child.  Important  legal  consequences  may  hereafter  en- 
sue from  a  more  general  adoption  of  this  practice  in  England  in 
respect  to  deformed  women.  Thus,  supposing  in  any  case  a  child 
were  removed  alive  while  the  woman  was  living,  both  of  them  dying 
shortly  afterwards:  would  the  husband  become  a  tenant  by  the 
courtesy  ?  The  law  says  the  child  must  be  born ;  and  some  lawyers 
would  find  ground  for  arguing  whether  extraction  by  the  Cesarean 
operation  should  be  regarded  as  "  legal  birth."  "Illucl  autern  valde 
controversum  est  inter  jurisconsultos,  an  is  qui  editus  est,  exsecto 
matris  ventre,  reputetur  partus  naturalis  et  legitimus  et  successionis 
capax."  (Caranza.)  According  to  Fonblanque,  the  question  is  set- 
tled in  the  affirmative — a  child  extracted  is  a  child  born.  ("  Med. 
Jur."  vol.  1,  p.  236.)  Our  ancient  law  authorities  do  not  appear  to 
have  contemplated  that  the  operation  would  ever  be  undertaken  on 
a  living  female.  The  words  of  Lord  Coke,  which  are  considered  to 
express  the  state  of  English  law,  are:  "If  a  woman  seised  of  lands 
in  fee  taketh  husband,  and  by  him  is  bigge  with  childe,  and  in  her 
travell  dyeth,  and  the  child  is  ripped  out  of  her  body  alive,  yet  shall 
he  not  be  tenant  by  the  curtesie,  because  the  child  was  not  born 
during  the  marriage,  nor  in  the  life  of  the  wife,  but  in  the  meantime 
her  land  descended."  According  to  Mr.  Hobler,  the  Cesarean  opera- 
tion does  not  divert  the  course  of  descent,  or  divest  the  husband  of 
the  life-estate,  provided  the  child  be  born  alive,  and  the  mother  was 
living  when  the  child  was  born.  '  ("  Obstetric  Record,"  vol.  3,  p.  6Q.) 
Birth,  and  extraction  by  the  Cesarean  operation,  are,  therefore,  treated 
by  him  as  similar  conditions. 

As  a  proof  that  this  operation  is  not  always  necessary,  even  when 
circumstances  may  appear  to  call  for  it,  the  following  case,  mentioned 
by  the  late  Sir  B.  Brodie  as  having  occurred  in  a  French  hospital,  is 
of  some  interest.  It  is  that  of  a  woman  whose  pelvis  was  considered 
to  be  too  narrow  for  the  egress  of  the  child.  As  she  was  at  the  full 
term  of  gestation,  the  Cesarean  section  was  proposed;  but  before 
the  operators  were  ready  to  commence,  the  child  was  expelled  by 
the  natural  efforts  of  the  uterus,  or,  as  Sir  Benjamin  expressed  it, 
"the  child  preferred  coming  into  the  world  by  fhe  old  road!" 
("Lancet,"  Dec.  1853.)  This,  however,  is  not  the  only  case  of  the 
kind  on  record.  There  is  great  reason  to  believe  that  continental 
practitioners  are  too  officious  in  suggesting  the  performance  of  this 
operation,  and  that  it  has  been  often  undertaken  to  the  serious  risk 
of  the  life  of  a  woman,  when,  if  left  to  nature,  she  would  have  done 
well.  A  case  is  reported  to  have  occurred  in  Scotland  in  1817,  in 
which  the  Cesarean  operation  was  considered  by  several  practitioners 


538  AGE.      QUESTIONS    CONNECTED    WITH 

of  experience  to  be  the  only  means  by  which  delivery  could  be 
accomplished.  Fortunately  for  the  woman,  the  labor  was  somewhat 
rapid,  and  she  was  delivered  of  a  dead  child,  weighing  about  three 
pounds,  before  the  arrival  of  those  who  had  considered  that  the 
operation  would  be  required.  (Ed.  "  Monthly  Journ."  July,  1847, 
p.  30.)  The  fact  is,  on  these  occasions  nature  often  adapts  means  to 
ends  in  a  most  unexpected  manner. 

Medical  jurists  have  differed  respecting  the  period  of  gestation  at 
which  the  operation  should  be  performed.  This  would  of  course 
depend  on  the  earliest  period  at  which  a  child  might  be  born  capable 
of  living.  In  reference  to  tenancy  by  courtesy,  a  child  might  be 
extracted  alive  as  early  as  the  fifth  month,  but  it  would  not  be  likely 
to  survive  unless  it  were  at  or  about  the  seventh  month.  Some  have 
alleged,  that  unless  the  operation  was  performed  immediately  after 
the  death  of  the  mother,  the  child  would  not  be  extracted  living. 
The  condition  of  the  foetus  in  utero  is,  however,  peculiar,  and  quite 
distinct  from  that  of  a  child  living  by  the  act  of  respiration.  It  is 
possible,  therefore,  that  there  may  be  a  limited  survivorship,  and 
that  the  operation  may  be  performed  so  late  as  an  hour  after  the 
death  of  the  mother  with  the  probability  of  extracting  a  living  child. 

3.  The  child  must  be  born  capable  of  inheriting ;  therefore,  if  it 
be  a  monster  which  cannot  legally  take  an  estate,  the  husband  does 
not  acquire  a  right  of  tenancy.  There  are  some  other  legal  condi- 
tions which  must  also  be  fulfilled,  but  these  remarks  are  confined  to 
that  which  may  become  matter  for  medical  evidence.  Admitting 
that  there  are  legal  proceedings  by  which  the  obnoxious  parts  of  this 
ancient  custom  may  be  set  aside  during  the  life  of  the  wife,  it  is 
hardly  just  that  the  knowledge  of  the  necessity  for  these  precautions 
should  be  left  to  be  acquired  by  accident.  It  would  be  better  to 
abolish  tenancy-by-courtesy  altogether,  than  to  allow  the  succession 
of  a  husband  to  his  wife's  estate  to  rest  upon  a  casualty  of  this  kind. 

[The  issue  must  not  only  be  "capable  of  inheriting,"  but  "capable 
of  inheriting  its  mother's  estate."  For  example,  if  the  mother  held 
an  estate-tail- female,  the  birth  of  issue  male  would  not  at  common 
law  give  the  husband  his  courtesy  (or  as  it  is  more  properly  spelled 
curtesy).  In  Pennsylvania,  by  act  of  8  April,  1833,  §  1,  art.  3,  cur- 
tesy is  made  no  longer  dependent  upon  the  birth  of  issue,  provided 
that  the  issue,  if  any,  would  have  inherited.  Upon  this  subject  the 
commissioners  to  revise  the  civil  code  remarked  as  follows:  "It 
appears  to  us  that  the  existing  rule  which  makes  the  estate  of  the 
husband  dependent  on  the  circumstance  of  there  being  issue  born 
alive  capable  of  inheriting,  has,  in  the  present  state  of  society  and 
government,  no"  sufficient  or  reasonable  foundation.  Derived,  accord- 
ing to  the  better  opinion,  from  the  feudal  system,  and  receiving  no 
support  from  analogies  inour  own  or  other  codes  of  jurisprudence,  it 
ought,  we  think,  long  since  to  have  shared  the  fate  of  similar  provi- 
sions of  that  system.  Besides  assimilating  the  estate  of  the  husband 
to  that  of  the  wife,  in  this  respect,  the  proposed  alteration  will  have 
the  effect  of  lessening  the  amount  of  litigation  by  removing  questions 


MINORITY    AND    MAJORITY.  539 

which  have  sometimes  occurred  respecting  the  birth  of  issue  and  the 
fact  of  its  having  been  born  alive." — P.] 

Minority  and  Majority. — The  word  minor  is  synonymous  with  that 
of  infant  (infans),  and  is  applied  in  law  to  any  one  under  the  age  of 
twenty-one  years.  The  age  of  a  person  may  render  him  incompe- 
tent to  the  performance  of  civil  duties.  Minors  are  frequently  called 
upon  to  act  as  witnesses  in  civil  and  criminal  cases.  In  rapes  com- 
mitted upon  children,  it  is  especially  important  to  notice  whether  the 
prosecutrix  is  or  is  not  competent  to  give  evidence.  The  law  has 
fixed  no  age  for  testimonial  competency,  and  I  have  never  heard  of  the 
question  being  referred  to  a  medical  practitioner.  The  child  is  al- 
ways orally  examined  by  the  court,  and  it  is  soon  rendered  apparent 
by  the  answers  whether  the  witness  possesses  a  proper  knowledge  of 
the  nature  and  obligations  of  an  oath.  If  not,  his  or  her  testimony 
is  not  received,  or,  in  a  case  of  rape,  the  trial  is  postponed,  and  the 
child  is  placed  under  instruction,  to  appear  again  at  the  following 
sessions  or  assizes.  The  competency  of  a  child  as  a  witness,  there- 
fore, does  not  depend  on  age,  but  upon  its  degree  of  understanding. 
In  respect  to  criminal  responsibility  as  affected  by  age,  it  was  held  by 
Keating,  J.,  in  a  recent  case  (Beg.  v.  Cowley,  1860),  in  which  the 
prisoner,  a  boy  aged  eight  years,  was  charged  with  felony,  that  up  to 
seven  years  of  age  the  law  presumed  that  a  child  could  not  distin- 
guish right  from  wrong,  so  as  to  be  capable  of  crime ;  and  evidence 
was  not  admissible  to  prove  that  he  possessed  that  capacity.  After 
the  age  of  seven,  and  up  to  fourteen  years,  although  the  law  pre- 
sumed a  child  to  he  prima  facie  incapable  of  crime,  this  presumption 
might  be  rebutted  by  evidence  which  showed  that  he  had  what  was 
called  a  mischievous  discretion.  [The  maxim  in  this  case  is  umali- 
tia  supplet  eetatem." — P.]  In  the  case  referred  to,  there  was  no  evi- 
dence of  that  sort,  and  therefore  his  lordship  directed  the  jury  to 
acquit  the  prisoner.  In  another  case,  tried  before  the  same  learned 
judge  in  May,  1863  (Whitby  v.  Hodgson),  an  action  for  trespass  and 
false  imprisonment  was  brought  against  a  man  for  giving  into  cus- 
tody on  a  charge  of  stealing,  a  boy  under  six  years  of  age.  It  ap- 
peared that  the  child  had  stolen  some  wood ;  but  it  was  held  that  at 
this  age,  and  under  seven  years,  a  child  was  in  point  of  law  doli  inca- 
%>ax,  hence  the  defendant  was  not  justified  in  giving  the  boy  into 
custody.     The  jury  returned  a  verdict  with  damages  against  him. 

According  to  the  principles  of  our  law,  a  male  at  fourteen  is  con- 
sidered to  be  at  years  of  discretion,  and  he  then  becomes  responsible 
for  his  actions;  at  twenty-one  he  attains  majority,  and  is  at  his  own 
disposal,  and  may  alienate  his  lands,  goods  and  chattels  by  deed  or 
will.  It  is  only  when  this  age  has  been  attained  that  an  individual 
can  be  sworn  to  serve  on  a  jury.  The  period  at  which  a  male  is 
considered  to  have  attained  full  age  varies  in  different  countries: 
thus,  in  the  kingdom  of  Naples  it  was  formerly  fixed  at  eighteen 
years;  in  Holland  at  twenty-five;  but  generally  throughout  the 
States  of  Europe  the  law  prescribes  twenty-one  years,  the  same  as 
the  common-law  of  England. 

A  child  under  fourteen  indicted  for  murder  must  be  proved  to 


540      AGE    FOR    CRIMINAL    AXD    CIVIL    RESPONSIBILITY. 

have  been  conscious  of  the  nature  of  the  act.  In  the  case  of  Reg.  v. 
Vampleiu  (Lincoln  Summer  Assizes,  1862),  a  girl  under  fourteen 
years  of  age  was  convicted  of  destroying  the  life  of  a  child  by 
strychnia.  It  was  shown  that  she  was  competent  to  understand  the 
nature  of  the  act.  Under  fourteen,  a  male  infant  is  presumed  to  be 
incapable  on  the  ground  of  incapacity,  of  committing  a  rape  as  a 
principal  in  the  first  degree,  or  even  of  committing  an  assault  with 
intent  to  perpetrate  this  crime;  but  if  the  boy  have  a  mischievous 
discretion,  he  may  be  convicted  as  a  principal  in  the  second  degree. 
The  patient  may  be  convicted  of  an  unnatural  crime,  although  the 
agent  be  under  fourteen.  A  female  under  the  age  of  ten  years  is 
presumed  to  be  incapable  of  consenting  to  sexual  intercourse. 
("Taylor  on  Evidence,"  vol.  1,  p.  117.) 

A  person  attains  his  legal  majority,  or  is  completely  of  age  the 
first  instant  of  the  day  before  the  twenty-first  anniversary  of  his  birth- 
day, although  forty-seven  hours  and  fifty-nine  minutes  short  of  the 
complete  number  of  days  counting  by  hours;  and  this  mode  of  cal- 
culating age  and  time  is  applicable  to  all  other  ages  before  and  after 
twenty-one.  This  is  on  the  principle  that  a  part  of  a  day  is,  in  a 
legal  point  of  view,  equal  to  the  whole  of  a  day.  A  few  minutes  or 
hours  may  thus  determine  the  attainment  of  majority,  and  with  this 
the  responsibility  of  minors  for  civil  contracts,  or  the  validity  of 
their  wills.  By  1  Vic.  c.  26,  no  will  made  by  any  person  under  the 
age  of  twenty-one  years  shall  be  valid ;  and  as  the  day  of  a  person's 
birth  is  included  in  the  computation  of  his  age,  and  there  being  in 
law  no  fraction  of  a  day,  a  valid  will  may  be  made  at  any  time  on 
the  day  before  that  which  is  usually  considered  the  twenty-first  an- 
niversary of  birth.  [The  law  (in  general)  "does  not  recognize  frac- 
tions of  a  day;"  that  is,  it  does  not  consider  the  hour  at  which  an 
event  takes  place,  and  looks  upon  it  as  the  same  thing  whether  a 
birth  occurs  upon  the  last  or  upon  the  first  minute  of  the  day.  At 
the  last  moment,  therefore,  of  the  clay  preceding  a  person's  twenty-first 
birthday,  he  actually  completes  his  twenty-first  year;  but  upon  the 
same  principle,  the  law  looking  upon  the  day  as  a  unit,  regards  the 
first  moment  of  it  as  a  completion  of  the  year,  just  as  much  as  the  last 
moment ;  and  hence,  though  his  birth  may  not  have  occurred  until 
the  last  hour  of  the  day  on  which  he  was  born,  the  law  regards  him 
as  of  age  on  the  first  hour  of  the  day  preceding,  or  48  hours  earlier 
than  in  point  of  fact  he  completes  his  twenty-first  year. — P.] 

There  is  another  aspect  in  which  this  question  of  age  may  be 
viewed — namely,  in  reference  to  the  responsibility  of  accused  per- 
sons for  debts,  or  alleged  criminal  acts.  In  Reg.  v.  Thar  ah  ill  (Staf- 
ford, Lent  Assizes,  1865),  the  prisoner  was  indicted  for  a  misdemeanor 
in  carnally  knowing  and  abusing  one  Mary  Sambrook,  being  a  girl 
above  the  age  of  10  and  under  the  age  of  12  years.  It  appeared  in 
evidence  that  the  girl's  birthday  was  on  the  5th  of  December  1852, 
and  the  offence  was  alleged  to  have  been  committed  on  the  1th  of 
December  1861.  The  question  then  arose  whether  the  girl  was 
under  the  age  of  12  years,  so  as  to  bring  the  offence  within  the 
statute.     It  was  objected  by  the  prisoner's  counsel,  that  as  on  the 


PLURAL    AXD    MONSTROUS    BIRTH.  5-11 

5th  of  December  the  girl  would  enter  on  her  18th  year,  she  had 
therefore  completed  her  12th  year  on  the  4th  of  December,  and  that 
the  law  did  not  recognize  a  fraction  of  a  day  in  such  a  case,  so  that 
she  was  12  years  old  as  much  on  the  first  hour  of  that  day  as  on  the 
last — and  his  lordship  (Pigott,  B.)  so  held.  The  indictment  con- 
tained counts  alleging  rape  and  assault,  but,  after  the  cross-examina- 
tion of  the  girl,  his  lordship  stopped  the  case,  and  the  prisoner  was 
acquitted.  It  is  obvious  that  this  principle  would  equally  apply  to 
charges  of  felony  for  the  carnal  knowledge  of  children  under  10 
years  of  age,  as  well  as  to  the  misdemeanor  of  taking  girls  under  the 
age  of  16  years  from  the  custody  of  their  parents  or  of  stealing  chil- 
dren under  the  age  of  14  years  from  their  parents  or  guardians.  (24 
&  25  Vict.  c.  100,  ss.  50,  51,  55,  56.)  The  proof  of  the  exact  date  of 
birth  sometimes  rests  with  the  medical  man. 

The  subject  of  plural  births  has  been  regarded  as  appertaining  to 
medical  jurisprudence;  but  I  am  not  aware  that  there  is  any  case  on 
record  in  which  the  evidence  of  a  medical  man  has  been  required 
respecting  it.  It  is  a  simple  question  of  primogeniture,  which  has 
been  generally  settled  by  the  aid  of  depositions  or  declarations  of 
old  relations  or  servants  present  at  the  birth.  Of  course  in  the 
absence  of  eyewitnesses  the  question  of  priority  of  birth  must  be 
a  matter  of  conjecture.  It  cannot  be  determined  by  the  size  or 
weight  of  the  child,  but  it  might  be  determined  by  the  observation 
of  certain  marks  or  deformities  in  one  or  more  of  the  children. 

Monstrous  Births. — The  law  of  England  has  given  no  precise  defi- 
nition of  what  is  intended  by  a  monster.  According  to  Lord  Coke, 
it  is  a  being  "  which  hath  not  the  shape  of  mankind  ;  such  a  being 
cannot  be  heir  to,  or  inherit  land,  although  brought  forth  within 
marriage."  A  mere  deformity  in  any  part  of  the  body,  such  as 
supernumerary  fingers  or  toes,  "twisted  or  deformed  limbs  will  not 
constitute  a  monster  in  law,  so  far  as  the  succession  to  property  is 
considered,  provided  the  being  still  have  "  human  shape."  Even  a 
supernumerary  leg  would  not  probably  be  allowed  to  avert  an  inhe- 
ritance !  but  the  privilege  might  be  denied  to  a  supernumerary  head 
or  body,  or  to  children  otherwise  well-formed,  but  born  without 
heads.  From  Lord  Coke's  descrij)tion  it  is  obvious  that  the  law  will 
be  guided  in  its  decision  by  the  description  of  the  monstrous  birth 
given  by  a  medical  witness.  It  would  not  rest  with  a  witness  to  say 
whether  the  being  was  or  was  not  a  monster — the  court  would  draw 
its  inference  from  the  description  given  by  him.  Various  classifica- 
tions of  monsters  have  been  made,  but  these  are  of  no  assistance 
whatever  to  a  medical  jurist,  because  each  case  must  be  decided  by 
the  peculiarities  attending  it;  and  his  duty  will  not  be  to  state  the 
class  and  order  of  the  monster,  but  simply  in  what  respect  it  differs 
in  shape  and  external  appearance  from  a  normal  child.  But  the 
question  here  presents  itself — What  is  a  normal  child,  or,  indeed, 
"  a  child"  in  a  legal  sense  ?  On  this  point  conflicting  decisions  have 
been   given    by   different  judges   (p.  443).     All   will   agree  that  a 


542  PLURAL    AND    MONSTROUS    BIRTHS. 

blighted  foetus  or  a  mole  is  not  a  child,  but  a  difference  has  arisen 
on  the  question  whether  the  partus  should  in  addition  to  having 
human  shape  have  reached  a  uterine  age  at  which  it  could  continue 
to  live.  (See  Concealment  of  Birth.)  A  correct  definition  of  a  normal 
child,  therefore,  is  still  a  desideratum  in  law.  Although  a  monster 
may  not  survive  its  birth  more  than  a  few  seconds,  yet  if  it  be 
legally  pronounced  from  the  medical  evidence  to  have  human  shape, 
it  may  transmit  an  estate  to  its  heirs-at-law,  as  in  the  case  of  nor- 
mally-formed children. 

Malpositions,  transpositions,  or  defects  of  the  internal  organs  of 
any  of  the  cavities  do  not  form  monstrous  births  within  the  meaning 
of  the  English  law.  The  legal  question  relates  only  to  external 
shape,  not  to  internal  conformation.  It  is  well  known  that  many 
internally  malformed  persons  live  to  a  great  age ;  and  it  is  not  until 
after  death  that  malpositions  and  defects  of  this  kind  are  discovered. 
In  French  jurisprudence  the  case  appears  to  be  different ;  if  the  mal- 
position or  defect  was  such  as  to  become  a  cause  of  death  soon  after 
birth,  the  child  would  be  pronounced  not  "  viable"  and  therefore 
incapable  of  acquiring  civil  rights.  Some  medical  jurists  have  dis- 
cussed the  question  of  "  viability"  in  new-born  children,  i.  e.,  their 
healthy  organization  with  a  capacity  to  continue  to  live,  as  if  it  were 
part  of  the  jurisprudence  of  this  country  ;  but  I  am  not  aware  of  any 
facts  which  bear  out  this  view.  The  English  law  does  not  regard 
internal  monstrosity  as  forming  a  bar  to  civil  rights  ;  and  the  cases 
decided  hitherto,  show  clearly  that  the  simple  question  in  English 
jurisprudence  is,  not  whether  a  child  (partus)  is  or  is  not  "viable" 
but  whether  it  has  manifested  any  distinct  sign  of  life  after  it  was 
entirely  born.  The  French  law  is  much  more  complex,  and  throws 
a  much  greater  degree  of  responsibility  on  French  medical  jurists. 
It  is  proper  to  state  that  no  person  is  legally  justified  in  destroying 
a  monster  at  birth  (p.  508). 


PRESUMPTION    OF    LEGITIMACY.  543 


LEGITIMACY. 


CHAPTER     LIU. 

Presumption  of  legitimacy. — natural  period  of  gestation. — 
duration  of  pregnancy  from  one  intercourse. — premature 
births. — short  periods  of  gestation. — viability. — earliest 
period  at  which  a  child  may  be  born  living. — evidence 
from  the  state  of  the  child. — protracted  births. — a  period 
of  gestation  not  fixed  by  law. 

Legal  Presumption  of  Legitimacy. — Every  child  born  either  in  law- 
ful matrimony,  or  within  a  period  after  the  death  of  the  husband  in 
accordance  with  the  natural  duration  of  gestation,  is  considered  by 
the  English  law  to  be  the  child  of  the  husband,  unless  the  contrary 
be  made  clearly  to  appear  by  medical  or  moral  evidence,  or  by  both 
combined.  [The  rule  at  common  law  (and  which  subsisted  from  the 
time  of  the  year  books  down  to  the  early  part  of  the  last  century), 
declared  the  issue  of  any  married  woman  to  be  legitimate,  except  in 
the  special  cases  of  the  impotency  of  the  husband,  and  his  absence 
from  the  realm.  But  in  Pendrelly.  Pendrell (Strange's  Rep.  925),  the 
absurd  doctrine  of  making  legitimacy  rest  entirely  and  exclusively 
upon  the  fact  of  the  husband  being  infra  quatuor  maria,  was  exploded, 
and  ever  since  that  time  the  question  of  legitimacy  or  illegitimacy 
of  the  child  of  a  married  woman  has  been  regarded  as  a  matter  of 
fact,  resting  on  decided  proof  as  to  the  non-access  of  the  husband, 
and  it  is  a  question  for  a  jury  to  determine  (2  Kent,  210-11).  In  a 
recent  case  in  Pennsylvania,  Dennison  v.  Page  (5  Casey,  420),  where 
a  child  was  born  three  months  after  marriage,  which  the  husband  in- 
stantly disclaimed,  and  never,  during  his  life,  recognized,  it  was  held, 
that  where  a  child  is  born  during  wedlock,  of  which  the  mother  was 
visibly  pregnant  at  the  marriage,  it  is  presumed,  juris  et  dejure,  to  be 
the  offspring  of  the  husband,  and  that  its  illegitimacy  cannot  be  proved 
by  the  mother  after  the  husband's  death.  But  see  the  very  able  dis- 
senting opinion  of  Lowrie,  J.,  1  Grant,  377. — P.]  It  is  only  in  refer- 
ence to  medical  evidence  that  the  subject  of  legitimacy  can  here  be 
considered;  but  it  is  extremely  rare  to  find  a  case  of  this  kind  de- 
termined by  medical  evidence  alone.  There  are  generally  circum- 
stances which  show  that  a  child  whose  legitimacy  is  disputed  is  the 
offspring  of  adultery,  while  the  medical  facts  may  be  perfectly  recon- 
cilable with  the  supposition  that  the  claimant  is  the  child  of  the 
husband.    These  cases,  therefore,  have  been  repeatedly  decided  from 


544  NATURAL    PERIOD    OF    GESTATIOX. 

moral  evidence  alone — the  medical  evidence  respecting  the  period  of 
gestation  or  physical  capacity  in  the- parties  leaving  the  matter  in 
doubt.  The  present  state  of  the  English  law  on  this  subject  appears 
to  be  this.  A  child  born  during  marriage  is  deemed  illegitimate, 
when,  by  good  medical  or  other  evidence,  it  was  proved  that  it  was 
impossible  for  the  husband  to  be  the  father — whether  from  his  being 
under  the  age  of  puberty,  from  his  laboring  under  physical  incapa- 
city as  a  result  of  age  or  natural  infirmity,  or  from  the  length  of 
time  which  may  have  elapsed  since  he  could  have  had  intercourse, 
whether  by  reason  of  absence  or  death.  When  the  question  turns 
upon  any  of  these  conditions,  medical  science  is  required  for  its  solu- 
tion, and  on  these  occasions  skilled  experts  are  usually  selected  by 
the  litigants.  With  proof  of  non-access  of  the  husband  or  immorality 
on  the  part  of  the  mother,  so  important  on  these  occasions,  a  medical 
witness  is  not  in  the  least  concerned.  In  cases  of  contested  legitimacj*, 
the  English  law  does  not  regard  the  date  of  conception  which  cannot 
be  fixed,  but  the  date  of  birth,  which  can  be  fixed.  Medical  evidence 
may  relate — 1st,  to  the  actual  length  of  the  period  of  gestation  :  this 
may  be  in  a  given  case  so  short  or  so  long,  as  to  render  it  medically 
impossible  that  the  husband  could  be  the  father.  2dly,  there  may 
be  physical  incapacity  in  the  husband  to  procreate  :  he  may  be  too 
old  or  too  young — or  he  may  labor  under  some  physical  defect  ren- 
dering it  impossible  that  he  should  be  the  father.  3dly,  there  may 
be  sterility  or  incapacity  in  the  wife,  rendering  it  impossible  that  the 
child  should  be  the  offspring  of  a  particular  woman:  in  other  words, 
the  claimant  may  be  a  supposititious  child. 

Natural  Period  of  Gestation.  Duration  from  one  Intercourse. — The 
first  point  to  be  considered  is — What  is  the  natural  period  of  gesta- 
tion, and  whether  this  is  a  fixed  or  variable  term.  According  to  the 
testimony  of  experienced  accoucheurs,  the  average  duration  of  gesta- 
tion in  the  human  female  is  comprised  between  the  thirty-eighth  and 
fortieth  weeks  after  conception.  Numerous  facts  show  that  the  greater 
number  of  children  are  naturally  born  between  these  two  periods. 
Out  of  186  cases  reported  by  Dr.  M  urphy ,  the  greater  number  of  delive- 
ries took  place  on  the  285th  day  ("  Obstetric  Reports,"  1844);  but  his 
opinion  is  that  801  days  may  be  taken  as  the  average  limit  of  gesta- 
tion. ("Lancet,"  Nov.  11,  1844,  p.  284.)  Dr.  Blundell  considered 
that  the  average  period  was  274  days; -Sir  J.  Simpson  (Bromivieh  v. 
Waters,  Chester  Lent  Assizes,  1863,  p.  825)  277  days,  i.  e.nine  calendar 
months  and  a  week  ;  and  other  accoucheurs  of  repute  have  fixed  upon 
280  days.  Among  500  cases  observed  by  the  late  Dr.  Reid,  there 
were  283  in  which  the  period  of  gestation  was  within  280  days,  and 
217  cases  in  which  it  went  bej-ond  this  period.  Dr.  Duncan  found, 
in  a  group  of  forty-six  cases,  that  275  days  is  the  average  interval 
between  that  which  he  terms  "insemination"  (intercourse)  and  partu- 
rition. The  largest  number  of  cases  on  any  particular  day  was  seven 
on  the  274th  day.  ("Edin.  Monthly  Journal,"  1854,  vol.  9,  p.  230.) 
The  most  common  cause  of  this  variation  in  time  is,  that  the  usual 
mode  of  calculation,  by  reference  to  the  suppresion  of  the  menstrual 
discharge,  even  in  a  healthy  female,  ma}"  lead  to  a  possible  error  of 


AVERAGE    DURATION    OF    GESTATION.  545 

two,  three,  or  even  four  weeks,  since  there  is  no  sign  whereby,  in  the 
majority  of  women,  the  actual  time  of  conception  can  be  determined. 
Some  females  have  been  able  to  determine,  by  peculiar  sensations, 
the  time  at  which  they  have  conceived ;  but  as  a  general  rule,  this 
must  be  a  matter  of  pure  conjecture  when  they  are  living  in  connubial 
intercourse. 

On  the  other  hand,  accidental  and  isolated  cases  have  clearly 
proved  that  a  great  difference  naturally  exists  among  women  with 
respect  to  the  period  of  gestation ;  and  it  is  probable  that  in  no  two 
is  it  necessarily  the  same.  When  there  has  been  only  one  intercourse, 
the  duration  of  pregnancy  may  be  certainly  calculated  without 
reference  to  any  changes  in  the  female  constitution :  for  the  date  of 
conception,  within  certain  limits  to  be  presently  mentioned,  would 
be  fixed.  Observations  of  this  kind  have  shown  that  women  have 
differed  from  each  other ;  and  in  several  instances  the  time  has  ex- 
ceeded or  fallen  short  of  the  period  of  forty  weeks,  which  has  been 
usually  set  down  as  the  legal  limit  of  natural  gestation.  In  three 
cases  of  one  intercourse  known  to  the  late  Dr.  Rigby,  labor  came 
on  in  260,  264,  and  276  days,  making  a  difference  of  sixteen  days. 
("Med.  Times,"  March  14,  1846,  p.  471.)  In  three  other  instances 
which  were  privately  communicated  to  me  by  Dr.  S.  W.  J.  Merriman, 
labor  commenced  at  281,  283,  and  286  days  respectively  after  one  in- 
tercourse; and  in  a  case  which  occurred  to  Dr.  Reid,  the  labor  did  not 
commence  until  after  the  lapse  of  293  days  from  a  single  intercourse. 
("  Lancet,"  July  20, 1 850,  p.  79.)  In  another  case  accurately  observed, 
communicated  to  me  in  March,  1865,  the  gestation  lasted  281  days. 
Menstruation  had  ceased  on  the  16th  Sept.,  intercourse  took  place 
on  the  20th,  quickening  occurred  on  the  23d  January  following,  and 
a  full-grown  male  child  was  born  on  the  28th  June  following.  In 
two  cases,  for  which  I  am  indebted  to  the  late  Mr.  Carrington,  the 
females  were  delivered  respectively  in  249  and  260  days  after  a  single 
intercourse.  In  a  third,  in  which  pregnancy  was  the  result  of  a  rape, 
there  was  an  interval  of  261  days  between  intercourse  and  delivery. 
Hence  it  will  be  perceived  that  in  well-observed  cases,  where  there 
could  be  no  motive  for  misstatement,  and  in  which  the  characters  of 
the  women,  some  of  whom  were  married  and  had  already  borne 
children,  were  beyond  the  reach  of  suspicion,  a  difference  of  not  less, 
than  thirty-three  days  has  been  observed  to  occur. — i.  e.  between  the 
earliest  case  recorded  by  Dr.  Rigby,  and  the  latest  reported  by  Dr. 
Reid.  This  is  worthy  of  remark,  because  in  one  case  {Luscombe  v. 
Prettyjohn),  it  was  held  that  299  days,  only  six  days  longer  than  in 
Dr.  Reid's  observation,  was  an  impossible  period  for  human  gestation!'. 
In  addition  to  the  above  facts,  showing  the  variability  of  the  period 
after  a  single  intercourse,  the  following  may  be  cited.  Dr.  Mac- 
ilwain,  U.  S.,  has  reported  a  case  of  gestation,  which  he  thinks  must 
have  extended  to  296  or  at  least  293  days.  ("Amer.  Journ.  Med. 
Sci."  July,  1848.)  I  am  indebted  to  my  colleague,  Dr.  Oldham,  for 
nine  cases,  which  have  fallen  under  his  observation,  in  which  the 
duration  of  pregnancvr  from  a  single  intercourse  was  accurately 
observed  : — 
35 


Case. 

Pay?. 

Case. 

1 

.     266 

6 

2 

.     2i8 

7 

3 

.     271 

8 

4 

.     280 

9 

5 

.     280 

546  DATE    OF    CONCEPTION. 

Days. 
.     281 
.     283 
.     284 
.     285 

It  is  to  be  observed  of  these  cases  that  Nos.  4,  5,  and  6  represent 
the  periods  of  gestation  in  the  same  woman  at  different  times.  Dr. 
Lockwood  has  published  the  following  as  the  result  of  his  experi- 
ence. The  actual  duration  of  the  term  of  gestation  in  the  human 
subject,  i.  e.,  the  interval  between  intercourse  and  delivery,  was  as- 
certained by  him  in  four  cases:  No.  1,  aged  19,  duration  272  days 
(first  confinement);  No.  2,  aged  30  (first  confinement),  duration  27') 
days;  No.  3,  aged  17,  duration  270  days;  No.  1,  aged  11  (seventh 
confinement),  duration  281  days,  the  child  weighing  fourteen  pounds. 
("  Brit.  Amer.  Jour."  Dec.  1847,  p.  211.)  M.  Devilliers  has  also  pub 
lished  the  particulars  of  nine  cases,  in  which  the  interval  from  a 
single  intercourse  was  accurately  determined.  Delivery  took  place 
at  the  following  periods:  229,  216,  257,  267,  301,  276-281,  278-283, 
27<>,  and  266-272  clays,  making  an  extreme  difference  of  19  days  in 
the  earliest  and  the  latest  periods  between  intercourse  and  delivery. 
("  Gaz.  Med."  Mars  1,  1818.) 

There  is  reason  to  believe  that  the  date  of  conception  after  a  single 
intercourse  varies  in  different  women  and  in  the  same  woman.  It 
is  customary  for  physiologists  to  date  conception  from  intercourse : 
but  the  researches  of  Bischoff  and  Raciborski  have  shown  that  a 
variable  interval  may  elapse,  according  to  the  situation  of  the  ovum 
at  the  time.  It  has  also  been  supposed  that  women  conceive  more 
readily  at  some  periods  than  at  others,  and  that  intercourse  had 
within  eight  to  twelve  days  from  the  cessation  of  the  menstrual  dis- 
charge is  more  favorable  to  conception  than  at  any  Other  period.  Dr. 
Oldham  met  with  a  case  in  which  impregnation  took  place  twelve 
days  after  menstruation ;  and  he  states  that  he  has  known  it  to  occur 
at  the  respective  times  of  ten  days,  twelve  days,  and  even  twenty- 
one  days  after  the  monthly  period;  and  he  knows  of  no  fact  to  dis- 
prove the  opinion  that  the  human  female  is  susceptible  of  impregna- 
tion at  any  time  between  her  monthly  periods.  According  to  Dr. 
Duncan,  a  single  insemination  at  any  period  of  the  interval  between 
two  menstrual  periods  may  result  in  fecundation.  ("Edin.  Monthly 
Journal;'  1854,  vol.  9,  p.  233.) 

The  experience  of  Dr.  Oldham  is  confirmed  by  that  of  the  late 
Dr.  Reid.  This  gentleman  admits  that  impregnation  is  more  likely 
to  occur  immediately  after  the  termination  of  a  menstrual  period 
than  at  any  time  during  the  interval.  The  next  most  likely  period 
is  immediately  previous  to  the  occurrence  of  menstruation,  and  the 
probability  of  conception  becomes  slighter  as  the  time  is  more  dis- 
tant from  this  epoch;  but  there  is  no  period  in  the  menstrual  inter- 
val at  which  impregnation  may  not  occur.  (''Lancet,"  Sept.  3, 1853.) 
A-Ccording  to  Raciborski,  from  observations  made  in  Paris  on  one 
hundred  women,  no  more  than  six  or  seven  had  become  impregnated 
at  the  mid-term  from  the  menstrual  periods.     In  several  cases  of 


VARIATIONS    IN    THE    PERIOD    OF    GESTATION.  547 

single  intercourse,  the  dates  being  certain,  conception  took  place 
twelve  and  fourteen  days  after  menstruation.  It  may  be  therefore 
fairly  taken  as  a  fact,  irrespective  of  any  modern  theories  of  ovula- 
tion, that  a  woman  may  conceive  from  intercourse  had  at  the  inter- 
menstrual period  (mid-period),  although,  in  a  given  number  of  in- 
stances, it  is  probable  that  the  conceptions  would  be  more  numerous 
within  six  or  seven  days  after  the  cessation  of  the  menses  than  at 
any  other  time. 

In  these  cases  it  is  assumed  that  intercourse  and  conception  are 
synchronous,  but  recent  physiological  researches  have  proved  that 
the  date  of  conception  is  not  fixed  by  the  date  of  intercourse.  The 
time  occupied  by  the  descent  of  the  ovum  along  the  Fallopian  tube 
varies,  while  the  time  required  for  the  passage  of  the  male  fluid  to 
meet  the  ovum  is  also  subject  to  variation.  The  investigations  of 
Bischoff  and  Valentin  show  that  the  spermatozoa  may  retain  their 
movements,  and  probably  their  fecundating  power,  for  so  long  a 
period  as  seven  days  within  the  body  of  a  female.  Fecundation  can- 
not result  unless  the  matured  ovum  meets  these  bodies  in  a  living 
condition ;  and  conception  may  be  regarded,  in  the  language  of  Dr. 
Meigs,  as  the  fixation  of  a  fecundated  ovum  upon  the  living  surface 
of  the  woman.  Conception  may  therefore  take  place  either  in  a  few 
hours,  or,  according  to  Valentin's  observations,  at  so  long  a  period 
as  seven  days,  after  intercourse.  But  they  do  not  satisfactorily  ex- 
plain such  extreme  differences  as  were  observed  in  the  cases  of  Dr. 
Bigby  and  Dr.  Beid  (thirty-three  days),  or  in  those  of  M.  Devilliers 
(forty-nine  days) — ante  p.  54:6.  "We  must  therefore  be  prepared  to 
admit,  either  that  conception  may  in  some  cases  be  delayed  for  so 
long  a  period  as  from  five  to  seven  weeks  after  intercourse,  or  that 
there  may  be  a  difference  of  from  five  to  seven  weeks  in  the  dura- 
tion of  pregnancy.  Whatever  may  be  the  explanation  adopted,  it 
is  obvious  that,  in  a  medico-legal  view,  the  only  conclusion  at  which 
we  can  arrive  is,  that  the  period  of  gestation  in  woman  is  not,  as  it 
was  formerly  supposed  to  be,  a  fixed  and  invariable  term. 

Great  mistakes  have  arisen  in  the  calculation  of  the  period  by  the 
use  of  the  word  "  month" — some  intending  by  this  a  lunar  and 
others  a  calendar  month.  Nine  lunar  months  would  be  equal  to  252 
days,  while  the  average  of  nine  calendar  months  would  be  270  days 
— the  latter  period  varying  according  to  the  particular  months  of  the 
year  over  which  the  pregnancy  might  extend.  To  prevent  mistakes, 
or  that  misunderstanding  of  evidence  which  has  so  frequently  arisen, 
it  would  be  advisable  that  medical  witnesses  should  always  express 
the  period  of  gestation  in  weeks  or  days,  concerning  which  there 
can  be  no  misunderstanding:  it  would  be  also  proper  to  adopt  the 
plan  of  always  commencing  the  calculation  from  the  period  of  the 
last  cessation  of  the  menses,  rather  than  from  two  weeks  later.  The 
hitter  rule  is  often  followed,  and  this  discrepancy  is  another  cause  of 
confusion. 

Premature  Births. — Short  Periods  of  Gestation. — From  the  preceding 
remarks  wo  may  regard  all  births  before  the  thirty-eighth  weri 
premature,  and  all  those  which  occur  after  the  fortieth  week  as  pro- 


548  SHORT    PERIODS    OF    GESTATION. 

tracted  cases;  and  one  great  point  for  a  medical  witness  to  determine 
is,  whether  the  external  characters  presented  by  a  child  correspond 
to  those  which  it  should  present,  supposing  it  to  be  legitimately 
born.  When  the  birth  is  premature,  this  sort  of  corroborative  evi- 
dence may  be  sometimes  obtained  ;  because,  assuming  that  there  has 
been  no  access  between  the  parties  before  marriage,  children  born  at 
the  fifth  or  sixth  month  after  marriage  cannot,  if  the  offspring  of  the 
husband,  present  the  characters  of  those  born  at  the  full  period.  It 
is  not  so  with  protracted  births,  for  children  are  not  more  developed 
in  protracted  cases  than  they  are  in  those  which  occur  at  the  usual 
period.  This  would  lead  to  the  inference  that  when  a  child  has 
reached  a  certain  stage  of  development  it  ceases  to  grow ;  a  view 
which  is  borne  out  by  the  observations  of  Dr.  Biittel.  (Henke's 
"  Zeitschrift,"  1844,  p.  247.)  This  gentleman  observed  that  the  size 
of  a  child  did  not  increase  in  proportion  to  the  length  of  gestation. 
In  protracted  human  and  animal  gestation,  the  offspring  is  not  re- 
markable for  size  and  weight.  Thus  robust  mothers  have  had  small 
children,  and  small  mothers  strong  and  sometimes  unusually  large 
children.  Dr.  Murplry  states  that  he  met  with  a  fulty-developed 
child  which  was  born  after  a  gestation  of  only  251  days.  ("  Lancet," 
Nov.  30,  1844,  p.  284.)  For  an  account  of  the  characters  presented 
by  children  at  different  uterine  ages,  see  Infanticide  (p.  467.) 

Development  of  the  Child. — In  judging  from  marks  of  development 
on  the  body  of  a  child,  as  a  test  of  uterine  age,  we  must  make  full 
allowance  for  the  exceptions  to  which  they  are  liable.  The  nearer 
the  supposed  premature  delivery  approaches  to  the  full  period  of 
gestation,  the  more  difficult  will  be  the  formation  of  an  opinion. 
Although  the  characters  of  a  seven-months'  child  as  a  general  rule, 
are  usually  well-marked,  and  may  be  known  by  common  observation, 
it  is  not  possible  to  distinguish  with  absolute  certainty  a  child  born 
at  the  eighth  from  one  born  at  the  ninth  month.  Burns  observes 
that  gestation  may  be  completed,  and  the  child  perfected  to  its  natu- 
ral size,  a  week  or  two  sooner  than  the  end  of  the  ninth  month  ;  ami 
other  accoucheurs  corroborate  this  view.  (Dr.  Murphy,  in  "  Lancet," 
Nov.  30,  1844,  p.  284.) 

When,  however,  the  facts  are  such  that  to  be  the  offspring  of  the 
husband  it  must  be  a  six  months'  child,  and  it  is  born  mature,  there  can 
be  no  reason  to  doubt  that  it  is  illegitimate.  [Eager  v.  Grimwood, 
Exchequer  Sittings,  Jan.  7,  1847.)  But  the  fact  that  a  child  born  at 
nine  months  is  small  and  resembles  in  size  and  weight  a  seven  or 
eight-months'  child,  cannot  be  taken  as  a  medical  proof  of  illegiti- 
macy. Children  born  at  the  full  period  vary  considerably  in  size 
and  weight;  yet,  although  small,  there  is  commonly  about  them  an 
appearance  of  development,  which  is  especially  apparent  in  the  fea- 
tures. If  there  be  a  general  want  of  development  in  the  body,  and 
if  certain  foetal  peculiarities  remain;  as,  for  example,  the  membrana? 
pupillares,  or,  in  the  male,  the  testes  do  not  occupy  the  scrotum  : 
these  facts  lead  to  a  strong  presumption  that  the  child  has  not  reached 
the  full  period.  On  the  other  hand,  when  a  child  is  born  with  the 
full  signs  of  maturity  about  it,  at  or  under  seven  months  from  pes- 


EVIDENCE    FROM    THE    STATE    OF    THE    CHILD.  519 

sible  access  of  the  husband,  there  is  an  equally  strong  presumption 
that  it  is  illegitimate.  The  great  progressive  stage  of  development 
is  considered  to  be  during  the  two  last  months  of  gestation ;  the 
changes  which  the  foetus  undergoes  are  greater  and  more  marked  at 
this  than  at  any  other  time.  The  general  opinion  is  that  an  eight- 
months'  child  is  not  with  any  certainty  to  be  distinguished  from  one 
born  at  the  ninth  month.  If  the  body  of  a  child  is  large  and  fully 
developed,  it  would  be  considered  to  have  been  born  at  the  full  pe- 
riod of  gestation,  and  any  opinion  which  had  led  to  the  supposition 
that  it  was  a  seven-months'  child,  would  be  attributed  to  some  mis- 
take in  the  calculation.  Dr.  Beck  states  it  as  barely  possible  that  a 
child  born  at  seven  months  may  occasionally  be  of  such  a  size  as  to 
be  considered  mature,  yet  he  qualifies  this  statement  by  the  remark, 
that  the  assertion  is  most  frequently  made  by  those  whose  character 
is  in  danger  of  being  destroyed.  The  important  medical  question 
is,  however,  has  a  really  seven-months'  child  ever  been  born  so  de- 
veloped as  to  be  mistaken  by  an  experienced  person  for  one  that 
was  mature  ?  He  adduces  no  case  of  this  kind  in  support  of  his 
opinion.  There  can  be  no  doubt  of  the  correctness  of  his  statement 
that  a  mature  child,  born  before  seven  full  months  after  intercourse, 
ought  to  be  considered  illegitimate ;  but  it  would  be  difficult  to  main- 
tain this  proposition  consistently  with  the  above  admission,  for  there 
is  no  obvious  reason  why  a  child  should  not  acquire  premature  de- 
velopment during  the  latter  half  of  the  sixth  as  well  as  at  the  sev- 
enth month. 

In  Bromwich  v.  Waters  (Chester  Lent  Assizes,  1862)  the  question 
of  premature  development  arose  incidentally  upon  an  alleged  ges- 
tation of  259  days.  It  was  stated  that  intercourse  had  taken  place 
upon  the  9th  November,  1861,  and  a  child  was  born  on  the  26th  July, 
1862,  a  period  of  259  days,  or  thirty-seven  weeks.  The  child  had 
the  appearance  of  a  mature  child.  The  counsel  for  defendant  ad- 
mitted that  a  child  born  at  this  period,  i.  e.,  three  weeks  before  ma- 
turity, might  be  as  large  as  one  bprn  at  the  ninth  month,  but  he 
denied  that  it  would  be  so  perfectly  developed  in  all  its  parts.  When 
the  question  was  put  to  Sir  J.  Simpson,  of  Edinburgh,  who  gave 
evidence  at  the  trial  in  favor  of  the  defendant,  he  said  that  the  full 
size  was  generally  combined  with  full  development ;  and  he  further 
stated  that  it  was  against  all  the  laws  of  nature  that  children  should 
be  born  full-grown  even  a  fortnight  before  the  usual  term  of  gesta- 
tion, which  he  fixed  at  nine  calendar  months  and  a  week.  Accord- 
ing to  this  view,  if  there  had  been  intercourse  on  the  9th  November, 
1861,  the  day  of  probable  delivery  would  be  a  week  after  the  9th  of 
the  following  August,  i.  e.,  on  the  16th  August,  1862.  Hence,  as 
the  child  was  actually  born  in  a  mature  state  on  the  26th  July,  this 
was  three  weeks  before  the  usual  term ;  and  therefore,  in  his  opinion, 
impregnation  from  some  other  person  had  probably  taken  place 
three  weeks  earlier  than  the  period  assigned  by  the  woman  (Whalley). 
Sir  J.  Simpson  considered  it  to  be  as  rare  that  a  child  should  be  born 
full-grown  three  weeks  before  the  usual  period,  as  thai  a  man  should 
attain  one  hundred  years  of  age!     ("  lteport  of  the  Trial  of  Brom- 


550  EVIDENCE    FROM    DEVELOPMENT. 

wich  v.  Waters"  1863,  p.  33.)  There  are  not  many  medical  witnesses, 
however,  who  would  venture  to  affirm  that  in  the  last  three  Aveeks 
of  gestation  there  are  such  marked  changes  in  the  body  of  a  child 
as  to  render  this  difference  in  time  always  perceptible,  or  who  would 
venture  to  bastardize  a  child  or  convict  a  woman  of  adultery  be- 
cause, when  born  at  the  259th  day  after  intercourse,  the  child  had 
about  it  the  usual  appearances  of  maturity.  This  would  be  equal  to 
affirming  that  variations  in  size  might  take  place  at  the  ninth  but 
not  at  the  eighth  month  of  gestation.  But  facts  are  adverse  to  the 
theory.  Dr.  Eiittel,  an  experienced  observer,  has  met  with  several 
instances  in  which  women  have  been  delivered  two  and  even  three 
weeks  before  the  expiration  of  the  ordinary  term  (280  days),  and  the 
children  were  as  perfectly  developed,  to  all  appearance,  as  other 
children  which  had  been  born  at  the  full  period ;  at  any  rate  they 
could  not  be  distinguished  from  them  by  a  competent  observer. 

In  another  part  of  this  work  (Infanticide,  p.  469),  some  cases 
are  related  which  prove  that  at  the  ninth  month  children  are  occa- 
sionally born  of  a  size  and  weight  greatly  exceeding  the  average. 
Thus  a  nine-months'  child  lias  been  born  weighing  eighteen  pounds 
and  measuring  thirty-two  inches,  whereas  the  usual  weight  is  from 
six  to  seven  pounds,  and  the  length  eighteen  inches.  In  such  an 
exceptional  case,  there  is  reason  to  believe  that  had  the  child  come 
into  the  world  at  the  seventh  month,  it  would  have  appeared  to  the 
accoucheur  to  have  reached  the  full  term.  As  it  is  impossible  to 
say  when  such  an  exception  is  likely  to  occur,  and  a  lawyer  is  al- 
ways entitled  to  take  advantage  of  either  extreme,  it  follows  that  in 
any  case  in  which  this  question  arises,  a  witness  will  be  bound  to 
admit  that  a  seven  mouths'  child  may  be  born  of  the  average  size  and 
weight  of  a  nine-months'  child,  or  to  give  some  valid  reason  for  the 
fact  that  great  variations  in  size  and  weight  may  occur  at  the  ninth 
but  never  at  or  about  the  seventh  or  eighth  month  of  gestation.  He 
must  also  be  prepared  to  affirm  from  facts  within  his  knowledge  that 
in  these  extreme  cases  the  doubling  of  the  weight  and  length  of  the 
child  is  not  progressive,  but  that  it  suddenly  takes  place  at  or  near 
the  ninth  month.  If  the  child  is  a  male,  and  the  testicles  are  found 
in  the  scrotum,  there  is  eveiy  reason  to  believe  that  it  has  passed 
the  seventh  and  even  the  eighth  month  of  uterine  life.  (See  Infan- 
ticide, p.  468.)  The  differences  of  opinion  among  obstetric  experts 
in  reference  to  this  question  appear  to  admit  of  explanation.  All 
will  agree  that,  as  a  general  rule,  a  seven-months'  child  might  be  dis- 
tinguished from  a  nine-months'  child,  unless  the  latter  was  a  twin  ; 
but  at  the  same  time  it  must  be  admitted  that  if  variations  in  deve- 
lopment take  place  at  the  full  term,  there  is  nothing  to  prevent  such 
variations  from  occurring  at  the  seventh  and  eighth  months  of  gesta- 
tion. Dr.  Hicks  informs  me  that  he  has  seen  a  child  born  seven 
months  after  marriage  as  large  as  at  the  full  term ;  but,  as  he  sug- 
gests, this  child  might  really  have  been  begotten  so  as  to  be  born  at 
the  full  term.  In  order  to  determine  this  point  by  unexceptionable 
facts,  it  would  be  necessary  to  collect  a  series  of  cases  of  impregna- 
tion from  one  intercourse  in  which  the  children  were  born  seven 


EARLIEST    PERIOD    CHILDREN    ARE    BORX    LIVING.      551 

months  after  sucli  intercourse,  and  were  proved  to  have  the  average 
size  and  weight  of  mature  children.  In  the  meantime  counsel  will 
care  little  for  the  rule,  but  will  take  every  advantage  of  the  existence 
of  admitted  exceptions. 

Earliest  Perio  I  at  which  a  Child  may  be  Born  Living.  Viability. — 
The  fact  that  a  child  has  had  the  strength  to  survive  its  birth  for  a 
certain  period  has  been  supposed  to  furnish  additional  evidence  of 
maturity ;  for  it  is  well-known  that  under  a  certain  age  children  are 
not  born  living,  or,  if  living,  they  speedily  die.  Therefore  it  has 
been  argued,  if  a  child  born  at  the  fifth  or  sixth  month  after  the  first 
cohabitation,  be  born  living,  or  survive,  this  should,  ipso  facto,  be 
taken  as  a  proof  of  its  illegitimacy.  According  to  the  English  law, 
it  is  not  necessary  that  a  child,  when  born,  should  be  capable  of  liv- 
ing, or  viable,  in  order  that  it  should  take  its  civil  rights.  Thus  it 
may  be  born  at  an  early  period  of  gestation  :  it  may  be  immature, 
and  not  likely  to  survive :  or,  again,  it  may  be  born  at  the  full 
period  of  gestation,  but  it  may  be  obviously  laboring  under  some 
defective  organization,  or  some  mortal  disease,  which  must  necessa- 
rily cause  its  death  within  a  short  time  after  its  birth.  Fortunately, 
these  points  are  of  no  importance  in  relation  to  the  right  of  inherit- 
ance :  an  English  medical  jurist  has  only  to  prove  that  there  was 
some  well-marked  physiological  sign  of  life  after  birth — whether  the 
child  was  mature  or  immature,  diseased  or  healthy,  is  a  matter  which 
does  not  at  all  enter  into  the  investigation.  In  this  respect  our  law 
appears  to  be  more  simple  and  just  than  that  which  prevails  in 
France.  By  Art.  725  of  the  Code  Napoleon,  no  child  that  is  born 
alive  can  inherit,  unless  it  is  born,  as  the  law  terms  it,  viable.  The 
meaning  of  this  word  is  not  defined  by  the  law  itself,  and  there  are 
probably  no  two  lawyers  or  physicians  in  that  county  who  place 
upon  it  the  same  interpretation.  The  French  law  seems  to  intend 
(Devergie,  vol.  1,  p.  700  :  Briand,  p.  173)  by  viability  in  a  new-born 
child,  that  it  should  have  breathed  and  be  capable  of  living  out  of 
the  womb  of  its  mother  and  independently  of  her  :  also,  that  it 
should  be  capable  of  living  for  a  longer  or  shorter  period  after  its 
birth.  It  would  be  difficult  for  any  system  of  jurisprudence  to  lay 
down  a  more  vague  or  incorrect  principle  than  this;  and  medical 
witnesses  may  consider  themselves  fortunate  that  in  this  country 
they  have  not  to  take  part  in  the  unsatisfactory  litigation  to  which 
such  a  principle  must  necessarily  give  rise. 

The  question  therefore  to  be  considered  is — What  is  the  earliest 
period  of  uterine  life  at  which  a  healthily-formed  child  can  be  born 
living,  and  Avith  a  capacity  to  live  after  its  birth  and  to  attain  ma- 
turity? It  is  now  universally  admitted  that  children  born  at  the 
seventh  month  of  gestation  are  capable  of  living,  although  they  are 
more  delicate,  and  in  general  require  greater  care  and  attention  to 
preserve  them  than  children  born  at  the  ninth  month  ;  the  chances, 
are,  however,  very  much  against  their  surviving,  it  was  the  opinion 
of  Dr.  William  Hunter,  and  it  is  one  in  which  most  modern  author- 
ities concur,  that  few  children  born  before  seven  <-<ii,'i,,>lur  months  (or 
210  days)  are  capable  of  living  to  manhood.     They  may  be  born 


552  UTERINE    AGE    AT    WHICH 

alive  at  any  period  between  the  sixth  and  seventh  months ;  or  even, 
in  some  instances,  earlier  than  the  sixth :  but  this  is  rare,  and,  if 
born  living,  they  commonly  die  soon  after  birth.  There  is  one  case 
on  record,  of  a  child  having  been  born  living  so  early  as  the  fourth 
month  of  gestation  ("Brit,  and  For.  Med.  Eev.,"  vol.  2,  p.  236);  and 
another,  in  which  a  woman  aborted  at  the  fourth-and-a-half  month 
of  pregnancy.  M.  Maisonneuve  saw  the  woman  two  hours  after  de- 
livery :  he  then  found  the  foetus  in  its  membranes,  and  on  laying 
these  open,  to  his  surprise  it  was  still  moving.  He  applied  warmth, 
and  succeeded  in  partially  restoring  it;  for  in  a  few  minutes  the  respi- 
ratory movements  were  performed  with  regularity,  but  in  spite  of 
the  establishment  of  respiration,  the  child  died  about  six  hours  after 
its  birth.  ("Journal  de'Medecine,"  and  "Med.  Gaz.,"  vol.  39,  p.  97.) 
In  two  instances  of  abortion  about  the  fifth  month,  Dr.  Davies,  of 
Hertford,  noticed  that  the  foetus  showed  signs  of  life  after  its  birth, 
by  moving  its  limbs  ("  Med.  Gaz."  vol.  40,  p.  1022) ;  and  the  follow- 
ing case,  in  which  a  child  born  at  the  fifth  month  survived  upwards 
of  twelve  hours,  occurred  to  Mr.  Smythe.  A  female  in  her  second 
pregnancy,  and  in  the  147th  day  of  gestation,  had  severe  flooding 
with  rupture  of  the  membranes.  Labor  occurred  on  the  following 
night,  when  a  small  but  well-formed  foetus  was  expelled,  giving  no 
other  indication  of  life  than  a  feeble  action  of  the  heart,  and  a  strong 
pulsation  in  the  umbilical  cord.  It  was  resuscitated,  and  cried  as 
strongly  as  a  child  born  at  the  full  period  of  pregnancy.  It  weighed 
less  than  two  pounds,  and  measured  exactly  twelve  inches.  It 
swallowed  some  nourishment,  but  died  about  twelve  hours  after 
birth.  The  membranas  pupillares  were  entire — the  testicles  had  not 
descended — the  head  was  well  covered  with  hair.  The  length  and 
weight,  as  well  as  the  presence  of  hair,  indicated  a  foetus  between 
the  sixth  and  seven  months ;  but,  as  it  is  asserted  that  the  period  of 
gestation  is  accurately  given,  this  must  be  regarded  as  an  extraor- 
dinary" instance  of  premature  development.  There  was  clearly  no- 
thing in  the  organization  of  this  child  to  have  prevented  its  grow- 
ing to  the  age  of  maturity — in  other  words,  it  was  viable.  ("Med. 
Chir.  Rev.,"  July,  1844,  p.  266.)  In  November,  1865,  Mr.  Carter 
communicated  to  me  the  particulars  of  a  case  in  which  a  child  was 
born  living  at  the  fifth  month  of  gestation.  It  cried  slightly  when 
it  was  born,  and  during  the  half  hour  that  it  was  kept  unsevered 
from  its  mother  it  made  frequent  efforts  to  breathe.  It  was  perfectly 
formed.  It  was  about  one  foot  in  length,  and  its  weight  was  fully 
one  pound  and  a  quarter.  It  died  soon  after  it  was  born.  A  case 
is  reported,  in  which  a  child  born  at  five-and-a-half  months  survived 
its  birth  between  three  and  four  hours  ("Med.  Gaz.,"  vol.  19,  p.  165); 
and  on  a  trial  for  child-murder  {Reg.  v.  West,  Nottingham  Lent  As- 
sizes, 1848),  a  midwife  was  indicted  for  causing  the  death  of  a  child 
by  bringing  about  the  premature  delivery  of  the  mother,  when  she 
was  between  the  fifth  and  sixth  months  of  pregnancy.  The  child 
in  this  instance  lived  five  hours  after  its  birth.  Capuron  mentions 
an  instance  in  which  a  child  was  born  at  the  sixth-and-a-half  month 
of  pregnancy,  and  at  the  time  he  reported  the  case  it  was  two  years 


A    CHILD    MAY    BE    BOKX    LIVING.  553 

old,  and  enjoyed  excellent  health.  In  another  instance  a  child  was 
born  at  the  same  period,  and  lived  to  the  age  of  ten  years.  ("Med. 
Leg.  des  Ace,"  pp.  162,  208.)  In  a  case  which  fell  nnder  my  own 
knowledge,  a  child  was  born  at  the  sixth-and-a-half  month  of  gesta- 
tion, and  lived  a  fortnight.  (See  another  case,  "Med.  Gaz.,"  vol.  32, 
p.  623.)  Capnron  considers  that  a  child  born  at  the  180th  day,  or 
at  the  sixth  month  after  conception,  may  be  sufficiently  mature  to 
live,  i.  e.,  that  there  would  be  no  reason  to  presume  it  was  illegitimate, 
merely  because  it  survived  its  premature  birth.  On  the  other  hand, 
if  born  before  the  sixth  month,  with  sufficient  maturity  to  live,  this 
fact,  although  by  no  means  a  proof,  affords,  in  his  opinion,  a  strong- 
presumption  of  its  illegitimacy.  Of  eight  cases  of  children  born 
living  (by  abortion)  at  the  sixth  month,  Mr.  Whitehead  states  that 
seven  perished  within  six  hours  after  birth,  and  one  only  attained 
to  the  age  of  ten  days.     ("  On  Abortion,"  p.  219.) 

Dr.  Eiittel,  who  has  examined  the  subject  with  great  care,  states, 
as  the  result  of  his  experience,  that  he  attended  a  married  woman, 
who  was  afterwards  delivered  of  a  living  child  in  the  fifth  month  of 
her  pregnancy:  the  child  survived  its  birth  for  tAventy-four  hours. 
He  delivered  another  woman  of  twins,  in  the  sixth  month  of  her  preg- 
nancy :  one  was  dead,  and  the  other  continued  alive  for  three  hours, 
its  life  being  indicated  only  by  the  visible  pulsation  of  the  heart, 
but  there  was  no  perceptible  respiration.  This  fact  corroborates  the 
remarks  made  elsewhere,  as  to  life  without  active  respiration  (In- 
fanticide, p.  472);  it  has  also  an  immediate  bearing  on  the  proof 
of  life  in  reference  to  tenancy  by  courtesy  (p.  535).  In  another  in- 
stance of  the  birth  of  male  twins,  at  the  sixth  month,  each  weighed 
three  pounds.  Dr.  Ruttel  saw  them  a  year  after  their  birth,  and  they 
were  then  two  healthy  strong  children.  (Henke's  "  Zeitschrift  der 
S.  A.,"  1811,  p.  211.)  Dr.  Barker,  of  Dumfries,  met  with  a  case,  in 
which  a  female  child  was  born  at  the  158th  day  of  gestation,  or 
twenty -two  weeks  and  four  days  after  intercourse.  The  size  and  weight 
of  the  child  corresponded  with  the  period  at  which  it  was  born :  it 
weighed  one  pound,  and  measured  eleven  inches.  It  had  only  rudi- 
mentary nails,  and  very  little  hair  on  the  back  on  the  head;  the  eyelids 
were  closed,  and  remained  closed,  until  the  second  day ;  the  nails  were 
hardly  visible;  the  skin  was  shrivelled.  The  child  did  not  suck  pro- 
perly until  after  the  lapse  of  a  month,  and  she  did  not  walk  until  she 
was  nineteen  months  old.  When  born,  the  child  was  wrapped  up  and  • 
placed  in  a  box  before  the  fire.  Three  and  a  half  years  afterwards, 
this  child  was  in  a  thriving  state  and  healthy,  but  of  small  make ;  she 
weighed  twenty-nine  pounds  and  a  half.  ("Med.  Times,"  Sept.  1850, 
p.  259 ;  also  Oct.  12,  p.  392.)  Mr.  Annan,  surgeon,  of  Kinross,  has 
recorded  a  case  in  which  a  child  was  born  between  the  end  of  the 
sixth  and  the  middle  of  the  seventh  month,  and  lived  for  a  period  of 
four  months  and  eight  days;  it  weighed  a  pound  and  a  half  when 
seven  days  old.  ("Med.  Times,"  Sep.  9,  1818,  p.  301.)  In  a  case 
which  occurred  to  Dr.  Outrepont  of  Bamberg  (reported  in  Henke's 
"Zeitschrift,"  vol.  6),  there  was  the  strongest  reason  to  believe  that 
gestation  could  not  have  exceeded  twenty-seven  weeks.     The  child 


554  PROTRACTED    BIRTHS. 

(a  male)  weighed,  when  born,  one  pound  and  a  half,  and  measured 
thirteen  and  a  half  inches.  The  skin  was  covered  with  down  and 
much  wrinkled — the  limbs  were  small — the  nails  appeared  like  white 
folds  of  skin,  and  the  testicles  had  not  descended.  It  breathed  as 
soon  as  it  was  born,  and  by  great  care  its  life  was  preserved.  It  is 
singular  that  its  development  was  very  slow  until  it  had  reached  a 
period  which  would  have  corresponded  to  the  forty-second  week  of 
gestation.  Dr.  Outrepont  saw  the  child  when  he  had  attained  the 
age  of  eleven  years,  and  then  he  appeared  to  be  of  the  size  of  a  boy  ' 
of  eight  years.  The  only  remarkable  point  about  the  case  is  the 
length  of  time  which  the  child  lived.  In  a  case  quoted  in  the  "Lan- 
cet" (Aug.  23,  1851,  p.  177),  a  child  born  at  six  months  and  ten  days 
was  thriving  satisfactorily  when  four  months  old.  (See  also  "Med. 
Times,"  Feb.  16,  1850,  p.  129.) 

Hence  it  may  be  considered  as  established  that  children  born  at 
the  seventh,  and  even  at  or  about  the  sixth  month,  may  be  reared, 
and  that  the  fact  of  their  surviving  for  months  or  years  cannot  be 
taken  as  evidence  of  illegitimacy.  In  forming  our  judgment  on 
these  occasions,  we  are  bound  to  look  less  at  the  period  at  which  a 
child  is  born,  than  at  the  marks  of  development  about  the  body. 
The  case  reported  by  Mr.  Smythe,  p.  552,  is  corroborative  of  this 
view.  Dr.  Bonnar  has  recently  published  a  tabulated  view  of  112 
cases  of  premature  births  of  living  children — the  dates  of  gestation 
extending  from  the  120th  to  the  210th  day.  Among  these  cases  35 
children  died  within  the  first  twenty-four  hours;  13  more  before  the 
completion  of  one  week ;  1  in  six  weeks ;  -£  in  four  months.  The 
following  lived,  or  were  living  at  the  date  of  the  report :  1,  seven 
and  a  half  months ;  8,  from  one  to  two  years ;  1,  three  and  a  half 
years ;  5,  from  ten  to  fifteen  years ;  6,  to  adult  age ;  5  lived  not 
stated  how  long.  ("  Critical  Inquiry  regarding  Superfoetation," 
1865,  p.  13.) 

Protracted  Births.  Long  Periods  of  Gestation. — The  questions  con- 
nected with  retarded  gestation  have  given  rise  to  considerable  dis- 
cussion in  legal  medicine.  That  gestation  may  be  retarded  or  pro- 
tracted beyond  the  fortieth  week  is  now,  I  believe,  not  disputed  by 
any  obstetric  writer  of  reputation.  Some  accoucheurs  have  denied 
it,  because  they  have  not  met  with  such  cases;  but  the  medico-legal 
relations  of  such  questions  do  not  depend  upon  the  solitary  experience 
of  practitioners.  It  is  only  by  the  accumulation  of  well-ascertained 
facts  from  all  authentic  sources  that  medical  knowledge  can  be  made 
available  for  the  purposes  of  the  law ;  otherwise,  owing  to  the  mere 
accident  of  a  witness  not  having  met  with  any  exceptional  instance, 
a  court  may  be  entirely  misled  in  its  judgment  by  trusting  to  his 
opinion.  It  is  the  more  important  to  attend  to  this,  because  most  of 
the  cases  involving  questions  either  of  contested  legitimacy,  or  the 
chastity  of  females,  turn  upon  protracted  rather  than  upon  premature 
delivery. 

In  standard  works  on  Midwifery  will  be  found  authentic  reports 
of  cases  in  which  gestation  continued  to  the  forty-first,  forty-second, 
forty-third,  and  even  to  the  forty-fourth  week.     Dr.  Murphy  regards 


LONG    PERIODS    OF    GESTATION 


555 


301  days,  or  forty-three  weeks,  as  the  average  limit  of  gestation. 
("Obstetric  Eeport,"  p.  4.)  Dr.  Lee  met  with  a  case  in  which  he  had 
no  doubt  that  the  pregnancy  lasted  287  days :  the  labor  did  not  take 
place  until  forty  one  weeks  after  the  departure  of  the  husband  to  the 
West  Indies.  ("Med.  Gaz.,"  vol.  31,  p.  917.)  Dr.  William  Hunter 
met  with  two  instances  in  which  gestation  was  protracted  until  the 
forty-second  week.  Dr.  Montgomery  met  with  a  case  in  which  deli- 
very did  not  ensue  until  between  the  forty-second  and  forty -fourth 
weeks.  ("  Med.  Gaz.,"  vol.  19,  p.  (3-1(3.)  Dr.  Merriman  has  published 
a  valuable  table  on  the  subject  of  protracted  gestation,  on  Avhich  the 
most  experienced  accoucheurs  have  been  in  the  habit  of  relying.  Of 
114  pregnancies,  calculated  by  him  from  the  last  day  at  which  the 
females  menstruated,  and  in  which  children  appeared  to  be  mature, 
the  following  were  the  periods : — 


Iu  the  37th  week 

"       38th     " 

.  "       39th     " 

"       40th     " 


3 
13 
14 
33 


In  the  41st  week 
"       42a      « 

"       43d       " 
"       44th     " 


22 

15 

10 

4 


Another  well-marked  case,  occurring  forty-four  weeks  precisely 
after  the  cessation  of  the  menses,  has  been  communicated  to  me  by 
Dr.  S.  W.  J.  Merriman. 

From  these  results  Dr.  Merriman  considers  that  in  the  greater 
number  of  women  gestation  is  completed  in  the  fortieth  week  from 
the  cessation  of  the  menses,  and  next  to  this  period  in  the  forty-first. 
In  the  evidence  given  by  this  gentleman  in  the  Gardner  Peerage  case 
before  the  House  of  Lords  in  1825,  the  case  of  longest  protraction 
on  which  he  was  able  to  rely  was  that  of  a  married  woman,  who 
was  in  the  habit  of  calculating  from  the  last  day  on  which  her 
monthly  period  ceased.  This  lady  was  delivered  309  days,  or  forty- 
four  weeks  and  one  day,  from  the  time  at  which  she  supposed  that  she 
had  conceived.  In  another  case  mentioned  by  the  witness  the  period 
was  303  days,  or  forty-three  weeks  and  two  days  from  the  termina- 
tion of  the  last  monthly  period.  It  was  objected  to  this  evidence,  by 
the  Attorney-General,  that  it  was  impossible  to  fix  the  exact  date  of 
conception,  and,  as  the  female  might  have  really  conceived  only  a 
day  or  two  before  the  expected  return  of  menstruation,  twenty-eight 
days  (or  four  weeks)  should  be  deducted  from  the  periods  assigned 
by  the  witness.  Admitting  the  validity  of  this  objection — and  the 
fact  upon  which  it  is  based  is  indisputable — it  followed  that  the 
longest  protracted  case  observed  by  Dr.  Merriman  might  have  really 
been  only  a  case  of  ordinary  gestation  extending  to  forty  weeks  and 
one  day.  An  objection  of  this  kind  may  of  course  be  successfully 
urged  in  law  to  any  inference  from  a  calculation  so  made,  and  it  was 
thus  in  the  Gardner  Peerage  case  the  medical  evidence  failed  to 
render  it  certain  that  gestation  might  be  so  protracted  as  to  support 
the  legitimacy  of  the  claimant:  namely  to  311  days  or  forty-four 
weeks  and  three  days.  Hence,  in  considering  this  question  il  is 
necessary  to  make  full  allowance  for  such  a  cause  of  error;  and,  in 
calculating  the  pregnancy  from  the  last  day  of  the  last  menstrual 
period,  we  should  deduct  the  interval  of  menstruation,  if  known, 


556  CASES    OF    PROTRACTED 

and  at  least  twenty-eight  days  if  unknown.  In  these  cases  of  con- 
tested legitimacy  the  offspring  is  commonly  the  result  of  a  single  in- 
tercourse, hence  the  date  of  conception  is  fixed  within  limits  already 
described  (p.  545) :  and  a  comparison  can  be  instituted  only  between 
the  period  of  gestation  thence  deduced,  and  the  periods  taken  in 
other  cases  which  are  equally  free  from  error.  / 

A  well-marked  case  of  gestation  passing  beyond  what  is  com- 
monly set  down  as  the  average  period  was  communicated  to  me  by 
Mr.  Howell,  of  Walton-on-Naze.  This  occurred  in  a  healthy  woman, 
aged  30,  who  had  borne  three  children,  the  youDgest  being  4  years 
old.  She  had  menstruated  with  regularity  up  to  the  third  week  in 
June:  the  menses  then  stopped  without  any  apparent  cause.  Her  de- 
livery took  place  323  days  after  their  last  appearauce.  Allowing  that 
impregnation  occurred  at  the  intermenstrual  period,  this  would  make 
the  gestation  309  days  ;  or  assuming  that  impregnation  did  not  occur 
until  twenty-eight  days  from  the  date  of  the  last  menstruation,  this 
would  make  the  period  295  daj^s,  or  forty -two  weeks  and  one  day.. 

A  case  is  reported  by  Dr.  Power  in  his  work  on  "  Human  Preg- 
nancy," in  which  gestation  is  said  to  have  extended  to  325  days. 
Mr.  Chattaway  of  Knighton,  a  former  pupil,  communicated  to  me 
the  following  instance  of  protracted  gestation.  A  healthy  woman, 
aet.  36,  the  wife  of  a  farmer,  applied  to  him  to  attend  her  in  her  con- 
finement, which  she  expected  to  take  place  in  September,  1856.  The 
menses  appeared  for  the  last  time  in  December,  1855,  and  she  quick- 
ened in  the  beginning  of  April,  1856.  About  the  middle  of  Septem- 
ber {%.  e.  on  the  283d  day,  dating  from  the  last  menstruation),  Mr. 
Chattaway  was  summoned  to  attend  her,  and  he  found  her  laboring 
under  severe  false  pains;  there  was  also  a  discharge  of  mucus  tinged 
with  blood.  The  case  went  on  until  the  19th  November  1856,  when 
the  patient  was  delivered  of  a  female  child  of  the  average  size.  It 
wrould  thus  appear,  according  to  the  ordinary  mode  of  calculation, 
that  deducting  twenty-eight  days  from  the  last  appearance  of  the 
menses,  gestation  was  protracted  in  this  instance  to  330  days,  or 
forty-seven  weeks  and  one  day. 

This,  of  course,  is  open  to  the  suggestion  that  the  menses  had 
ceased  from  some  accidental  cause,  and  that  pregnancy  had  taken 
place  some  weeks  subsequently.  In  reference  to  this  objection,  it 
may  be  observed  that  few  women  have  such  unusually  protracted 
pregnancies.  Then,  again,  all  practitioners  may  not  have  met  with 
protracted  cases;  but  the  fact  being  clearby  ascertained  in  one  case, 
it  is  unnecessary  to  search  for  more,  unless  we  doubt  the  credibility 
of  reporters  well  qualified  to  observe,  and  who  could  have  had  no  con- 
ceivable motive  to  misrepresent  the  facts  which  came  before  them. 
On  this  part  of  the  question  I  think  it  is  unnecessary  to  argue.  The 
advocates  of  a  fixed  and  limitable  period  differ  from  each  other  by 
a  space  of  at  least  ten  or  twelve  days,  and  each  must  either  take  his 
own  experience  for  the  final  decision  of  this  question,  or  it  must  be 
allowed  that  men  of  equal  powers  of  observation  with  themselves, 
have  met  with  exceptional  instances. 

Protracted  cases  of  gestation  are  always  open  to  the  objection  that 


GESTATION.  557 

the  menstrual  function  may  have  been  suspended  from  some  hidden 
morbid  cause,  one  or  two  months  before  the  actual  date  of  concep- 
tion, and  that  there  may  have  been  some  error  in  the  calculation  by 
which  the  period  has  been  determined.  If,  however,  the  objection 
is  admitted  under  these  circumstances,  it  would  be  only  equally  just 
to  admit  that  in  any  given  case  the  ordinary  and  so-called  fixed 
period,  also  calculated  from  the  cessation  of  menstruation,  is  based 
on  a  fallacy.  The  menstrual  function  may  have  accidentally  ceased, 
or  continued  for  several  intervals  after  conception,  and  thus  a  cor- 
responding change  should  be  made  in  fixing  the  ordinary  period  of 
gestation.  This  view  of  the  question  implies  that  no  reliance  can 
be  placed  on  the  date  of  the  cessation  of  the  menses  as  evidence  of 
the  actual  duration  of  pregnancy,  whether  natural,  premature,  or 
protracted.  My  colleague  Dr.  Hicks  informs  me  that  he  met  with  a 
case  in  which  the  pregnancy  of  a  woman  appeared  to  be  protracted 
to  between  twelve  and  thirteen  months.  There  was  every  reason  to 
believe  that  this  woman  became  pregnant  during  the  absence  of  the 
menses,  and  that  these  had  been  suspended  for  some  time  before  in- 
tercourse took  place.  This  is  no  doubt  the  explanation  of  a  large 
number  of  cases  of  alleged  protracted  gestation. 

In  the  Gardner  Peerage  case,  the  Attorney-General  was  quite 
willing  to  rely  upon  the  cessation  of  the  menstrual  discharge  as  a 
good  criterion  of  the  duration  of  pregnancy,  when  by  such  a  mode 
of  calculation  this  was  not  made  to  exceed  forty  weeks,  and  thus 
fitted  in  with  his  own  view  of  the  case !  But  it  is  obvious  that  this 
condition  must  be  either  taken  or  rejected  altogether  as  evidence : 
if  taken,  we  have  no  right,  in  alleged  protracted  cases,  to  refer  the 
suppression  to  disease,  for  the  sake  of  shortening  the  period,  when 
in  ordinary  cases  we  do  not  refer  its  continuance  to  disease,  because 
this  would  tend  to  lengthen  it :  if  rejected,  it  would  be  in  the  high- 
est degree  unjust  not  to  give  to  a  claimant  the  beneficial  presump- 
tion of  his  having  been  born  legitimate,  when  the  cases  adduced  in 
evidence  against  his  claim  are  actually  based  upon  a  precisely  simi- 
lar mode  of  calculation ! 

It  is,  however,  difficult  to  admit  that  all  the  protracted  cases  re- 
corded by  different  observers  have  depended  upon  mistakes  being 
made  in  the  calculation  of  the  period,  since  this  calculation  is  based 
on  the  same  principles  as  those  adopted  in  cases  of  ordinary  preg- 
nancy. Hence,  if  there  is  a  mistake  in  the  one  case,  there  would  be 
in  the  other :  if  an  error  in  the  exception,  there  would  be  an  error 
in  the  rule.  Either  the  average  term  of  pregnancy  is  wrongly  cal- 
culated by  most  accoucheurs  at  the  thirty-eighth  or  fortieth  week, 
or  it  is  rightly  calculated  to  extend  occasionally  to  the  forty- fourth, 
or,  admitting  these  protracted  cases,  to  the  forty-sixth  week.  But, 
even  setting  aside  the  obvious  answer  to  an  objection  of  this  nature, 
some  of  the  protracted  cases  observed  were  instances  of  impregna- 
tion from  a  single  intercourse ;  and,  making  due  allowance  for  the 
interval  for  conception,  the  general  inference  would  not  be  affected, 
and  no  fallacy  could  have  arisen  in  these  cases  of  protraction,  from 
mistakes  dependent  on  the  cessation  of  menstruation. 


558  DURATION    OF    GESTATION. 

The  late  Dr.  EeicVs  conclusions,  derived  from  numerous  facts  and 
cases,  represent  the  views  of  an  experienced  observer  on  this  much- 
disputed  question.  They  are — "  1.  The  duration  of  pregnancy  is 
qo1  altogether  a  fixed  period:  it  varies  somewhat  in  the  human 
female,  as  it  does  in  the  lower  orders  of  animals.  2.  This  deviation, 
however,  is  not  to  any  great  extent :  the  only  certain  data  of  calcu- 
lation are  those  dependent  on  the  known  time  of  conception  (of  inter- 
course ?).  3.  The  average  duration  of  the  pregnant  state,  when  cal- 
culated from  this  event,  is  about  275  days,  or  it  may  have  a  range 
of  from  270  to  280  days.  4.  There  is  no  full  or  satisfactory  evidence 
of  gestation  having  been  prolonged  beyond  293  days.  5.  The  Code 
Napoleon,  which  allows  300  days,  may  be  regarded  as  liberal.  6. 
The  menstrual  period  must  generally  serve  as  our  guide  in  default 
of  some  exact  knowledge :  it  is,  however,  often  fallacious,  and  is 
only  a  means  of  approximation  to  the  probable  time  of  parturition. 
7.  The  fortieth  week  after  the  last  appearance  of  the  menses  is  the 
most  likely  period,  and  the  forty-first  week  the  next."' 

Dr.  Duncan  ("  Edin.  Monthly  Journal,"  1854,  vol.  9,  p.  230)  draws 
the  following  conclusions  regarding  the  duration  of  pregnancy :  1. 
That  the  interval  between  conception  and  parturition  (the  real  dura- 
tion of  pregnancy)  has  not  been  exactly  ascertained  in  any  case.  2. 
That  the  average  interval  between  insemination  (intercourse)  and 
parturition  (commonly  called  the  duration  of  pregnancy)  is  275  days. 

3.  That  the  average  intervals  between  the  end  of  menstruation  and 
parturition  have  no  standard  length,  but  vary  within  certain  limits. 

4.  That  while  absolute  proof  of  the  prolongation  of  real  pregnancy 
bej'ond  its  usual  limits  is  still  deficient,  there  is  evidence  to  establish 
the  probability  that  it  may  be  protracted  beyond  such  limits  to  the 
extent  of  three  or  even  four  weeks. 

It  will  be  perceived  from  the  conclusions  drawn  by  Dr.  Eeid,  that 
he  admits  a  variation  of  23  days,  i.  e.,  from  270  days  (the  shortest 
period)  to  293  days,  the  longest  known  to  himself  from  a  single  in- 
tercourse. There  appears  to  be  no  valid  reason  why  the  variation 
should  not  be  even  greater  than  that  which  is  here  assigned,  and 
why  the  duration  of  pregnancy  might  not  extend  occasionally  to 
29(5  and  even  to  301  days.  It  is  merely  a  question  of  individual 
experience.  An  accoucheur  who  admitted  a  variation  of  23  days, 
and  who  had  known  gestation  to  be  protracted  to  the  293d  day  after 
intercourse,  would  hesitate  to  pronounce  a  child  illegitimate  merely 
because  it  had  been  born  on  the  296th  or  the  300th  day  after  possi- 
ble access  of  the  husband.  There  is  no  doubt  a  limit  to  gestation, 
but  it  is  not  in  our  power  to  fix  it :  hence  we  find  obstetric  writers 
of  repute  adopting  periods  which  have  no  point  of  agreement  among 
themselves.  Some  stop  short  at  280  days;  others,  like  Dr.  Eeid, 
fix  the  maximum  yet  known  at  293  days;  Dr.  Murphy  allows  from 
his  experience  at  least  324  days :  and  Dr.  Meigs  considers  that  ges- 
tation may  be  continued  to  twelve  months,  or  365  days.  ("Obste- 
trics, the  Science  and  the  Art,"  1849,  p.  194.)  The  fact  is,  the  term 
has  not  yet  been  fixed  even  approximately  by  medical  science: 
hence,  in  a  disputed  case,  other  circumstances  must  be  looked  to  in 


GESTATION    FOR    LOXG    PERIODS.  559 

order  to  lead  a  court  of  law  to  a  safe  decision.  It  is  at  present  hope- 
less to  reconcile  the  conflicting  medical  opinions  which  exist  on  the 
subject  of  the  duration  of  pregnancy  in  the  human  female.  There 
is,  indeed,  only  one  point  on  which  all  modern  observers  agree — 
namely,  that  the  period  cannot  be  limited  to  a  fixed  and  invariable 
number  of  days  or  weeks  but  that  it  is  liable  to  variation  according 
to  circumstances  not  fully  understood. 

It  has  been  elsewhere  observed  that  the  date  of  intercourse  does 
not  furnish  us  with  the  date  of  conception,  and  according  to  some 
authorities  all  evidence  connected  with  the  function  of  menstruation 
is  untrustworthy.  In  spite  of  these  objections  the  menstrual  period 
must  generally  serve  as  a  guide  in  default  of  more  certain  criteria. 
It  is,  however,  a  curious  fact,  and  one  which  the  mind  of  an  acute 
lawyer  will  not  fail  to  appreciate,  that  the  date  of  the  cessation  of 
the  menses  is  taken  by  some  physicians  as  a  guide  (in  married  life 
with  constant  intercourse),  so  long  as  gestation  does  not  extend  be- 
yond 280  days ;  while,  supposing  it  to  extend  to  300  days,  they  will 
assume  that  some  other  cause  than  pregnancy  must  have  led  to  an 
earlier  suppression,  and  thus  to  an  error  in  the  calculation  !  There 
may  be  no  more  evidence  of  suppression  from  a  morbid  cause  in 
the  one  case  than  in  the  other,  and  the  period  of  280  days  may  be 
as  much  based  on  error  as  the  period  of  300  days.  It  is  strange 
that  clever  writers,  who  adopt  this  mode  of  making  facts  square 
with  a  foregone  conclusion,  do  not  perceive  that  they  must,  in  fair- 
ness, either  reject  altogether  the  evidence  derivable  from  a  cessation 
of  the  menses,  or  admit  it  adversely  to  their  own  views,  in  cases  in 
which  the  facts  connected  with  the  cessation  have  been  as  carefully 
observed  and  recorded  by  others  as  by  themselves.  No  evidence 
on  this  subject  can  be  drawn  from  an  examination  of  the  body  of  a 
child.  There  is  no  increase  of  size  or  development  after  the  ninth 
month  has  passed.  Children  born  at  the  full  period  of  nine  months, 
have  been  larger  and  heavier  than  many  children  born,  as  it  was 
believed,  at  a  later  period.  In  cases  of  alleged  protracted  gestation, 
it  may  be  considered  that  the  child  should  always  have  attained  its 
full  growth  and  most  perfect  development. 

Period  of  Gestation  not  Fixed  by  Lata. — In  all  cases  of  contested 
legitimacy,  the  question  respecting  the  duration  of  gestation,  when 
it  arises,  is  left  entirely  open  by  the  English  law.  The  French  law, 
under  the  "Code  Napoleon,"  allows  300  days,  and  the  Prussian  law 
301  days;  but  no  period  has  been  fixed  by  English  jurists  wJthin 
which,  or  beyond  which,  a  child,  if  born  in  wedlock,  will  J^e  pre- 
sumed to  be  illegitimate.  The  decision  of  a  court  of  law  vrould  be 
founded,  quoad  the  duration  of  pregnancy,  on  the  opinions  of  ex- 
perts selected  for  the  occasion,  and  each  case  would  be  decided  on 
its  own  merits.  Precedents  can  have  but  little  influence  on  these 
occasions,  because  a  court  may  think  fit  to  pronounce  illegitimate, 
on  non-medical  grounds,  a  child  born  in  the  thirty-eighth  week  of 
gestation,  while  it  may  decide  that  another  was  legitimate  thai  had 
been  born  in  the  forty-third  week.  By  some  law-authorities  forty 
weeks  (or  280  days),  and  by  others  forty-three  weeks  (or  291  days), 


560  DISPUTED    PATERNITY. 

have"  been  taken  as  the  "ultimum  tempus  pariendi ;"  bnt  as  the  pe- 
riod of  human  gestation  is  wholly  independent  of  legal  dicta,  it  is 
not  the  custom  of  courts  to  act  upon  any  definite  rule.  Neverthe- 
less, it  is  clear  in  some  extreme  cases  that  the  law  may  fairly  inter- 
pose, and  pronounce  for  a  reasonable  limit.  In  the  case  of  Cotierall 
v.  Cotterall  (decided  in  the  Consistory  Court,  July,  1847),  a  child 
was  born  during  the  marriage,  and  the  husband  proceeded  against  the 
wife  for  a  divorce  on  the  ground  of  adultery.  The  main  proof 
was  based  on  the  fact  that  in  order  to  have  been  the  child  of  the 
husband  it  must  have  been  born  after  twelve  months1  gestation.  Dr. 
Lushington,  without  entering  into  the  question  of  protracted  gesta- 
tion, upon  proof  of  this  allegation,  at  once  pronounced  for  the 
divorce.  Such  a  duration  of  pregnancy  is  not  supported  by  any 
known  facts,  and  is  altogether  opposed  to  medical  probability.  In  suits 
of  contested  legitimacy  the  general  practice  consists  in  establishing 
possibility  of  access  on  the  part  of  the  husband :  when  this  is  proved, 
the  medical  question  arises,  whether  the  term  of  gestation  falls 
within  the  limits  assigned  by  the  best  medical  experience.  In  two 
instances,  children  have  been  pronounced  legitimate,  which  were 
born,  the  one  in  forty-one  weeks  and  three  days,  and  the  other  in 
forty-one  wreeks  and  four  days,  after  the  death  of  the  husband. 
Legitimacy  has  been  allowed  where  gestation  was  probably  protracted 
to  the  forty-third  week  (Anderton  v.  Gibbs,  1854).  In  the  United 
States,  a  decision  in  favor  of  paternity  has  been  made  in  a  case  in 
which  gestation  extended  to  forty-five  weeks  and  two  days  (Common- 
wealth Y.Porter).  Legitimacy  has  been  disallowed  in  the  English 
Courts,  although  probably  on  non-medical  grounds,  where  it  was 
protracted  to  forty-four  weeks  and  three  days  (Gardner  Peerage  case, 
1825);  in  one  case  paternity  was  denied  (judicially)  because  gesta- 
tion had  extended  to  forty  tico  weeks  and  five  days  (Luscombi  v. 
Prettyjohn),  and  in  another  {Dyson)  because  it  had  extended  to  forty- 
eight  weeks. 


PATERNITY 


CHAPTER  LIT. 

Disputed  paternity. — parental  likeness. — affiliation. — post- 
humous CHILDREN. — SUPERFCETATION  IN  RELATION  TO  LEGITI- 
MACY.— SUPPOSITITIOUS  CHILDREN. — SEXUAL  MALFORMATIONS. 

Disputed  Paternity.  Parental  Likeness. — It  has  been  stated  that 
the  law  does  not  pretend  to  determine  who  begat  a  child  when  it 
has  been  born  during  wedlock,  and  from  circumstances  it  might  be 
the  child  either  of  the  husband  or  of  an  adulterer.     But  medical 


DISPUTED    PATERNITY.  561 

jurists  have  recommended  that  family-likeness  should  be  looked  to 
on  these  occasions — not  merely  a  likeness  in  feature  and  figure,  but  in 
gesture  and  other  personal  peculiarities  which  may  have  character- 
ized the  alleged  parent.  These  are  called  questions  of  paternity: 
they  seldom  occur  except  in  reference  to  cases  of  bastardy,  and  when 
they  do  present  themselves,  the  evidence  thus  produced,  even  if 
affirmative,  is  properly  regarded  as  only  corroborative.  In  the  Town- 
shend  Peerage  case  (House  of  Lords,  May,  1843),  a  presumption  based 
on  family-likeness  was  admitted  by  their  lordships.  The  person 
whose  legitimacy  was  in  question  was  sworn  by  one  of  the  witnesses 
to  bear  so  strong  a  likeness  as  a  child  to  the  alleged  adulterer,  that 
he  should  have  known  him  among  five  hundred  children. 

The  proceedings  in  the  Douglas  Peerage  case  (1767-9)  show  that 
evidence  of  this  kind  is  occasionally  of  some  importance.  The  peer- 
age was  claimed  by  Archibald  Douglas — the  survivor  of  two  brothers 
after  the  death  of  the  alleged  parents,  Sir  John  and  Lady  Douglas. 
The  claim  was  disputed,  on  the  ground  that  the  appellant  and  his 
deceased  brother  were  supposititious  children.  Evidence  for  and 
against  the  legitimacy  of  the  claimant  had  been  collected  from  every 
quarter,  and  after  it  had  been  most  minutely  sifted  and  criticized, 
the  case  came  on  for  judgment,  in  the  Court  of  Session  in  Scotland, 
on  the  7th  of  July,  1767.  So  important  was  the  cause  deemed,  that 
the  fifteen  judges  took  eight  days  to  deliver  their  opinions.  The 
result  was  that  seven  of  the  judges  voted  in  favor  of  the  identity  or 
legitimacy  of  Mr.  Stewart,  and  seven  against  it ;  the  Lord  President, 
who  had  the  casting-vote,  agreed  with  the  latter,  by  which  Archibald 
Douglas,  alias  Stewart,  was  cast  on  the  world  without  either  name  or 
estate — thus  furnishing  one  among  numerous  instances  that  learned 
judges  as  well  as  doctors  can  differ  with  precisely  the  same  facts  before 
them.  An  appeal  from  this  decision  was  taken  to  the  House  of 
Lords,  by  which  the  judgment  of  the  Court  of  Session  was  reversed 
in  1769,  and  Archibald  Stewart  "(or  Douglas)  declared  to  be  the  un- 
doubted son  of  Lady  Jane,  the  sister  of  the  previous  holder  of  the 
title.  Much  stress  was  laid,  in  favor  of  the  legitimacy  of  these  chil- 
dren, on  the  fact  that  they  closely  resembled — the  one  Sir  John,  and 
the  other  Lady  Douglas.  The  resemblance  was  said  to  be  general ; 
it  was  evident  in  their  features,  gestures,  and  habits.  Lord  Mans- 
field, in  delivering  judgment,  made  the  following  remarks,  which 
comprise  all  that  can  be  said  on  this  subject :  "  I  have  always  con- 
sidered likeness  as  an  argument  of  a  child  being  the  son  of  a  parent,, 
and  the  rather  as  the  distinction  between  individuals  in  the  human 
species  is  more  discernible  than  between  other  animals.  A  man  may 
survey  ten  thousand  people  before  he  sees  two  faces  exactly  alike ; 
and  in  an  army  of  a  hundred  thousand  men,  every  man  may  be  known 
from  another.  If  there  should  be  a  likeness  of  feature,  there  may 
be  a  difference  in  the  voice,  gesture,  or  other  characters,  whereas  ;i, 
family-likeness  runs  generally  through  all  these ;  for  in  everything 
there  is  a  resemblance,  as  of  feature,  voice,  attitude,  and  action." 
This  kind  of  evidence  has  been  strongly  objected  to  from  its  uncer- 
tainty;  and  I  am  informed,  on  sood  authority,  that  it  was  in  this 
36 


502  PATERNITY    FROM    PERSONAL    PECULIARITIES. 

instance  much  disputed  whether  one  of  the  children  did  resemble 
Lady  Douglas,  but  it  seems  to  have  been  generally  admitted  that  the 
other  child  resembled  the  husband,  Sir  John.  From  this  account  it 
will  be  seen  that  evidence  from  family-likeness  is  not  strictly  medico- 
legal ;  it  can  be  furnished  only  by  friends  and  relatives  who  have 
known  the  parties  well,  and  are  competent  to  speak  of  the  facts  from 
personal  acquaintance  with  them.  It  will  also  be  apparent  that  the 
affirmative  evidence  in  such  cases  will  be  stronger  than  that  which 
is  negative,  for  it  could  hardly  be  inferred  that  a  person  was  illegi- 
timate because  he  did  not  resemble  his  parent. 

Parental  likeness  may  be  occasionally  indicated  by  color  or  pecu- 
liarities belonging  to  the  varieties  of  mankind,  as  of  the  intermixture 
of  the  Negro  or  Mongolian  with  one  of  the  Caucasian  variety.  In  such 
a  case  the  evidence  afforded  becomes  much  stronger;  and  supposing 
that  two  men  of  different  varieties  have  intercourse  about  the  same 
time  with  the  same  woman,  the  color  of  the  skin  of  the  offspring 
might  enable  a  court  to  determine  the  question  of  paternity.  It  is 
stated  to  have  happened,  on  more  than  one  occasion,  that  a  black 
woman  has  given  birth  at  the  same  time  to  a  black  child  and  a 
mulatto;  Dr.  Cunningham  refers  to  a  case  in  which  a  negress  gave 
birth  to  twins,  one  a  black  and  the  other  a  white  child.  ("Lancet," 
May  9,  1846,  p.  525.)  This  was  probably  a  case  of  superconception. 
In  Siothard  v.  Aldridge  (Bail  Court,  January,  1856),  the  plaintiff  sued 
the  defendant  for  damages  for  the  seduction  of  his  wife.  The  defen- 
dant was  a  man  of  color,  and  the  child  born  of  the  alleged  adulterous 
intercourse  was  proved  by  the  medical  witness  to  have  been  born 
colored  and  with  woolly  hair.  The  husband  and  wife  were  both 
light.  This  peculiarity  fixed  the  paternity  of  the  child  on  the  black 
defendant. 

Personal  deformities  are  not  necessarily  transmitted  from  parent  to 
child ;  yet  it  would  appear  from  the  subjoined  case,  that  a  disputed 
question  of  affiliation  has  been  settled  on  this  principle.  A  woman 
alleged  that  a  gentleman  in  whose  service  she  had  lived,  was  the 
father  of  a  child  of  which  she  had  been  recently  delivered.  The 
solicitor  who  appeared  to  support  the  affiliation,  rested  his  ease 
chiefly  on  the  fact  that  the  child  had  been  born  with  five  fingers  and 
a  thumb  on  the  right  hand,  the  defendant  himself  having  been  born 
with  a  similar  malformation  on  both  of  his  hands.  It  was  argued, 
on  the  other  side,  that  the  deformity  might  have  arisen  from  the 
mother's  imagination,  as,  while  pregnant,  she  was  constantly  in  the 
habit  of  seeing  the  defendant.  The  magistrates  decided  that  he  was 
the  father  of  the  child,  and  condemned  him  to  pay  the  necessary 
expenses  for  its  support.  ("  Med.  Times."'  March  6,  1847,  p.  47.)  It 
is  very  likely  that  the  decision  was  here  influenced  by  moral  cir- 
cumstances, for  otherwise  the  defendant  might  have  been  the  victim 
of  a  coincidence.  Six-fingered  children  are,  it  is  well  known,  born 
occasionally  of  five-fingered  parents;  and  as  the  deformity  existed 
only  on  one  hand  in  the  child,  while  it  was  on  both  hands  in  the 
parent,  the  medical  proof  that  it  was  actually  transmitted  by  genera- 
tion was  certainly  not  clearly  made  out.  In  some  instances  attempts 


EVIDENCE    IX    CASES    OF    AFFILIATION.  563 

Lave  been  made  to  fix  the  paternity  of  a  child  by  the  color  of  the 
hair,  but  this  evidence  is  far  less  conclusive  than  that  afforded  by 
the  color  of  the  skin.  In  the  case  of  Frazer  v.  Bagley  (Feb.  1844) 
it  was  alleged  that  the  wife  of  the  plaintiff  had  had  criminal  inter- 
course with  the  defendant,  and  the  last  two  children  were  stated  to 
be  the  offspring  of  the  latter.  The  plaintiff  and  his  wife  had  dark 
hair,  as  well  as  all  the  children  with  the  exception  of  the  two  last : 
these  had  red  hair  ;  and  it  was  further  proved  that  the  defendant 
had  red  whiskers  and  sandy  hair.  No  particular  stress  was  laid 
upon  this  evidence,  but  it  was  received  as  a  kind  of  indirect  proof. 
Not  much  confidence  can  be  placed  in  facts  of  this  description, 
since  red-haired  children  are  often  born  to  parents  who  have  dark 
hair ;  and  in  one  case  the  children  born  in  wedlock  were  observed 
to  have  dark  and  red  hair  alternately. 

Affiliation. — -Questions  of  paternity  are  involved  in  those  relating 
to  ((filiation.  A  man  may  allege  that  he  is  not  the  father  of  a  par- 
ticular child,  by  reason  of  certain  circumstances  upon  which  a  med- 
ical opinion  may  be  required.  The  necessary  transmission  of  gonor- 
rhoea or  syphilis  by  intercourse  may  thus  become  a  medical  question. 
In  September,  1844,  a  man  was  required,  under  the  law  of  bastardy, 
to  support  two  children  alleged  by  a  female  to  be  his ;  the  time  of 
gestation  was  within  nine  months.  The  accused  denied  that  he  had 
had  intercourse  with  the  deceased,  or  that  he  could  have  been  the 
father,  since  he  was  at  the  time  under  medical  treatment  for  venereal 
disease.  The  medical  questions  may  therefore  assume  this  shape : 
1.  Are  these  diseases  invariably  transmitted  by  intercourse  ?  2.  Do 
they  interfere  with  the  act  of  procreation  ?  Under  common  circum- 
stances they  must  both  be  answered  in  the  negative. 

A  singular  case  of  bastardy  is  reported  to  have  occurred  in 
Appenzell,  Switzerland.  The  question  was,  which  of  two  persons, 
who  had  had  intercourse  with  the  same  woman  within  a  period  of 
seventeen  days,  was  the  father  of  an  illegitimate  child  borne  by  the 
woman  ?  The  council,  to  which  the  case  was  referred,  gravely  re- 
solved to  postpone  their  decision  until  the  features  of  the  child  were 
so  far  developed  as  to  enable  them  to  decide  from  paternal  likeness. 
The  equity  of  this  difficult  case  would  have  been  met  by  compelling 
each  man  to  contribute  to  the  support  of  the  child  1  (Schneider's 
"Annalender  Staatsarzneikunde,"  1836,  IB.  s.  470.)  The  following, 
which  is  a  more  doubtful  case,  was  the  subject  of  a  communication 
to  the  "Lancet"  (March  13,  1847,  336):  Two  men,  A  and  B,  had 
intercourse,  unknown  to  each  other,  with  a  young  woman  of  deli- 
cate health;  and  after  this  had  continued  for  some  years,  she  was 
delivered  of  a  female  child — nine  calendar  months  and  three  days 
after  sexual  intercourse  with  A,  and  nine  calendar  months,  less  five 
days,  after  similar  intercourse  with  B  ;  or  at  the  end  of  27!)  days 
after  intercourse  with  A,  and  at  the  end  of  271  days  after  intercourse 
with  B  :  that  is,  a  period  of  eight  days  elapsed  between  the  periods 
of  intercourse  with  the  two  men.  The  woman  had  no  menstrual 
discharge  in  the  meantime,  and  it  is  not  believed  that  she  knew  any 
other  man  ;   she  went  her  full  time,  had  a,  good  labor,  and  produced 


56-i  EVIDENCE    IN    CASES    OF    AFFILIATION. 

a  fine  healthy  girl ;  she  had  a  plentiful  supply  of  milk,  and  enjoyed 
better  health  during  her  pregnancy  and  suckling  than  at  any  other 
time.  The  woman  died,  and  the  circumstances  of  the  mixed  inter- 
course having  become  known  to  A  and  B,  they  both  refused  to 
maintain  the  child.  A  contended  that,  as  the  woman  was  not  de- 
livered until  nine  months  and  three  days  after  the  connection  with 
him,  it  was  physically  impossible  the  child  could  be  his.  B  con- 
tended, on  the  other  hand,  that  280  days,  and  not  nine  months,  is  the 
period  of  gestation ;  and  that  the  child  having  been  born  279  days 
after  connection  with  A,  and  only  271  days  after  connection  with  B, 
it  was  therefore  probable  that  the  child  was  begotten  by  A.  There 
was  no  perceptible  likeness  to  either  of  the  men  in  the  child,  but  a 
marked  likeness  to  the  mother.  It  is  obvious  from  the  remarks  else- 
where made  (ante,  p.  545),  that  the  periods  of  271  and  279  days  are 
comprised  within  the  ordinary  range  of  gestation  :  hence  there  would 
be  no  medical  ground  for  affiliating  the  child  to  one  more  than  the 
other.  When  two  men  have  intercourse  with  the  same  female  on  the 
same  day,  it  is  impossible  to  settle  the  paternity  except  by  the  accident 
of  likeness ;  as  in  the  former  case,  justice  to  the  offspring  and  to  each 
possible  father  requires  that  each  should  be  bound  to  support  the 
child.  In  cases  of  affiliation  under  the  law  of  bastardy,  the  evidence 
of  the  mother,  if  corroborated,  is  received  in  support  of  a  question 
of  disputed  paternity  ;  but  sometimes  these  cases  are  decided  by  the 
length  of  the  period  of  gestation.  A  man  may  prove,  or  a  woman 
may  state,  that  the  intercourse  took  place  at  such  a  remote  period  as 
to  be  inconsistent  with  the  ordinary  duration  of  pregnancy.  On 
this  point  some  remarks  have  been  made  elsewhere  (ante,  p.  560). 
In  the  United  States  it  appears  that  very  long  dates  are  allowed  in 
bastardy  cases  ;  while  in  this  country  the  tendency  is  to  reject  med- 
ical evidence  altogether.  In  a  case  at  Cheltenham  (July,  1853),  the 
date  of  intercourse  was  proved  to  have  been  319  days  before  the 
birth  of  the  child.  The  medical  evidence  on  the  whole  was  in  favor 
of  this  protraction — one  of  the  witnesses  having  met  with  two  cases 
in  which  gestation  was  protracted,  as  he  believed,  to  310  days  from 
intercourse — but  the  case  was  summarily  dismissed. 

These  questions  of  affiliation,  when  the  interval  is  less  than  six  or 
eight  weeks,  can  rarely  be  determined  by  medical  evidence;  in  a 
twin-case,  it  would  be  only  just  that  one  child  should  be  affiliated  to 
each  individual.  In  a  recent  case  of  affiliation,  an  attempt  was  made 
to  set  aside  the  order  of  a  magistrate  fixing  the  paternity  on  the  pu- 
tative father,  on  the  ground  that,  as  the  intercourse  was  had  and  the 
child  conceived  in  France,  although  born  in  England,  it  was  re- 
moved from  the  jurisdiction  of  an  English  magistrate,  and  should  be 
left  to  the  French  courts.  The  objection  was  properly  overruled, 
and  the  alleged  father  was  ordered  to  pay  the  usual  sum  for  mainte- 
nance. The  place  of  birth  should  properly  fix  the  liability,  as  any 
other  rule  would  be  too  vague.  From  what  has  been  elsewhere 
stated  it  will  be  perceived  that  intercourse  might  take  place  in  Scot- 
land, followed  by  conception  in  England,  and  birth  in  Ireland.  So 
that  there  is  a  due  relation  between  the  date  of  intercourse  and  the 
date  of  birth,  no  other  proof  is  required. 


POSTHUMOUS    CHILDREN.  565 

Posthumous  Children. — Tt  has  been  supposed  that  a  case  involving 
a  question  of  paternity,  might  present  itself  on  the  marriage  of  a 
widow  soon  after  the  death  of  her  first  husband.  If  a  child  were 
born  after  the  lapse  of  ten  months,  it  might  be  a  question  whether  it 
was  a  child  of  the  first  or  second  marriage — of  the  dead  or  the  living- 
husband;  and  although  there  might  be  no  dispute  concerning  its 
legitimacy,  yet  it  would  be  difficult  to  settle  its  paternity.  Such  a  case 
appears  hypothetical.  [Lord  Hale,  however,  mentions  the  two  fol- 
lowing cases :  "  18  R.  2.  where  a  woman  in  such  a  case,  immediately 
after  the  death  of  the  first  husband,  took  a  second  husband,  and  had 
issue  born  forty  weeks  and  eleven  days  after  the  death  of  the  first 
husband,  it  was  held  to  be  the  issue  of  the  second  husband.  M.  4 
Car.  in  Cur.  Ward,  and  afterwards,  P.  5  Car.  B.  R.  Thecar  marries  a 
lewd  woman,  but  she  doth  not  cohabit  with  him  and  is  suspected  of 
incontinency  with  Duncomb  :  Thecar  dies:  Duncomb  within  three 
weeks  after  the  death  of  Thecar  marries  her ;  281  days  and  1(3  hours 
after  his  death  she  is  delivered  of  a  son.  Here  is  was  agreed,  1.  If 
she  had  not  married  Duncomb,  without  question  the  issue  should  not 
be  a  bastard,  but  should  be  adjudged  the  son  of  Thecar.  2.  No 
averment  shall  be  received  that  Thecar  did  not  cohabit  with  his 
wife.  3.  Though  it  is  possible  that  the  son  might  be  begotten  after 
the  husband's  death,  yet  being  a  question  of  fact,  it  was  to  be  tried 
by  a  jury,  and  the  son  was  found  to  be  the  issue  of  Thecar."  Hale 
MSS. — P.]  In  order  that  any  doubt  should  exist,  a  woman  must 
marry  within,  at  the  furthest,  six  weeks  after  the  death  of  her  first 
husband,  or  the  birth  of  the  child  would  fall  beyond  the  furthest 
limit  of  gestation,  so  far  as  he  was  concerned.  The  customs  of 
society  are,  however,  a  bar  to  such  marriages;  and  admitting  that 
a  child  was  so  born,  and  that  it  might  be  the  offspring  of  either  hus- 
band, then  the  fact  of  its  having  been  born  during  the  marriage  of 
the  second  husband  would  presumptively  fix  the  offspring  upon  him, 
unless  it  could  be  shown  that  there  was  no  possibility  of  access  on 
his  part.  If  there  was  a  supposed  greater  likeness  to  the  first  than 
the  second  husband,  still  this  would  not  be  allowed  to  defeat  the 
legal  presumption  of  the  real  parentage  of  the  child.  It  appears  to 
me  that  evidence  much  stronger  than  this  would  be  required  for 
such  a  purpose.  (See  Henke's  "Zeitschrift,"  1888,  vol.  2,  p.  432.) 
["If  a  man  hath  a  wife  and  dyeth,  and  within  a  very  short  time  after, 
the  wife  marrieth  againe,  and  within  nine  months  hath  a  childe,  so  as 
it  may  be  the  childe  of  the  one  or  the  other,  some  have  said,  that  in 
this  case  the  childe  may  choose  his  father,  quia  in  hoc  casu  filiatio 
non  potest  probari,  and  so  is  the  booke  to  be  intended;  for  avoiding  of 
which  question  and  other  inconveniences,  this  was  the  law  before  the 
conquest — l  Sit  omnis  vidua  sine  rnarito  duodecim  mensibus  et  si  mart- 
taverit  perdat  dotem.'  "  Co.  Litt.,  8,  a.  Blackstonc,  vol.  1,  p.  483,  says 
that  in  such  case  the  child  is  said  to  be  "more than  ordinarily  legiti- 
mate." This  doctrine  rests  upon  a,  dictum,  of  Bereford,  and  no  case 
of  paternity  seems  to  have  been  so  decided.  The  dictum  is  given  by 
Brooke  (Abr.  Bastardy,  pi.  L8),  who  says  of  it  that  it  is  not  law. 
The  better  opinion  is  that  the  question  of  paternity  would  depend 
upon  circumstances,  to  be  decided  by  a  jury.    Sec  supra,  Lonl  Hale's 


5Qti        SUPERFCETATION    IN    RELATION    TO    LEGITIMACY. 

note  to  Co.  Litt.,  fol.  8,  cited  in  Hargrave's  note,  190,  to  Co.  Litt., 
128,  b.— P.] 

Superfcetation  in  Relation  to  Legitimacy. — Most  medico-legal  wri- 
ters, in  treating  legitimacy,  have  considered  it  necessary  to  introduce 
the  .subject  of  superfcetation.  By  this  Ave  are  to  understand  that  a 
second  conception  may  at  any  time  follow  the  first,  and  that  gestation 
may  go  on  to  its  full  period  in  each  instance  independently  of  the 
other:  so  that  if  a  woman  were  impregnated  when  in  the  third  month 
of  gestation,  she  would  bear  the  first  child  mature  in  nine  months, 
and  the  second  child,  also  mature,  at  the  end  of  twelve  months  after 
the  first  conception.  This  subject  has  been  said  to  involve  "not  only 
the  conjugal  fidelity  of  a  wife,  but  the  disposition  of  property,  and 
much  of  the  comfort  and  happiness  of  society."  Its  importance  to  a 
medical  jurist  appears  to  me  to  have  been  here  considerably  exagge- 
rated. So  far  as  I  have  been  able  to  ascertain,  not  only  is  there  no  legal 
case  involving  this  question  to  be  met  with  in  the  judicial  records 
of  this  country,  but  none  in  reference  to  this  state  is  ever  likely  to 
occur  which  would  create  the  least  practical  difficulty.  If  we  admit 
that  a  woman  may,  during  marriage,  present  such  a  deviation  from 
the  common  course  of  nature,  as  to  produce  two  perfectly  mature  and 
fully-developed  children,  the  one  three  or  four  months  after  the 
other,  how  can  such  an  event  be  any  imputation  on  her  fidelity? 
Superfcetation,  if  it  occur  at  all,  may  occur  as  readily  in  married 
life,  during  connubial  intercourse,  as  among  unmarried  women. 
The  following  appears  to  be  the  only  possible  case  wherein  a  medical 
opinion  might  be  required  respecting  this  alleged  phenomenon.  A 
married  woman,  six  months  after  the  absence  or  death  of  her  first 
husband,  gives  birth  to  an  apparently  mature  child,  that  dies:  three 
months  afterwards,  and  nine  months  after  the  absence  or  death  of 
her  husband,  she  may  allege  that  she  has  given  birth  to  another 
child,  also  mature.  A  medical  question  may  arise,  whether  two  ma- 
ture children  could  be  so  born,  that  the  birth  of  one  should  follow 
three  months  after  the  birth  of  the  other;  or  whether  this  might  not 
be  a  case,  by  no  means  uncommon,  of  twin-children — the  one  being- 
born  prematurely,  and  the  other  at  the  full  period.  (For  a  case  of 
this  kind,  at  two  months'  interval,  see  "Med.  Gaz.,"  vol.  87,  p.  '27: 
and  for  another,  at  eight  days'  interval,  see  the  same  journal,  vol.  47, 
p.  227;  for  a  third,  at  thirty-two  days'  interval,  "Am.  Jour.  Med. 
Sci.,"  April,  18-15,  p.  503.)  In  one  case  the  abortion  of  one  fcetus 
occurred  at  the  third  month,  while  the  other  attained  the  full  period. 
("Assoc.  Medical  Journal,"  November  11,  1853,  p.  997.) 

Admitting  that  each  child  when  born  was  mature  and  fully  de- 
veloped, and  therefore  that  the  second  child  presented  a  case  of 
superfcetation,  the  first  delivery  must  have  taken  place  in  the  pre- 
sence of  witnesses,  and  it  would  then  have  been  known  whether 
another  child  remained  in  the  uterus  or  not.  If  the  two  children 
were  born  within  the  usual  period  of  gestation  after  the  absence  or 
death  of  the  husband,  then  their  legitimacy  would  be  presumed,  until 
the  fact  of  non-access  had  been  clearly  established.  The  mere  circum- 
stance of  their  being  apparently  mature,  and  born  at  different  periods, 
would  per  se  furnish  no  evidence  of  their  illegitimacy.     On  the  other 


SUPPOSITITIOUS    CHILDREN'.  507 

hand,  if  one  or  both  of  them  were  born  out  of  the  ordinary  period, 
then,  according  to  the  evidence  given,  they  might  or  might  not  be 
pronounced  illegitimate.  The  law  therefore  appears  to  have  no  sort 
of  cognizance  of  the  subject  of  superfcetation,  as  such  ;  it  is  gene- 
rally merged  in  the  question  of  protracted  gestation,  which  has 
already  been  fully  considered  (p.  554). 

Dr.  Bonnar  has  lately  examined  the  subject  of  superfcetation  in 
another  aspect,  and  some  of  the  facts  which  he  has  brought  for- 
ward are  not  consistent  with  the  theory  of  the  birth  of  twins  at 
different  intervals  ("A  Critical  Inquiry  regarding  Superfcetation, 
with  Cases,"  1805).  The  first  question  to  which  his  researches  were 
directed  was — at  what  period  after  parturition  are  the  female  pro- 
creative  organs  capable  of  again  exercising  their  functions?  It 
has  been  supposed  that  a  period  of  thirty  days  must  elapse  in  order 
to  enable  the  organs  to  reacquire  procreative  power ;  but  according 
to  Dr.  Bonnar,  the  earliest  period  may  be  taken  at  the  fourteenth 
day  after  delivery.  Impregnation  is  not  likely  to  take  place  until 
the  organs  have  resumed  their  natural  condition,  and  this  will  de- 
pend on  the  disappearance  of  the  signs  of  recent  delivery — such  as 
the  tender  and  swollen  state  of  the  vagina,  the  enlargement  of  the 
uterus  with  its  relaxed  mouth,  and  lochial  discharge.  The  persistence 
of  the  lochial  discharge,  the  average  duration  of  which  after  de- 
livery Dr.  Bonnar  considers  to  be  from  one  to  three  or  four  weeks, 
is  of  the  greatest  importance,  as  it  is  most  likely  to  interfere  with 
impregnation.  The  time  for  the  restoration-  of  the  sexual  organs  to 
their  natural  state  varies  in  different  women,  so  that  the  date  for 
re-impregnation  must  be  more  or  less  conjectural. 

It  has  been  usually  considered  that  after  the  second  or  third 
month  of  pregnancy  the  cavity  of  the  uterus  is  so  sealed  up  in  the 
development  of  the  embryo  as  a  result  of  impregnation,  that  it  is  im- 
possible that  any  fruitful  intercourse  can  take  place.  In  two  instances, 
however,  according  to  Dr.  Bonnar,  viable  children  were  born  of  the 
same  woman  at  five  and  a  half  and  four  months  respectively  after  the 
first  delivery.  On  the  theory  of  superconception  the  uterine  organs 
must  have  been  susceptible  of  a  second  impregnation  up  to  the  fourth 
month  of  gestation.  But  if  the  children  were  not  born  mature,  the 
power  of  re-impregnation  must  have  existed  for  one  or  two  months 
longer  than  the  period  usually  assigned — i.e.  up  to  the  fifth  or  sixth 
month  of  a  pregnancy  already  existing.  These  researches  may 
help  to  explain  some  legal  difficulties  which  have  occurred  in  refer- 
ence to  gestation.  They  furnish  a  curious  comment  upon  the  sug- 
gestion made  by  some  medical  jurists,  that  superfcetation  involves 
the  conjugal  fidelity  of  a  wife,  for  no  suspicion  of  illegitimacy 
could  be  for  a  moment  entertained  simply  on  account  of  the  short- 
ness of  the  interval  between  the  two  deliveries  of  the  same  mar- 
ried woman. 

Supposititious  Children. — Another  medico-legal  case,  in  relation  to 
legitimacy,  occurs  when  a  woman  feigns  delivery,  and  represents 
the  child  of  another  person  to  be  her  offspring.  She  may  substii  uf  <■ 
the  living  child  of  another  woman  for  a  dead  child  of  which  she 
herself  has  been  delivered,  or  for  a  mole  which  may  have  passed 


568  SUBSTITUTION    OF    CHILDREN. 

from  her.  So,  again,  a  male  may  be  substituted  for  a  female  child, 
and  vice  versa.  The  practising  of  a  fraud  of  this  nature  may  se- 
riously affect  the  rights  of  inheritance  of  parties;  but  it  cannot  be 
accomplished  without  great  dexterity  and  cunning,  or  without  the 
co-operation  of  several  accomplices.  Frauds  of  this  kind  have,  in 
general,  been  committed  by  the  aid  of  a  low  class  of  midwives. 
One  instance  occurred  at  Chelsea,  in  July,  1842,  where  the  fraud 
was  brought  to  light  by  the  death  of  the  supposititious  child.  The 
calling-in  of  a  professional  man  would  infallibly  lead  to  discovery, 
when  the  question  was  simply  whether  delivery  had  or  had  not  taken 
place;  but  if  it  be  alleged  that  one  living  child  has  been  substituted 
for  another,  the  proof  of  this  can  depend  on  medical  evidence  only 
when  the  age  of  the  supposititious  child  does  not  happen  to  corre- 
spond to  the  date  of  the  pretended  delivery.  (See  "Ann.  d'Hyg.," 
1829,  vol.  2,  p.  227.)  The  legitimacy  of  the  claimant  of  the  Douglas 
Peerage  was  disputed  on  this  ground,  but  apparently  without  foun- 
dation. A  remarkable  case  of  this  description  will  be  found  in 
Henke's  "Zeitschrift  der  S.  A."  (1845,  vol.  2,  p.  172) ;  and  a  trial  took 
place  some  years  since  in  England,  involving  the  alleged  substitu- 
tion of  a  child,  but  requiring  no  medical  evidence  for  its  elucida- 
tion. (Day  v.  Day,  Leicester  Lent  Ass.  1845.)  In  another  case  it 
was  proved  that  a  woman  had  substituted  a  doll  for  the  dead  body 
of  a  child  of  which  she  pretended  she  had  been  delivered.  In  a 
case  mentioned  by  Dr.  Cheevers,  one  Mussamat  Janoo,  a  midwife  of 
Hisar,  being  employed  to  attend  a  woman  in  her  confinement,  per- 
suaded her  that  the  child  of  which  she  had  been  delivered  was  a 
monster  with  two  heads,  not  fit  to  be  looked  at :  she  aftewards  said 
that  it  was  dead,  and  she  would  take  it  away  and  bury  it.  She 
accordingly  went  away.  Next  morning,  the  midwife's  services 
being  required,  she  was  sent  for.  She  excused  herself  from  going 
under  the  pretence  that  she  (the  midwife)  had  just  been  delivered 
of  a  child.  This  improbable  story  excited  suspicion,  and  the  police 
were  called  in  :  she  declared  that  the  child  was  her  own.  This  she 
also  maintained  at  the  trial.  It  appeared,  however,  from  the  evi- 
dence of  midwives  who  examined  her  shortly  after  the  discovery 
of  the  child  in  her  house,  and  also  by  the  deposition  of  the  civil 
surgeon,  that  she  exhibited  no  signs  of  recent  confinement.  Several 
of  the  neighbors,  who  were  constantly  in  the  habit  of  seeing  her, 
deposed  that  she  had  not  exhibited  any  outward  signs  of  pregnancy. 
She  did  not  attempt  to  prove  how  she  had  disposed  of  the  body  of 
the  child  which  she  alleged  had  died  immediately  after  its  birth. 
She  was  convicted,  and  sentenced  to  imprisonment  for  seven  years. 
("  Med.  Jur.  for  India,"  p.  512,  from  the  "Nizamut  Adawlut  Ke- 
ports,"  26th  April,  1853.) 

Cases  involving  a  question  of  substitution  are  not  very  common. 
One  of  these  (Hutchins  v.  Hutchins)  was  heard  in  the  Vice  Chancel- 
lor's Court  in  May,  1851;  and  in  this  the  amount  of  ingenuity  re- 
quired to  perpetrate  the  fraud  was  only  equalled  by  the  skill  with 
which  the  facts  were  exposed,  and  justice  ultimately  done  to  the 
rightful  claimant.  In  another  (Gedney  v.  Smith,  Rolls  Court,  Nov. 
lo64)  the  fraud  was  nearly  successful,  and,  but  for  the  dying  declara- 


SEXUAL    MALFORMATIONS.  569 

tion  of  the  woman  herself,  would  probably  have  escaped  detection 
and  exposure.  The  cases  that  have  hitherto  been  tried,  illustrate 
the  importance  of  accurate  observation  on  the  part  of  medical  men 
in  their  practice  as  accoucheurs.  Notes  of  all  cases  should  be  made 
and  preserved,  including  dates  of  attendance,  &c,  daily  symptoms, 
and  treatment.  This  should  be  an  invariable  rule  when  a  medical 
man  is  suddenly  called  upon  to  attend  in  her  confinement  a  woman 
who  may  not  have  previously  consulted  him.  If  he  has  had  no 
previous  knowledge  of  the  pregnancy  of  a  woman,  and  if  when  he 
arrives,  the  child  is  said  to  have  been  born  and  is  in  the  hands  of  a 
nurse,  he  should  most  distinctly  satisfy  himself,  by  a  personal  ex- 
amination, that  the  woman  has  been  actually  delivered.  He  should 
also  observe  whether  the  child  presents  the  appearance  of  a  new-born 
child  in  reference  to  the  state  of  its  skin,  the  appearance  of  the  cut 
navel-string,  and  other  circumstances.  It  is  an  awkward  thing  for  a 
medical  man  to  hear  at  a  trial  many  years  afterwards,  that  his  patient 
was  not  delivered  of  a  child,  that  a  post-mortem  examination  of  her 
body  had  shown  that  she  had  never  borne  a  child,  and  that  the  sup- 
posed new-born  babe  was,  at  the  date  of  his  first  visit,  several  days 
old — in  short,  to  find  that  he  himself  has  been  cleverly  made  to  give 
support  to  a  fraud. 

Sexual  Malformation} — The  legitimacy  of  a  child  is  open  to  be 
contested  under  other  circumstances  than  those  connected  with  the 
duration  of  gestation.  The  alleged  parent  may  have  labored  under 
physical  incapacity:  if  a  male,  he  may  have  been  affected  with  impo- 
tency ;  if  a  female,  she  may  have  labored  under  sterility  ;  and  if 
either  of  these  conditions  be  proved,  the  illegitimacy  of  a  child  will 
be  established  although  the  alleged  period  of  gestation  may  be  com- 
prised within  the  ordinary  limits.  The  sexual  conditions  now  about 
to  be  considered  have  also  important  bearings  in  relation  to  divorce, 
and  occasionally  to  the  civil  rights  of  a  child  that  may  be  the  subject 
of  the  malformation.  One  of  the  most  common  and  obvious  causes 
of  impotency  or  sterility  is  malformation  of  the  sexual  organs,  to 
which  species  of  monstrosity  the  term  hermaphroditism  is  commonly 
applied. 

Owing  to  arrested  development,  during  the  growth  of  the  foetus, 
the  sexual  organs,  which  can  scarcely  be  distinguished  at  the  fourth 
month,  occasionally  assume  an  abnormal  arrangement.  These  organs 
appear  to  be  at  that  time  more  or  less  mixed;  and  sometimes  the 
male,  and  at  others  the  female  characters  predominate.  With  this 
defective  sexual  development,  the  other  peculiarities  of  the  sexes  are 
either  wanting,  or  we  find  them  more  or  less  blended.  When,  there- 
fore, the  being  has  the  characters  of  a  male  with  malformation  of  the 
generative  organs  it  is  called  androgynus — when  the  characters  are 
those  of  a  female  with  a  like  malformation,  androgyna.  There  can 
be  no  difficulty  in  identifying  such  cases,  and,  according  to  the 
degree  of  malformation,  a  medical  jurist  can  have  no  hesitation  in 
pronouncing  these  persons  to  be  incurably  impotent.     The  organs 

1  [The  remainder  of  this  chapter  is  extracted  from  the  last  edition  of  this  work.] 


570  DISTINCTION"    OF    SEX. 

are  commonly  so  defective  as  to  be  wholly  unfitted  for  the  functions 
of  either  sex.  It  is  not  intended  to  be  said  that  it  is  in  all  cases  easy 
to  assign  the  sex,  but  this  is  of  minor  importance  ;  the  main  question 
is,  whether  the  malformation  is  or  is  not  such  as  to  justify  divorce 
or  the  imputation  of  illegitimacy  upon  children  claiming  to  be  the 
offspring  of  these  beings. 

Distinction  of  Sex. — The  determination  of  sex  in  these  cases  of  de- 
formity has  been  considered  to  be  necessary  under  certain  circum- 
stances; as  when,  for  instance,  a  title  or  entailed  inheritance  of  land- 
is  in  question.  Lord  Coke  has  stated  that,  according  to  the  laAV  of 
England,  an  hermaphrodite  may  be  either  male  or  female,  and  it  shall 
succeed  according  to  the  kind  of  sex  which  doth  prevail.  Thus  it  is 
obvious,  that  the  law  will  decide  each  case  according  to  the  special 
circumstances  attending  it:  but  it  must  not  be  supposed  that  the 
decision  is  so  easy  as  Lord  Coke's  doctrine  would  imply.  There  are 
many  cases  in  which  neither  sex  can  be  said  to  prevail.  The  beings 
are  positively  neuter.  The  chief  character  of  the  male  would  consist 
in  the  presence  of  testicles,  and  of  the  female  in  the  presence  of  a 
uterus  and  ovaries.  But  in  a  case  which  occurred  to  Mr.  Grigor,  both 
the  testicles  and  the  ovaries  were  wanting;  there  were  no  essential 
characters  of  either  sex,  and  during  life  it  would  have  been  impos- 
sible to  say  whether  this  being  was  male  or  female.  ("  Cormack's 
Monthly  Journal,"  July,  1845,  p.  492.)  In  the  same  journal  (p.  531) 
is  reported  another  case,  in  which,  notwithstanding  the  external  re- 
semblance to  a  female,  the  presence  of  one  testicle  in  a  scrotum  showed 
that  this  individual  was  of  the  male  sex.  Yet  this  person  passed  for 
a  woman  until  he  had  reached  his  26th  year  !  It  is  rare  that  there 
is  external  malformation  without  internal  defect,  and  even  when  the 
female  character  preponderates  in  the  person,  it  is  not  improbable 
that  the  uterus  or  the  ovaries  may  be  absent,  or  the  former  may  be 
malformed.  Such  beings  are  not  known  to  menstruate,  and  even  if 
there  be  capacity  for  intercourse,  they  are  permanently  sterile. 
Sexual  desires  are,  however,  commonly  absent. 

When  the  person  is  young,  mistakes  respecting  the  sex  are  more 
common  than  at  an  advanced  period  of  life.  So  soon  as  the  age  of 
puberty  is  passed,  certain  changes  take  place  in  the  configuration  of 
the  body,  which  may  aid  a  medical  practitioner  in  forming  an  opinion. 
Thus,  a  grave  tone  of  voice,  the  presence  of  a  beard,  the  width  of 
the  shoulders,  and  narrowness  of  the  pelvis  will  indicate,  cseteris 
paribus,  the  male  sex :  while  when  these  conditions  are  absent,  and 
there  is  a  rotundity  of  the  members,  with  want  of  prominence  in  the 
muscles,  and  a  development  of  the  mammae,  Ave  may  pronounce  upon 
the  female  sex  predominating.  Although  no  testicles  are  apparent, 
still  the  being  may  be  of  the  male  sex,  since  it  is  well  known  that  in 
persons  otherwise  well  formed  these  organs  occasionally  do  not  de- 
scend to  occupy  the  scrotum.  Dr.  Harris,  of  Clarkesville,  has  related 
a  singular  case,  in  which,  although  no  testicles  could  be  found,  there 
was  a  short  but  naturally-formed  penis,  through  which  the  being 
regularly  menstruated!  The  female  character  predominated  in  the 
corporeal  development,  and  there  was  the  rudiment  of  a  vagina  ("  Med. 
Gaz.,"  vol.  xl.  p.  562.)      The  fact  that  the  being  menstruated  was 


MIXED    CASES    OF    HERMAPHRODITISM.  571 

here  sufficient  to  assign  it  to  the  female  sex.  How  easily  mistakes 
may  be  made  in  the  sex  of  young  children  is  shown  by  a  case  which 
occurred  to  Mr.  Terry,  and  is  quoted  in  "Cormack's  Journal"  (April, 
1845,  p.  307).  The  child  was  christened  as  a  female,  and  was  so  con- 
sidered by  the  parents  for  two  months,  when,  owing  to  some  defect 
in  the  passage  of  the  urine,  it  was  brought  to  Mr.  Terry,  and  he 
found  there  was  a  malformation  of  the  penis — no  vagina,  a  scrotum 
with  one  testicle  down  and  the  other  descending.  He  therefore  pro- 
nounced it  to  be  a  male,  and  its  costume  was  altered  accordingly. 
The  presence  of  a  beard  and  whiskers  is  usually  considered  to  cha- 
racterize a  male,  but  the  growth  of  hair  on  the  chin  and  face  is  some- 
times more  profuse  in  females  than  in  the  generality  of  males.  Dr. 
Chowne  examined  a  female  named  Joseph  Boisdechine  on  behalf  of 
a  man  who  was  about  to  marry  her,  but  who  required  a  certificate  as 
to  the  real  sex  of  his  intended  wife!  Dr.  Chowne  found  nothing  in 
her  external  conformation  indicative  of  doubtful  sex.  The  breasts 
were  large  and  full,  and  the  only  resemblance  to  a  male  was  in  the 
abundance  of  beard  and  profuse  whiskers.  The  upper  lip  was  free 
from  hair.  (See  "  Lancet,"  Oct.  11, 1851,  p.  335 ;  January  15,  1853,  p. 
66 ;  "  Med.  Times  and  Gaz.,"  January  15, 1853,  p.  71.  Dr.  Chowne  has 
published  a  full  account  of  this  case  in  the  "  Lancet"  for  May  1,  1852, 
p.  -121.)  He  has  appended  an  engraving  which  displays  the  female 
beard  and  whiskers.  It  is  stated  that  this  female  was  born  with  a 
quantity  of  hair  on  her  chin,  and  that  at  eight  years  of  age  the  beard 
was  two  inches  long! 

In  some  cases  an  external  examination  will  entirely  fail  in  indi- 
cating the  sex,  and  even  the  opportunity  of  an  examination  of  the 
dead  body  may  leave  the  case  in  doubt.  An  ingenious  writer  has 
laid  it  down  that  there  are  analogous  organs  in  the  two  sexes  which 
are  never  found  in  the  same  subject,  and  the  separate  existence  of 
which  would  enable  us  to  determine  the  sex.  These  analogous  parts 
are  the  penis  and  the  clitoris — the  scrotum  and  the  labia — the  testi- 
cles and  the  ovaries — the  prostate  gland  and  the  uterus.  This,  how- 
ever, is  an  artificial  and,  as  facts  show,  an  incorreet  means  of  dis- 
tinction. (See  report  of  a  case,  in  which  a  body  resembling  the 
prostate  gland  and  a  uterus  existed  in  the  same  being,  "Med.  Times 
and  Gaz.,"  Feb.  18,  1860,  p.  177.)  If  a  penis  could  always  be  clearly 
distinguished  from  a  clitoris,  and  a  scrotum  from  the  labia,  the  rule 
might  be  serviceable :  but  it  fails  where  it  is  most  required,  i.  e.  in 
the  mixed  conditions.  As  to  the  other  means  of  distinction,  even  it* 
correct,  they  will  only  enable  an  examiner  to  form  an  opinion  of  sex 
in  the  dead,  whereas  it  is  during  the  life  of  one  of  these  beings  that 
the  law  requires  the  aid  of  medical  science  in  the  solution  of  these 
questions.  The  reader  will  find,  in  the  "  Med.  Times  and  Gaz.,"  an 
account  of  some  remarkable  cases  of  sexual  malformation  bv  Mr. 
Curling  (Jan.  24,  1852,  p.  84);  by  Mr.  Fletcher  (Feb.  7,  1852,  p. 
136);  by  Mr.  Broadhurst  (Feb.  21,  1852,  p.  187);  and  by  Mr.  Waters 
(May  21,  1853,  p.  538).  Other  cases,  reported  by  Mr.  Mann  and  Mr. 
Churchill,  will  be  found  in  the  "Association  Journal,"  18.").';  (Aug. 
19,  p.  720,  and  Sept.  9,  p.  799). 

Mixed  Cases. — A  case  has  been  already  mentioned  in  which  neither 


572  HERMAPHRODITISM.      CAUSES. 

testicles  nor  ovaries  were  found  after  death,  and  more  than  one  in- 
stance has  occurred  in  which  both  have  been  found — a  case  of  inter- 
mixture of  the  sexes  or  real  hermaphroditism,  physically  speaking, 
but  of  course  without  the  functional  power  of  self-impregnation. 
The  following  case  is  mentioned  by  Briand :  The  subject  was  about 
eighteen  years  of  age  when  he  died.  The  body  was  partly  that  of 
a  male  in  configuration,  and  partly  that  of  a  female.  An  examina- 
tion of  the  sexual  organs,  externally,  led  to  no  satisfactory  distinc- 
tion; and  on  inspection  after  death  a  testicle  was  found  in  what  was 
supposed  to  be  the  left  labium,  with  an  epididymis  and  a  spermatic 
cord  attached  to  it  as  usual ;  while  on  the  other  side  were  an  ovary, 
Fallopian  tube,  and  the  rudiments  of  a  uterus.  The  authenticity  of 
this  case  was  for  some  time  a  matter  of  dispute ;  but  another,  equally 
singular  in  its  features,  occurred  to  Prof.  Mayer,  of  Bonn.  This 
case  clearly  shows  that  such  extraordinary  deviations  may  be  met 
with  in  nature.  The  person  examined  by  Mayer  died  in  1835,  at 
the  age  of  55.  Different  opinions  had  been  formed  during  the  life- 
time of  the  being  respecting  the  sex,  by  the  first  anatomists  in 
Europe :  some  affirming  that  it  was  a  male,  while  others  contended 
that  it  was  a  female.  This  difference  of  opinion  is  sufficient  to  prove 
that  an  external  examination  does  not  always  enable  even  a  good 
anatomist  to  pronounce  an  opinion  on  the  probable  sex  of  the  being. 
In  the  dead  body  was  found,  on  the  right  side,  a  withered  testicle, 
with  a  penis  and  prostate  gland,  as  male  peculiarities ;  while  on  the 
left  side  was  an  ovary,  with  a  uterus,  vagina,  and  .Fallopian  tube. 
("Med.  Gaz.,"  vol.  xix.  p.  135.)  It  should  be  stated  that  the  gen- 
eral configuration  of  the  body  in  this  case  was  that  of  a  female :  but 
there  was  a  duality  of  sex.  The  right  half  of  the  body  was  male, 
and  the  left  half  female. 

Causes. — The  causes  of  malformation  of  the  sexual  organs,  as  of 
all  other  kinds  of  monstrosity,  are  involved  in  mystery.  We  know 
that  in  the  early  part  of  utero-gestation,  the  sex  of  a  foetus  cannot 
be  distinguished;  while,  even  when  it  has  reached  the  fourth  month, 
the  genital  organs  are  so  similar  that  the  sex  can  seldom  be  deter- 
mined on  inspection.  Some  organs  or  parts  appear  to  be  formed  by 
equal  and  symmetrical  portions,  which  gradually  approximate  and 
unite  in  the  median  line  of  the  body.  We  observe  this  mode  of 
union  in  the  bones  of  the  head,  chest,  and  spine,  as  also  in  the  vari- 
ous fissures  (raphes)  of  the  skin,  which  are  the  remains  of  a  union 
between  two  equal  and  symmetrical  parts  of  an  organ,  now  become 
one.  In  regard  to  defects  in  organization,  it  may  be  remarked  that 
they  almost  invariably  occur  in  or  about  some  part  of  the  median 
line ;  and  they  appear  to  proceed  from  a  mere  arrest  of  growth  or 
development  of  those  particular  parts,  either  on  one  side  or  both, 
during  the  early  stage  of  uterine  existence.  In  this  respect,  the 
fissures  sometimes  observed  in  the  palatine  bones,  in  the  palate  itself, 
or  in  the  lip — the  openings  occasionally  noticed  in  the  chest,  dia- 
phragm, anterior  parietes  of  the  bladder,  as  well  as  in  the  spinal 
canal,  are  precisely  analogous  in  origin  to  the  defective  development 
of  the  sexual  organs.  There  is  nothing  absolutely  removed  or  lost, 
but  there  is  an  arrest  of  development ;  an  opening,  or  fissure,  which 


LEGAL     RELATIONS    OF    HERMAPHRODITES.  573 

nature  intended  to  be  only  temporary,  becomes  permanent  by  reason 
of  an  arrest  of  growth.  In  the  evolution  of  the  male  genital  organs, 
the  part  corresponding  to  the  scrotum  is  at  first  always  divided  by  a 
considerable  fissure  :  and  the  penis  and  clitoris  having,  at  this  period 
of  life,  much  the  same  kind  of  physical  exterior,  the  sexual  organs 
cannot  be  well  defined.  Should  this  fissure  in  the  male  not  be  after- 
wards filled  up,  then  we  shall  have  the  most  common  variety  of 
sexual  malformation — the  hermaphroditic  form,  with  the  male  pre- 
dominating. These  observations  are  not,  of  course,  applicable  to 
those  cases  in  which  the  sexes  are  positively  mixed.  In  these 
instances  there  appears  to  be  a  separate  sexual  organization  on  the 
two  sides  of  the  body,  with  an  imperfect  development  of  each  set  of 
sexual  organs.  According  to  Weber,  there  is  in  the  prostate  gland 
a  rudimentary  uterus  in  every  male.  ("  Baly  and  Kirke's  Eecent 
Advances  in  Physiology,"  1848,  p.  112.  Also  papers  by  Dr.  Knox, 
'•  Med.  Gaz.,"  Nov.  ancfDec.  1813.) 

One  circumstance  is  worthy  of  note,  namely,  that  sexual  mon- 
strosity appears  occasionally  to  occur  in  the  successive  pregnancies 
of  a  well-formed  female.  The  late  Dr.  Lever  met  with  a  singular 
instance  of  this  in  a  female  aged  28.  She  had  given  birth  to  four 
children  in  three  confinements,  the  first  being  a  twin  labor ;  both 
the  children  males  :  and  in  both  there  was  an  arrest  of  development 
of  the  sexual  organs.  On  the  third  delivery  the  child  was  a  male, 
and  its  sexual  organs  presented  the  same  deformity  as  those  of  the 
twins.     ["  Med:  Gaz.,"  vol.  xxxviii.  p.  916.) 

Lerjal  Relations. — These  beings,  owing  to  defective  development, 
are  impotent  and  sterile.  Questions  connected  with  the  legitimacy 
of  offspring,  divorce  and  affiliation  may,  therefore,  be  raised  with 
respect  to  them.  Sexual  monstrosity  is  not  a  ground  for  depriving  a 
being  of  the  rights  of  inheritance  except  under  peculiar  legal  con- 
ditions. Thus  a  right  of  succession  or  inheritance  to  landed  estate 
may  depend  upon  the  sex  of  the'  offspring — as  where,  for  instance, 
two  children  are  born,  the  first  hermaphrodite,  the  second  a  well- 
formed  male  child.  The  parents  die,  and  a  title  of  nobility  or  lands 
may  fall  to  the  first-born  male.  Here  the  sex  of  the  first-born  must 
be  determined  before  possession  can  be  had.  In  a  case  of  this  kind, 
if  medical  evidence  should  establish  that  male  peculiarities  predom- 
inate in  the  first-born,  the  second  child  would  be  cut  off.  Again,  if 
an  estate  were  limited  by  entailment,  as  where  it  is  settled  upon 
heirs  male  and  female  of  a  particular  family,  the  birth  of  an  herma- 
phrodite, an  only  child,  would  create  the  legal  necessity  for  a  positive 
determination  of  the  predominance  of  sex.  So,  if  the  hermaphrodite 
live  but  a  few  minutes  after  birth,  and  then  die,  the  rights  of  per- 
sons may  be  subsequently  much  affected  by  the  medieal  attendant 
having  come  to  an  opinion  respecting  its  sex.  Since  we  cannot  de- 
termine under  what  circumstances  litigation  may  ensue,  it  is  always 
right  in  a  doubtful  case  to  observe  the  sex,  and  make  notes  on  the 
spot  when  a  child  thus  malformed  survives  its  birth  but  for  a  short 
period.  The  question  of  tenancy  by  courtesy,  or  the  right  of  the 
husband  to  landed  estate  of  which  the  wife  was  seized,  will  depend 


574  ELECTORAL    RIGHTS    OF    HERMAPHRODITES. 

entirely  upon  the  attention  of  the  accoucheur  to  this  point.  (See 
"Tenancy  by  Courtesy."  ante,  page  535.) 

When  these  beings  have  reached  adult  age,  other  questions  may 
arise  with  respect  to  them.  According  to  an  old  law  of  France,  an 
hermaphrodite  was  permitted  to  choose  one  sex,  and  thereafter  com- 
pelled to  keep  it !  Hermaphrodites,  or  sexual  monsters,  were  for- 
merly ranked  with  infamous  persons ;  and  it  has  been  a  grave  ques- 
tion in  our  courts,  whether  the  calling  a  man  an  hermaphrodite  was 
not  such  a  libel  or  slander  upon  him  as  to  render  it  a  ground  for  a 
civil  action.  In  a  case  reported  by  Chitty  ("Med.  Jour.,"  374),  the 
use  of  this  term  was  held  not  to  be  actionable  unless  it  was  proved 
that  it  had  been  attended  with  special  damage.  A  dancing-master 
brought  an  action  against  a  party  for  calling  him  an  hermaphrodite, 
and  it  was  decided  that  it  was  not  sustainable:  1.  Because  such  a 
union  of  the  sexes  cannot  exist  in  fact,  and  every  one  must  be  sup- 
posed to  know  it ;  consequently  the  assertion  could  not  be  supposed 
to  prejudice.  2.  Because,  admitting  the  possibility  of  such  a  double 
function,  the  party  would  be  just  as  good,  and  perhaps  even  a  safer 
dancing-master,  than  if  only  one  perfect  sex  had  been  discoverable ; 
eonsequently  the  words  would  not,  in  legal  presumption,  injure  him 
in  his  profession  or  occupation ! 

I  am  indebted  to  a  learned  member  of  the  bar  for  a  note  on  the 
remarkable  case  of  the  Cht  valier  <V Eon.  There  was  a  great  dispute 
concerning  the  sex  of  the  Chevalier,  and  it  came  before  a  court  of 
law  on  an  action  to  recover  a  wager  under  the  following  circum- 
stances (JJ"  Costa  v.  Jones,  "  Cowper's  Reports,"  vol.  ii.  p.  729).  The 
plaintiff  claimed  of  the  defendant  a  sum  of  three  hundred  pounds. 
On  the  4th  of  October,  1771,  plaintiff  paid  to  the  defendant  seventy- 
five  guineas,  on  the  condition  that  he,  the  plaintiff,  should  receive 
from  the  defendant  a  sum  of  three  hundred  pounds  in  case  the  Cheva- 
lier d'Eon  should  at  any  time  prove  to  be  a  female.  The  cause  was 
tried  before  Lord  Mansfield,  at  G-uildhall,  aud  the  jury  found  a  ver- 
dict for  the  plaintiff,  damages  three  hundred  pounds,  thereby  affirm- 
ing that  the  Chevalier  was  a, female.  A  motion  was  subsequently 
made  on  behalf  of  the  defendant  to  arrest  the  judgment,  or  at  least 
to  stay  the  proceedings,  on  the  ground  that  the  action  could  not  be 
supported,  as  being  upon  a  wager  tending  to  introduce  indecent  evi- 
dence, and  also  as  being  one  which  materially  affected  the  interests  of 
a  third  person.  The  question  thus  raised  on  the  motion  was  argued 
before  the  court  of  King's  Bench,  and  the  judges  unanimously  agreed 
that  the  judgment  must  be  arrested ;  the  law  not  allowing  wagers 
upon  subjects  leading  to  the  introduction  of  indecent  evidence  (this 
being  contra  bonos  mores),  nor  upon  such  subjects  as  are  calculated  to 
have  an  injurious  effect  upon  the  interests  or  character  of  a  third 
person.  Irrespective  of  this  decision,  the  verdict  was  based  upon 
what  subsequent ly  turned  out  to  be  untrue.  The  Chevalier  was 
really  a  male,  and  not  a  female.  He  was  carefully  examined  by  Sir 
Anthony  Carlisle,  who  satisfied  all  present  of  the  perfect  condition 
of  the  testicles.     (See  Paris  and  Fonblanque,  vol.  i.  p.  229.)1 

1  [The  Chevalier  D'Kox  had  served  as  a  military  officer,  had  acted  as  a  diplomatist, 
and  had  fought  duels,  but  his  appearance  was  very  effeminate  :  and  alter  he  had  re- 


ELECTOEAL    RIGHTS    OF    HERMAPHRODITES.  575 

It  would  appear,  from  a  singular  case  reported  by  Dr.  Barry,  that, 
in  the  United  States,  the  rights  of  citizenship  and  the  privilege  of 
voting  for  members  of  Congress  have  depended  on  the  determina- 
tion of  sex.  In  March,  1843,  he  was  requested  to  examine  the  case 
of  Levi  Suydam,  aged  23  years,  a  native  of  Salisbury,  Conn.  At 
the  exciting  and  warmly-contested  election  of  the  spring  of  that 
year,  almost  everything  bearing  the  semblance  of  the  human  form, 
of  the  male  sex,  is  stated  to  have  been  brought  to  the  ballot-box. 
It  was  at  this  time,  and  under  these  circumstances,  that  the  above- 
mentioned  person  was  presented  by  the  whigs  to  be  made  a  freeman. 
He  was  challenged  by  the  opposite  party  on  the  ground  that  he  was 
more  a  female  than  a  male,  and  that,  in  his  physical  organization,  he 
partook  of  both  sexes.  The  following  was  the  result  of  the  first 
examination  by  Dr.  Barry.  There  was  a  mons  veneris  covered  with 
hair  in  the  usual  way ;  an  imperforate  penis,  subject  to  erections, 
and  about  two  inches  and  a  half  in  length,  with  corresponding  di- 
mensions; the  dorsum  of  the  penis  was  connected  by  the  cuticle  and 
cellular  membrane  to  the  pubis,  leaving  about  an  inch  and  a  half 
free,  or  not  bound  up,  and  towards  the  pubic  region.  This  penis 
had  a  well-formed  glans;  a  depression  in  the  usual  place  of  the  mea- 
tus urinarius,  with  a  well-defmed  prepuce  and  foramen.  The  scrotum 
was  not  fully  developed,  inasmuch  as  it  was  but  half  the  usual  size, 
and  not  pendulous.  In  the  scrotum,  and  on  the  right  side  of  the 
penis,  there  was  one  testicle  of  the  size  of  a  common  filbert,  with  a 
spermatic  cord  attached.  In  the  perineum,  at  the  root  of  the  corpora 
cavernosa,  an  opening  existed  through  which  micturition  was  per- 
formed; this  opening  was  large  enough  to  admit  the  introduction  of 
an  ordinary-sized  catheter.  Having  found  a  penis  and  one  testicle, 
though  imperfectly  developed,  Dr.  Barry,  without  further  examina- 
tion, gave  it  as  his  opinion,  that  the  person  in  question  was  a  male 
citizi  //,  and  consequently  entitled  to  vote  and  enjoy  all  the  privileges 
of  a  freeman/ 

On  the  morning  of  the  first  Monday  in  April  (election  day),  Dr. 
Barry  was  informed  that  Dr.  Ticknor  would  oppose  Suydam's  ad- 
mission on  medical  grounds.  Suydam  came  forward,  and  Dr.  Ticknor 
objected  to  him  as  a  female,  and  therefore  not  entitled  to  vote.  Dr. 
Barry  then  stated  to  the  meeting,  that,  from  an  examination  he  had 
made,  he  considered  the  person  in  question  to  be  a  male,  and  re- 
sided some  years  in  England,  frequenting  race-courses  and  gaming-houses  in  male 
attire,  Mr.  Dacosta  wagered  a  large  sum  with  Mr.  Jones  that  the  supposed  Chevalier 
was  a  woman,  and  brought  the  action  mentioned  in  the  text,  which  resulted  as  there 
Stated.  Lord  Campbell,  speaking  of  this  case,  says  :  "Although  the  verdict  was  set 
aside  on  legal  grounds,  it  was  allowed  to  settle  many  other  hets  which  had  been  laid 
on  the  same  question.  The  Annual  Register  for  17b"(j,  p.  167,  says,  '  By  this  decision 
no  less  a  sum  than  £75,000  will  remain  in  this  country,  which  would  otherwise  have 
been  transmitted  to  Paris.  The  Chevalier  lias  left  Rngland, declaring  that  she  has  no 
interest  whatever  in  the  policies  opened  on  her  sex.'  The  Chevalier,  then  assuming 
female  attire,  remained  in  France,  supported  by  a  pension  from  the  French  Govern- 
ment, tor  having  long  heeii  a  spy  of  Louis  XV.,  till  the  breaking  out  of  the  Revolution 
iu  1790.  He  then  came  to  England,  and,  being  in  great  distress,  lived  with  a  lady  of 
reputation  as  her  companion  ;  hut  dying  in  the  year  IblO,  was  found,  on  a  post-mortem 
examination,  to  he  indeed  of  the  sex  which  he  had  originally  claimed,  and  in  ail  re- 
spects perfectly  formed." — Lives  of  the  Chief  Justices,  vol.  -,  324  (Life  of  Lord 
Mansfield.)— P.] 


576  DESTRUCTION    OF    SEX    BY    OPERATION*. 

quested  that  Dr.  Ticknor  might,  with  the  consent  of  Suyclam,  retire 
into  an  adjoining  room,  and  examine  for  himself.  This  was  done, 
when  Dr.  Ticknor  ultimately  came  to  the  conclusion  that  Suydam 
was  a  male.  Suydam  accordingly  was  admitted  a  freeman;  and  his 
vote  was  received  and  registered. 

A  few  days  after  the  election,  Dr.  Barry  heard  that  Suydam  had 
regularly  menstruated.  The  sister  of  Suydam  informed  him  that 
she  had  washed  for  him  for  years,  and  that  he  menstruated  as  regu- 
larly, but  not  so  profusely,  as  most  women.  Suydam,  when  ques- 
tioned, very  unwillingly  confessed  that  such  was  the  fact.  He  was 
again  examined  by  two  physicians,  when  the  following  additional 
particulars  were  elicited  :  Said  Suydam  is  five  feet  two  inches  in 
height,  light-colored  hair,  fair  complexion,  with  a  beardless  chin, 
and  decidedly  a  sanguineous  temperament,  narrow  shoulders  and 
broad  hips;  in  short,  every  way  of  a  feminine  figure.  There  were 
well-developed  breasts  with  nipples  and  areolae.  On  passing  a  female 
catheter  into  the  opening  through  which  micturition  was  performed, 
and  through  which,  he  again  stated,  he  had  a  periodical  bloody  dis- 
charge monthly,  instead  of  traversing  a  canal  and  drawing  off  urine, 
the  catheter  appeared  to  enter  immediately  a  passage  similar  to  the 
vagina,  three  or  four  inches  in  depth,  and  in  which  there  was  a  con- 
siderable play  of  the  instrument.  He  stated  that  he  had  amorous 
desires,  and  that,  at  such  times,  his  inclination  was  for  the  male  sex  : 
his  feminine  propensities,  such  as  a  fondness  for  gay  colors,  for  pieces 
of  calico,  comparing  and  placing  them  together,  and  an  aversion  for 
bodily  labor,  and  an  inability  to  perform  the  same,  were  remarked 
by  many.  Dr.  Barry  further  learned  from  an  old  lady,  who  was 
present  at  the  birth  of  Suydam,  that  on  the  second  clay  after  his 
birth,  Dr.  Delamater,  who  attended  as  accoucheur,  made  with  an  in- 
strument the  opening  through  which  he  had  ever  since  performed 
micturition.     ("American  Journ.  of  the  Med.  Sciences,"  July.  1847.) 

This  was  certainly  an  embarrassing  case — one  to  which  Lord  Coke's 
rule  for  a  decision,  i.  e.,  the  prevalence  of  either  sex,  is  hardly  ap- 
plicable. The  presence  of  a  penis  and  one  testicle  referred  the  being 
to  the  male,  while  the  bodily  configuration,  and  still  more  strongly 
the  periodical  menstrual  discharge,  referred  him  to  the  female  sex. 
The  right  of  voting  might  have  been  fairl}r  objected  to,  because, 
while  the  female  characters  were  decided,  the  organs  indicative  of 
the  male  sex  are  described  as  having  been  imperfectly  developed. 

Dr.  Hartshorne,  the  American  editor  of  this  work,  quotes  a  ease 
in  which  an  attempt  was  made  by  Dr.  Gross,  a  surgeon  in  the  United 
States,  to  destroy  all  sexuality,  and  thereby  all  rights  of  citizenship. 
in  the  case  of  an  infant  whose  sexual  organs  were  imperfect.  (A  re- 
port of  this  case  will  be  found  in  the  "  American  Journal  of  Med.  Sci." 
for  Oct.  1852,  and  the  "Ed.  Monthly  Jour."  for  Jan.  1853.)  The 
child,  when  seen  by  Dr.  Gross,  was  three  years  of  age,  and  had  always 
up  to  that  period  been  regarded  as  a  girl,  and  in  fact  had  been  so 
pronounced  at  her  birth  by  the  accoucheur.  At  the  age  of  two  years 
she  began  to  evince  the  taste,  disposition,  and  feelings  of  the  male 
sex;  she  rejected  dolls  and  similar  articles  of  amusement,  and  became 
fond  of  boyish  sports.     She  was  well  grown,  perfectly  healthy,  and 


CASES    OF    CONCEALED    SEX.  577 

quite  fleshy.  Her  hair  was  dark  and  long,  the  e}res  black,  and  the 
whole  expression  most  agreeable.  A  careful  examination  of  the 
external  genitals  disclosed  the  following  circumstances.  There  was 
neither  a  penis  nor  a  vagina;  but  instead  of  the  former  there  was  a 
small  clitoris,  and  instead  of  the  latter  a  superficial  depression  or 
cul-de-sac  covered  with  mucous  membrane,  and  devoid  of  everything 
like  an  aperture  or  inlet.  The  urethra  occupied  the  usual  situation 
(in  the  female?)  and  appeared  to  be  natural;  the  nymphae  were  re- 
markably diminutive,  but  the  labia  were  well  developed,  and  con- 
tained each  a  well-formed  testicle  quite  as  large  and  as  firm  as  this 
organ  generally  is  in  boys  at  the  same  age.  The  hips,  chest,  thighs, 
and  upper  extremities,  were  perfect.  From  this  description  it  is 
pretty  clear  that  the  child  was  an  androgynus,  or  there  was  imper- 
fect development  of  the  sexual  organs,  with  predominance  of  those 
of  the  male.  There  was  no  indication  of  uterus  or  ovaries,  nor  any 
external  peculiarity,  except  that  which  is  frequently  met  with  in 
hermaphrodites,  in  which  there  is  an  arrest  of  male  development, 
but  no  intermixture  of  the  sexes.  Dr.  Gross  considered  that  for  the 
child's  future  welfare  and  happiness,  it  would  be  better  that  it  should 
have  no  testicles  at  all,  than  that  it  should  retain  them  under  such  an 
imperfect  development  of  the  other  organs.  He  therefore  removed 
them  by  operation  from  the  labia  or  divided  scrotum,  and  had  the 
dissatisfaction  to  find  that  they  were  perfectly  formed  in  every  respect, 
and  that  the  spermatic  cords  were  quite  natural.  The  operation  was 
performed  in  July,  1849,  and  three  years  subsequently  (in  1852)  it 
was  found  that  emasculation  was  complete,  for  the  disposition  and 
habits  of  the  being  had  materially  changed,  and  were  those  of  a 
girl :  she  was  found  to  take  great  delight  in  sewing  and  housework, 
and  she  no  longer  indulged  in  riding  sticks,  and  other  boyish  ex- 
ercises. 

The  reasons  assigned  for  the  performance  of  this  operation — 
namely,  the  entire  deprivation  of  sex,  and  thereby  of  any  sexual 
feelings  in  after-life — appear  to  me  to  be  unsatisfactory.  It  is  clear, 
from  Dr.  Gross's  description,  that  this  being  was  deprived  of  the 
rights  and  privileges  of  a  male  by  the  removal  of  the  testicles.  (See 
the  case  of  Levi  Suydam,  ante,  p.  574.)  Dr.  Gross  appears  to  have 
contemplated  the  case  only  in  a  matrimonial  point  of  view ;  but  in 
a  country  where  the  rights  of  citizenship  and  power  of  voting  for 
members  of  Congress  are  much  valued,  where  they  depend  on  direct 
proofs  of  sex,  and  are  so  strongly  contested  by  opposing  parties — it 
is  a  serious  question  whether  he  has  not  here  struck  a  severe  blow 
at  the  political  rights  of  these  beings,  in  thus  wilfully  destroying 
the  physical  evidence  of  the  male  sex!  In  this  country  it  might 
have  been  a  question  whether  he  had  not  rendered  himself  liable  in 
damages  for  thus  tampering  with  the  laws  of  nature. 

Concealed  Sex. — It  is  almost  superfluous  to  say  that  in  some  cases 
sex  cannot  be  determined  by  the  dress,  appearance,  or  even  voice  of 
the  individual.  Cases  in  which  males  have  passed  for  many  years 
unsuspectedly  as  females,  and  vice  versa,  have  been  numerous.  In 
some  instances  the  secret  has  been  disclosed  only  by  death.  Facts 
•67 


578  CAUSES    OF    I1IPOTEXCY. 

of  this  kind  belong  rather  to  the  annals  of  imposture  than  to  those 
of  medical  jurisprudence.  A  somewhat  singular  case  of  this  descrip- 
tion, that  of  Eliza  Edwards,  occurred  to  me  in  1833.  An  unclaimed 
body  was  sent  to  Guy's  Hospital,  by  the  Inspector  of  anatomy,  as  a 
female.  On  removing  the  dress,  however,  it  was  found  to  be  that  of 
a  male!  From  some  suspicion  respecting  the  cause  of  death,  and 
the  habits  of  this  person,  a  coroner's  inquest  was  held.  It  turned 
out  that  the  deceased,  whose  age  was  twenty-four,  had  assumed  the 
dress  of  a  female  at  the  age  of  fourteen,  and  had  performed  in  many 
parts  of  England  as  an  actress.  The  features  had  a  somewhat  femi- 
nine character;  the  hair  was  very  long,  and  parted  in  the  centre; 
the  beard  had  been  plucked  out,  and  the  remains  of  this  under 
the  chin  had  been  concealed  by  a  peculiar  style  of  dress.  It  was 
remarked  during  life  that  the  voice  was  hoarse.  The  breasts  were 
like  those  of  a  male,  and  the  male  sexual  organs  were  perfectly  de- 
veloped. They  had  evidently  been  subjected  to  great  traction,  and 
appeared  to  have  been  drawn  forward  to  the  lower  part  of  the  abdo- 
men. The  state  of  the  rectum  left  no  doubt  of  the  abominable  prac- 
tices to  which  this  individual  had  been  addicted.  It  was  found  that 
death  had  taken  place  from  natural  causes.  The  most  remarkable 
circumstance  in  the  case  is,  that  the  deceased  had  been  attended  in 
his  last  illness  by  an  eminent  physician  (now  deceased)  for  disease 
of  the  lungs;  and  so  well  was  the  imposition  maintained,  that  his 
medical  attendant  did  not  entertain  a  suspicion  of  the  real  sex  of  his 
patient!     ("Med.  and  Phys.  Jour.,"  Feb.  1833,  p.  168.) 


IMPOTENCY.   STERILITY. 


CHAPTER   LV. 

IMPOTENCY. — CAUSES. — PROCREATIVE  POWER  IN  THE  MALE. — PU- 
BERTY7.— AGE  FOR  VIRILITY". — VIRILITY'  OF  CRY'PSORCHIDES  AND 
MONORCHIDES. — STERILITY'. — PROCREATIVE  POAVER  IN  THE  FEMALE. 
— EARLIEST  AND  LATEST  PERIODS  FOR  CHILD-BEARING. — LEGAL 
RELATIONS. 

Definition. — Impotency  is  defined  to  be  an  incapacity  for  sexual 
intercourse.  It  may  depend — 1st,  upon  physical,  2dly,  upon  moral 
causes.  With  regard  to  the  moral  causes  of  impotency  they  do  not 
concern  a  medical  jurist.  Such  causes  are  not  recognized  by  law, 
and  he  has  no  duty  to  perform  beyond  the  application  of  the  prin- 
ciples of  medicine  to  the  purposes  of  the  law. 

Causes. — Impotency  may  arise  from  age,  from  certain  physical 
causes,  e.  g.,  disease,  or  from  congenital  malformation  or  defect.  With 


CAUSES    OF    IMPOTENCY.  579 

regard  to  physical  causes,  a  distinction  must  be  made  between  those 
which  are  remediable  and  those  which  are  not.  The  presence  of  a 
disease  of  the  testicle,  such  as  atrophy  or  fungous  tumor,  may  give 
rise  to  incapacity ;  but  this  incapacity  may  be  sometimes  removed 
by  an  operation  or  by  medical  treatment,  and  therefore  the  physical 
cause  may  be  removed :  in  other  words  it  is  remediable.  To  such 
cases  as  these  the  law  does  not  extend ;  but  it  is  always  expected,  in 
alleged  incapacity,  that  the  practitioner  examined  on  the  subject 
should  be  able  to  say  whether  there  is  or  is  not  a  prospect  of  cure. 
In  forming  a  judgment  upon  this  point  a  good  knowledge  of  his 
profession  can  alone  assist  hinj ;  no  rules  can  be  laid  down  for  his 
guidance,  for  there  may  not  be  two  cases  that  will  precisely  resem- 
ble each  other  in  their  features.  Hence  it  will  be  necessary  in  this 
place  to  point  out  the  chief  causes  of  impotency  which  are  of  an 
irremediable  nature,  or  those  in  which  the  incapacity  is  absolute  and 
permanent ;  a  point  upon  which  a  medical  opinion  is  chiefly  required. 

In  strictness  of  language,  the  definition  of  impotency,  as  above 
given,  may  be  applied  to  a  female  as  well  as  to  a  male ;  and  un- 
doubtedly, a  physical  incapacity  for  sexual  intercourse  may  exist  in 
either  sex.  As  an  instance  of  this  incapacity  in  the  female,  may 
be  mentioned  occlusion  of  the  vagina — a  condition  not  necessarily 
indicative  of  sterility.  The  mere  occlusion  of  the  vagina  may  be 
a  remediable  form  of  the  malady  ;  but  its  entire  obliteration  would 
be  absolute  and  irremediable.  This  latter  condition,  however,  is  the 
only  instance  of  complete  impotency  in  a  female.  A  protrusion  of 
the  uterus  or  of  the  bladder  into  the  vagina  is  mentioned  by  some 
writers  as  a  cause  of  physical  incapacity  for  intercourse ;  but  these 
forms  of  disease  may  be  commonly  remedied  by  art,  and  therefore 
require  no  further  notice  in  this  place. 

In  professional  language,  the  term  impotency  has  been  hitherto 
applied  exclusively  to  a  defect  in  the  male  sex ;  and  the  term  ster- 
ility is  usually  confined  to  all  those  conditions  in  the  female  which 
not  only  render  intercourse  impossible,  but  which  render  it  unfruit- 
ful. A  male  may,  however,  be  sterile  without  being  impotent — a 
condition  observed  in  some  crypsorchides ;  or  he  may  be  impotent 
without  being  sterile,  as  where  proper  intercourse  is  prevented  by 
reason  of  physical  defect  in  the  virile  member,  although  the  testi- 
cles may  be  in  a  normal  condition.  See  on  this  subject,  Curling  on 
"Sterility  in  Man"  (1864).  This  author  points  out  that  sterility  in 
the  male,  apart  from  impotency,  may  depend  on  three  causes — 1st, 
malposition  of  the  testicles ;  2dly,  obstructions  in  the  excretory 
ducts ;  and  3dly,  impediments  to  the  escape  of  the  seminal  fluid. 
A  man  may  not  be  impotent,  i.  e.  incapable  of  intercourse,  but,  by 
reason  of  one  of  the  conditions  above-mentioned,  such  intercourse 
would  be  unfruitful. 

In  reference  to  the  male,  the  English  law  does  not  appear  to  go 
beyond  the  establishment  of  impotency  from  some  clear  and  demon- 
strable cause,  and,  unless  the  alleged  sterility  were  accompanied  by 
impotency,  it  would  take  no  cognizance  of  that  condition.  Further, 
sterility  from   such   causes  could   hardly   be  demonstrated  during 


580  PROCREATIVE    POWER    IN    THE    MALE. 

the  life  of  a  person — it  would  rest  chiefly  on  presumption  or  pro- 
bability. 

Procreative  Power  in  the  Male.  Puberty. — Until  the  period  of 
puberty  the  testicles  are  small,  and  they  increase  very  little  in  size 
in  proportion  to  other  parts.  Mr.  Curling  found  that  the  size  of  the 
seminal  tubes  differed  but  little  at  the  ages  of  18  months  and  8  years. 
The  sexual  function  in  the  male  depends  entirely  on  the  develop- 
ment of  these  organs ;  but  the  age  at  which  it  appears  differs  in 
different  persons.  The  age  of  puberty  in  a  healthy  male  in  this 
country  varies  from  14  to  17  years;  its  appearance  is,  however, 
affected  by  climate,  constitution,  aud  the  moral  circumstances  under 
which  the  individual  is  placed :  in  some  cases  it  is  not  fully  deve- 
loped until  the  age  of  21. 

The  access  of  puberty  in  the  male  is  indirectly  connected  with 
the  subject  of  rape.  A  boy  under  the  age  of  fourteen  years  is  pre- 
sumed in  law  to  be  incapable  of  committing  a  rape.  (1  Hale,  p.  631, 
and  Mathew's  "Digest,"  p.  57.)  This  presumption  is  probably  based 
on  the  supposition  that  a  boy  at  that  age  is  impotent.  The  statute 
law,  however,  now  merely  requires  proof  of  penetration,  and  rape 
therefore  may  be  physically  perpetrated  by  a  boy  at  or  even  under 
14  years  of  age.  In  Beg.  v.  King  (York  Winter  Assizes,  1853),  a 
boy  aged  fifteen  was  convicted  of  rape  on  a  girl  under  10  years  of 
age.  In  a  case  elsewhere  related  (see  Eape),  a  boy  aged  19  com- 
municated syphilis  to  a  girl  of  6  years  of  age.  It  appears  that  in 
India  puberty  shows  itself  much  earlier  in  the  male.  Dr.  Chevers. 
quoting  from  the  "Nizamut  Adawlut  Eeports,"  states  that  a  boy  of 
13  or  14  years  of  age  was  found  guilty  of  rape  and  sentenced,  in 
consideration  of  his  youth,  to  three  years'  imprisonment.  A  lad  of 
fourteen  was  convicted  of  rape  on  a  girl  of  the  same  age ;  and  in 
another  case  a  boy  only  ten  years  old,  was  convicted  of  rape  on  a 
girl  3  years  of  age !  He  was  sentenced  to  a  year's  imprisonment. 
("Med.  Jur.  for  India,"  p.  403.) 

The  seminal  secretion  in  the  male  is  not  considered  to  be  prolific 
until  it  contains  those  peculiar  filiform  bodies  which  are  known 
under  the  name  of  spermatozoa  or  zoosperms.  These  are  regarded 
by  some  physiologists  as  parasitic  animals,  but  by  others,  with  some 
probability,  as  freely  moving  cilia.  ("Recent  Advances,"  Baly  and 
Kirkes,  1848.)  All  agree  that  they  are  normal  and  essential  con- 
stituents of  the  healthy  and  prolific  seminal  fluid.  They  are  pecu- 
liar to  the  spermatic  secretion,  and,  in  healthy  males,  are  always 
present  in  it  after  the  age  of  puberty.  They  disappear  in  certain 
states  of  disease,  and  sometimes  in  advanced  age :  they  have  not 
been  found  in  the  undeveloped  testicles  of  crypsorchides.  In  cases 
in  which  they  are  absent,  from  whatever  cause,  it  is  a  fair  inference 
that  the  person  is  impotent,  or  that  he  has  lost  the  power  of  pro- 
creation. (See  on  this  subject  "Observations  on  Sterility  in  Man." 
by  T.  B.  Curling,  1864.)  In  this  pamphlet  one  case  is  related  in 
which  a  man  aged  42,  who  was  married,  and  whose  wife  had  borne 
a  son  then  8  years  of  age,  had  died  after  fonr  days'  illness  from 
strangulated   hernia.     The   testicles,   from   the  fact   of  their   being 


ILLEGITIMACY    AND    IMPOTEXCY.  581 

found  in  the  inguinal  canal,  were  examined  separately  by  Drs. 
Gosselin  and  Grodard,  and  no  spermatozoa  were  discovered  in  either 
of  them ;  but  these  may  have  been  absent  at  the  time  of  examina- 
tion, as  the  child  begotten,  was  then  eight  years  of  age.  In  this 
long  interval  the  secretion  may  have  undergone  a  change,  and  have 
become  unprolific. 

Impotency  from  Age. — It  may  be  fairly  assumed  that  a  male  is  in- 
capable of  procreating  until  spermatozoa  have  appeared  in  the  semi- 
nal secretion,  and  that  he  loses  this  power  when  they  disappear. 
The  age  at  which  they  are  formed  varies  with  all  the  causes  that 
affect  puberty.  In  one  instance  they  were  found  by  Casper  in  the 
seminal  fluid  of  a  crypsorchid  boy  only  14J  years  old,  and  Mr.  Cur- 
ling found  them  in  the  secretion  of  a  boy  aged  18.  This  gentleman 
found  spermatozoa  in  the  liquid  taken  from  the  testicles  of  a  man 
upwards  of  seventy  years  of  age,  and  on  one  occasion  in  the  tes- 
ticles of  a  person  aged  eighty-seven.  Wagner  states  that  they  are 
to  be  found  in  the  secretions  of  men  between  70  and  80  years  of  age. 
M.  Rayer  fcrand  them  in  the  secretion  of  a  man  aged  82  years  ("Gaz. 
Med."  Juin  2,  1849).  Other  cases  of  a  similar  kind  are  recorded  by 
Debrou.  ("Gaz.  Hebdom."  4th  Janvier,  1861,  p.  6.)  Facts  tend  to 
render  it  highly  probable  that  the  fecundating  power  may  be  re- 
tained by  the  male  up  to  the  age  of  100.  According  to  Dr.  Duplay, 
the  seminal  fluid  of  old  men  contains  spermatozoa  even  when  they 
are  beyond  the  age  for  fecundation  ("Med.  Times  and  Gazette," 
June  4,  1853,  p.  581) ;  but  he  does  not  state  the  circumstances  which 
enabled  him  to  arrive  at  this  conclusion.  Sexual  propensities  are 
often  strongly  developed  in  children,  and  thus  they  may  be  prolific 
at  an  early  age.  Dr.  Riittel  met  with  a  case  in  which  a  female  at 
the  age  of  14,  became  pregnant  by  a  boy  of  the  same  age.  ("Henke's 
Zeitschrift  der  S.  A."  1844,  p.  249.)  This  is  the  earliest  age  at 
which,  so  far  as  I  can  ascertain,  the  procreative  power  has  appeared  in 
the  male.  Dr.  Hartshorne  refers  to  an  instance  of  extraordinary  deve- 
lopment of  the  male  sexual  organs  in  a  child  4  years  old.  ("  Amer. 
Jour.  Med.  Sci."  Oct.  1852,  p.  561.)  In  a  case  of  contested  legitimacy 
or  affiliation,  this  question  regarding  the  age  at  which  a  procreative 
power  appears  in  the  male,  may  have  an  important  bearing  on  the 
issue.  Thus  the  person  may  be  so  young  as  to  render  it  impossible 
that  he  should  be  the  father  of  a  child  imputed  to  him.  Cases  in- 
volving questions  of  legitimacy  on  this  ground  are  not  heard  of  in 
the  present  day :  but  in  ancient  law-books  there  are  decisions  rela- 
tive to  the  illegitimacy  of  children  born  during  marriage,  because 
the  alleged  fathers  were  7,  6,  and  even  3  years  old!     (Amos.) 

The  following  case  in  reference  to  the  affiliation  of  children  oc- 
curred in  1840  :  A  woman  wished  to  affiliate  a  child  on  a  youth  who 
was  in  his  sixteenth  year.  The  boy  denied  that  he  was  the  father  of 
the  child  ;  and  there  was  reason  to  suspect  that  the  imputation  had 
been  wrongly  thrown  upon  him  in  order  to  divert  suspicion  from 
the  real  offender.  There  was  some  difficulty  in  this  case ;  but  it 
appears  to  me  that  the  rule  for  a  medical  man  to  follow  on  these  oc- 
casions is  this:  not  to  regard  the  mere  age  of  the  youth,  whether  he 
is  above  or  below  the  average  age  of  puberty,  but   to   observe 


582  IMPOTENCY    FROM    LOCAL 

whether  the  sexual  organs  are  fully  developed,  and  whether  there 
are  about  him  any  of  the  marks  of  virility,  indicated  by  muscular 
development,  the  growth  of  a  beard,  and  a  change  in  the  voice.  If 
these  signs  are  present,  whatever  may  be  his  age,  there  is  strong 
reason  to  suppose  that  the  sexual  functions  are  developed.  We 
occasionally  hear  of  instances  of  extraordinary  precocity ;  but  the 
development  of  sexual  power  is  generally  accompanied  by  other 
well-marked  changes  in  the  person.  Sometimes  these  changes  do 
not  make  their  appearance  until  after  the  age  of  21.  [Some  re- 
markable cases  of  precocious  puberty  are  given  in  "Wharton  and 
Stille's  Medical  Jurisprudence,  §  421  —  P.] 

On  the  other  hand,  it  may  be  a  question  at  what  time  the  procrea- 
tive  power  disappears  in  a  male.  That  impotency  is  one  of  the  na- 
tural consequences  of  advanced  age  is  undoubted :  but  this,  as  we 
know,  forms  no  legal  impediment  to  the  marriage  of  parties,  how- 
ever old.  The  legal  presumption  is,  that  the  generative  faculty  does 
not  disappear  through  age ;  and  if  this  be  alleged,  and  legitimacy 
disputed  on  this  ground,  it  must  be  satisfactorily  proved  by  those 
who  would  benefit  by  the  allegation.  This  amounts  to  almost  an 
impossibility,  because  it  is  well  known  that  there  is  no  fixed  age  at 
which  the  sexual  functions  cease  either  in  the  male  or  the  female ; 
and  individuals,  at  least  of  the  male  sex,  who  had  passed  the  ages  of 
60,  70,  and  even  80  years,  have  been  known  to  be  capable  of  fruit- 
ful intercourse.  M.  Dunley  believes,  from  his  anatomical  observa- 
tions on  the  bodies  of  aged  persons,  that  the  cause  of  impotency 
(sterility)  in  advanced  age  are  to  be  found  rather  in  the  excretory 
than  in  the  secretory  apparatus.  Thus  he  has  met  with  obliterations 
in  the  canal  of  the  epididymis,  the  vas  deferens,  and  the  vesicular, 
the  effect  of  which  is  to  prevent  the  accumulation  and  passage  of  the 
seminal  fluid.  ("  Med.  Times  and  Gazette,"  June  28,  1856,  p.  650.) 
Lord  Erskine,  in  the  Baribury  Peerage  claim,  quoted  the  case  of  Sir 
Stephen  Fox,  who  was  married  at  77,  and  had  tour  children,  the  last 
when  he  was  81.  Dr.  Schneider  met  with  a  case  in  which  a  man  of 
71  had  a  child  by  his  wife,  who  was  only  17.  ("  Henke's  "Zeits- 
chrift,"  1812,  vol.  2,  p.  165.)  Dr.  Eiittel  mentions  the  case  of  a  man 
who,  at  the  age  of  92  years,  married  and  had  two  children  by  his 
wife.  When  the  procreative  power  even  appears  to  be  lost  at  an 
advanced  age,  the  stimulus  for  intercourse  is  often  very  great.  The 
same  authority  mentions  cases  in  which  these  erotic  feelings  were 
remarked  by  him  in  reference  to  men  between  75  and  86  years  of 
age.  (Henke's  "Zeitschrift,"  1811:,  p.  252.)  In  all  cases  of  pro- 
longed virility  it  is  observed  that  the  bodily  and  mental  powers  are 
also  retained  in  an  extraordinary  degree,  showing  the  close  relation 
which  exists  between  the  sexual  function  and  corporeal  and  mental 
development,  even  to  the  latest  period  of  life.  Sir  S.  Komilly  re- 
marked in  reference  to  the  retention  of  procreative  power  in  advanced 
age,  that  the  liberality  of  the  English  law  on  this  subject  was  ex- 
cessive; for  there  was  no  age,  from  seven  upwards,  at  which  a  man 
had  been  denied  the  power  of  procreating  children !  ^See,  in  refer- 
ence to  this  subject,  Henke's  "Zeitschrift  der  S.  A.,"  1812,  p.  332.) 


DISEASE    OR    ACCIDENT.      C  RYPSORCHIDES.  583 

Males  at  the  age  of  14,  and  females  at  the  age  of  12,  are  legally 
competent  to  contract  marriage. 

Impotency  from  Local  Disease  or  Accident. — The  loss  or  destruction 
of  the  penis  or  testicles,  either  by  disease,  accident,  or  from  necessary 
operations,  would  be  sufficient  to  render  a  man  irremediably  impo- 
tent. The  loss  of  one  or  both  testicles,  from  any  of  these  causes, 
would  be  indicated  by  the  presence  of  distinct  cicatrices  in  the 
scrotum.  When  both  have  been  removed  by  operation,  the  person 
is  incurably  impotent ;  but  if  the  organs  are  healthy,  a  sufficiency 
of  the  spermatic  fluid  to  confer  procreative  powers  may  remain  in 
the  ducts  for  two  or  three  weeks  after  the  operation.  Thus  it  is  that 
animals  have  been  known  to  be  prolific  for  a  certain  time  after  cas- 
tration ;  and  one  case  is  on  record  in  which  a  man,  both  of  whose 
testicles  had  been  carried  off  by  a  gunshot,  is  said  to  have  retained 
the  power  of  impregnating  his  wife  after  the  healing  of  the  wound. 
(See  a  paper  by  Dr.  Krugelstein,  Henke's  "Zeitschrift,"  1842,  vol.1, 
pp.  348  and  352.)  The  loss  of  one  testicle  only,  by  accident  or  ope- 
ration, does  not  render  a  man  impotent.  Monorchides,  as  they  are 
called,  have  been  known  to  be  prolific.  Cases  of  this  kind  must 
not  be  confounded  with  those  in  which  one  or  both  testicles  have 
not  descended  into  the  scrotum. 

In  some  rare  instances,  the  testicles  do  not  descend  into  the 
scrotum  at  the  usual  period ;  but  one  or  both  may  remain  in  the 
abdomen,  or  in  the  inguinal  canals,  and  only  descend  some  time 
after  birth ;  or  one  may  be  found  in  the  scrotum,  and  the  other  re- 
main during  life  in  the  abdomen,  or  both  may  be  retained  in  the 
abdomen.  In  some  cases  of  partial  descent  the  organs  have  been 
mistaken  for,  and  treated  as,  ruptures  by  the  application  of  a  truss ! 
(Henke's  "Zeitschrift  der  S.  A."  1844,  vol.  1,  p.  249;  Curling  on 
"Disease  of  the  Testis,"  2d  ed.  p.  31.)  In  one  instance  the  attempt 
to  reduce  the  tumor,  mistaken  for  hernia,  and  the  application  of  a 
truss,  caused  the  death  of  the  person.  ("Med.  Times  and  Gaz.," 
March  2,  1861,  p.  240.)  When  one  testicle  only  has  descended, 
there  is  no  ground,  caeteris  paribus,  to  impute  impotency :  the  de- 
scended organ  has  been  found  healthy,  and  to  contain  spermatozoa, 
while  the  retained  testicle  and  its  ducts  have  not  been  found  to  con- 
tain spermatozoa.  Mr.  Curling  has  collected  six  of  these  cases,  of 
which  four  fell  under  his  own  observation.  ("  On  Sterility  in  Man," 
1846,  p.  6,  and  "Med.  Times  and  Gaz.,"  Feb.  23,  1861.)  When 
neither  testicle  has  descended,  the  scrotum  will  be  found  empty, 
without  any  scar  indicative  of  a  removal  by  operation,  but  the 
other  marks  of  virility  may  still  be  present.  These  persons  have 
been  called  Crypsor chides.  It  has  been  stated  that  in  such  cases  the 
testicles  are  to  be  regarded  as  congenitally  defective,  and  further 
that  the  individual,  although  capable  of  sexual  intercourse,  is  in- 
curably sterile. 

The  non-descent  of  the  testicles  is  a  state  rarely  seen.  Mr.  Mar- 
shall met  with  only  one  case  of  non-descent  of  one  testicle  in  1,000 
recruits,  and  with  one  case  of  non-descent  of  both  testicles  in  10,000 
recruits.  There  are  three  preparations,  showing  the  non-descent  of 
these  organs,  in  the  Museum  of  Guy's  Hospital :  one  of  them  was 


58-i  ALLEGED    STEEILITY    OF    CRYPSORCHIDES. 

taken  from  a  gentleman  who  shot  himself  from  despondency  at  his 
supposed  defective  condition.  Hunter  thought  that  the  undescended 
testicles  were  always  imperfect  both  in  their  structure  and  functions, 
and  that  crypsorchides  were  invariably  impotent  (sterile).  Some 
recent  researches  have  tended  to  support  the  views  of  Hunter.  In 
January,  1860,  Mr.  Partridge  communicated  to  the  Pathological 
Society  the  case  of  a  man  of  25,  in  whom  both  testicles  were  found 
in  the  abdomen.  Several  specimens  of  the  secretion  were  examined, 
and  no  spermatozoa  were  detected.  Another  case  was  examined 
with  a  like  result  ("Lancet,"  January,  1860,  p.  Q6),  and  a  third  by 
Mr.  Curling  ("  Med.  Times  and  Gaz.,"  February  23,  1861).  The  con- 
clusion to  which  these  observations  have  led  is,  that  although  in 
cases  of  non-descent  there  may  be  a  capacity  of  sexual  intercourse, 
it  would  not  be  prolific :  the  person  will  be  sterile.  According  to 
this  view,  malposition  of  the  organs  must  be  taken  as  synonymous 
with  defective  condition :  as  a  result  of  this  malposition  they  are 
not  capable  of  secreting  prolific  spermatic  fluid,  and  the  person  is  as 
sterile  as  if  he  had  no  testicles.  The  cases  of  monorchides  reported 
by  Mr.  Curling  (Op.  cit.  p.  8)  to  some  extent  support  this  theory, 
since  spermatozoa  were  found  only  in  the  fluid  of  that  testicle  which 
occupied  its  usual  position  in  the  scrotum.  He  has  also  collected 
from  various  sources  seven  cases  of  crypsorchides,  in  which  both 
testicles  were  either  in  the  abdomen  or  in  the  inguinal  canals ;  the 
fluid  contained  in  them  was  destitute  of  spermatozoa,  and  although 
impotency  did  not  exist,  these  persons  either  were  or  were  presumed 
to  be  unproliflc.  M.  Godard  has  noticed  that  horses  whose  testicles 
are  retained  in  the  abdomen,  although  capable  of  intercourse,  are 
sterile. 

On  the  other  side  of  the  question  there  are,  however,  facts  which 
are  wholly  inconsistent  with  this  theory.  Many  years  since  I  pub- 
lished the  account  of  two  cases  of  crypsorchides  communicated  to 
me  by  my  friend  and  colleague  Mr.  Cock.  The  testicles  in  these 
men  had  not  descended,  but  their  virile  functions  were  undisputed. 
One  of  them,  before  he  had  reached  the  age  of  30  years,  had  been 
twice  married,  and  had  had  children  by  each  wife,  besides  illegiti- 
mate children  which  were  affiliated  on  him  during  the  time  he  lived 
in  service.  In  a  report  of  cases  of  hernia  by  Mr.  Poland  ("Guy's 
Hospital  Reports,"  1843,  vol.  1,  p.  163),  there  is  the  case  of  a  man, 
aged  29,  a  crypsorchid,  whose  testicles  had  never  descended.  Mr. 
Poland  states  that  there  was  not  the  slightest  trace  of  scrotum ;  the 
penis  was  well-developed,  and  there  were  all  the  other  signs  of  vi- 
rility. This  man  married  when  he  was  20 :  he  had  had  two  chil- 
dren by  his  first  wife,  and  at  the  time  of  his  admission  into  the  hos- 
pital had  been  married  two  years  to  a  second  wife.  In  January, 
1862,  I  saw,  in  Guy's  Hospital,  a  patient  under  Mr.  Durham :  the 
testicles  of  this  man  had  not  descended— they  were  lodged  in  the 
inguinal  canals.  The  man  was  32  years  of  age,  well-developed, 
with  every  appearance  of  virility  about  him,  and  with  the  same 
masculine  development  which  is  seen  in  other  men  of  the  same 
This  man  was  married,  and  had  had  two  children  by  his  wife. 
.Since   puberty  he  had  always   been  competent,  and  he  ridiculed 


VIRILE    POWERS    OF    CRYPSORCHIDES.  585 

the  idea  that  his  testicles  were  inefficient.  Another  case  is  referred 
to  by  Mr.  Curling  (Op.  cit.  p.  9),  which  occurred  to  Dr.  Debrou,  of 
Orleans.  The  testicles  were  in  the  inguinal  canals ;  there  was  no 
scrotum.  The  man  had  been  married,  and  had  had  one  son  hj  his 
wife.  These  facts  prove  that  crypsorchides,  in  some  cases,  have  a 
power  of  procreation  like  normally  constituted  men.  Casper  relates 
a  case  in  which  a  crypsorchid  was  charged  with  an  unnatural  offence. 
He  was  a  boy  between  14  and  15  years  of  age,  and  it  appeared  that 
he  had  been  guilty  of  unnatural  conduct  towards  another  boy  8 
years  of  age.  Spermatozoa  were  detected  by  Casper  on  his  shirt 
sixteen  days  after  the  act.  On  examining  the  boy,  both  testicles 
were  found  in  the  inguinal  canals.     ("Ger.  Med."  vol.  2,  p.  187.) 

By  these  facts,  therefore,  it  is  satisfactorily  established  that  cryp- 
sorchides are  not  necessarily  sterile,  and  that  no  absolute  rule  can  be 
laid  down  respecting  the  existence  or  non-existence  of  prolific  power 
under  such  circumstances.  It  has  been  objected  that  in  the  above 
instances  of  prolific  power  spermatozoa  have  not  been  proved  to  exist 
in  the  spermatic  secretions  of  the  individuals,  and  that  the  evidence 
is  therefore  incomplete.  But  these  bodies  have  not  been  proved  to 
be  absent,  and  most  persons  will  agree  that  there  is  no  better  evidence 
of  prolific  power  than  the  procreation  of  children,  whether  sperma- 
tozoa are  or  are  not  detected ;  a  matter  which  will  sometimes  depend 
on  the  accuracy  of  observation  or  experience  of  the  examiners  or, 
it  may  be,  on  a  morbid  state  of  the  secretion.  If  none  were  found 
under  these  circumstances,  it  would  only  prove  that  our  present 
theories  of  generation  would  require  to  be  modified.  One  affirma- 
tive instance  is  sufficient  for  all  the  purposes  of  law,  to  overthrow 
ninety-nine  negative  instances ;  and  as  a  physiological  fact,  it  is  ob- 
vious that  the  organs  which  have  not  descended  are  not  always 
defective  in  structure  or  function.  The  cases  hitherto  observed  are 
so  nearly  balanced  that  it  is  difficult  to  say  whether  it  is  the  rule  or 
the  exception  that  crypsorchides  should  be  found  prolific;  the  facts 
above  mentioned  clearly  prove  that  there  is  no  reasonable  ground 
for  pronouncing  them  to  be  absolutely  sterile  or  unprolific  merely 
because  their  testicles  are  not  in  the  scrotum.  If  with  a  non-descent 
of  these  organs  there  should  be  a  non-development  of  the  other 
external  organs,  and  this  is  accompanied  by  a  total  want  of  the  char- 
acters of  virility,  then  the  person  may  be  impotent  or  sterile.  The 
testicles  may,  in  such  a  case,  be  either  congenitally  absent  or  physi- 
cally imperfect ;  a  fact  only  ascertainable  by  an  examination  of  the 
body  after  death.  On  the  other  hand,  in  cases  in  which  there  are  no 
external  marks  of  effeminacy,  or  other  grounds  for  suspecting  a 
want  of  procreative  power,  and  the  person  is  capable  of  sexual  in- 
tercourse, this  imperfection  does  not  offer  any  bar  to  marriage,  nor 
is  it  a  sufficient  ground  for  divorce.  It  would  not  justify  a  medical 
man  in  denying  the  paternity  of  a  child  on  a  question  of  affiliation, 
bastardy,  or  inheritance ;  and  so  long  as  a  power  of  sexual  inter- 
course existed,  it  would  not  justify  him  in  pronouncing  a  person  to 
be  incurably  sterile.  The  capacity  for  sexual  intercourse  is  tin'  fact 
to  which  the  English  law  commonly  looks  on  these  occasions.  If 
this  exists,  then  it  will  hardly  entertain  the  question — surrounded 


586  EFFECT    OF    SEXUAL    MALFORMATION. 

as  it  may  be  with  conflicting  medical  opinions — whether,  from  the 
mere  retention  of  the  organs  in  the  abdomen,  the  fluid  secreted  is 
or  is  not,  microscopically  speaking,  of  a  prolific  nature  ?  Women 
may  be  sterile  from  a  variety  of  causes  affecting  the  internal  organs, 
only  ascertainable  after  death.  The  ovaries  may  be  so  diseased  that 
no  prolific  intercourse  can  take  place,  although  there  may  be  no 
physical  incapacity.  In  a  case  related  elsewhere,  the  incapability  of 
conception  on  the  part  of  a  woman  was  held  by  Dr.  Lushington  not 
to  be  a  sufficient  ground  for  pronouncing  a  sentence  of  nullity  of 
marriage  (p.  594 ;)  and  doubtless  the  want  of  power  on  the  part  of 
a  man  to  effect  impregnation,  unless  it  depended  on  some  visible 
physical  defect,  would  be  viewed  in  a  similar  light.  Such  persons 
are  not  impotent  but  sterile,  and  sterility  in  an  irremediable  form  is 
rather  assumed  than  demonstrated  to  exist. 

The  presence  of  what  have  been  called  supernumerary  testicles 
does  not  affect  the  virile  powers  of  the  individual.  These  have  in 
general  been  found,  by  dissection,  to  be  tumors  connected  with  the 
healthy  glands,  and  not  at  all  adding  to  or  interfering  with  their 
functions.  Even  the  presence  of  two  or  three  penes,  according  to 
Mende.  is  no  bar  to  the  exercise  of  sexual  power,  provided  only  one 
possesses  the  normal  characters  of  the  male  organ.  ("  Ausfuhrl. 
Handb.  d.  ger.  Med.,"  vol.  4,  p.  337.)  In  the  summer  of  1865,  a  Por- 
tuguese youth,  aged  19,  I.  B.  dos  Sautos,  was  seen  by  many  medical 
men  in  London.  He  was  well  formed  except  in  reference  to  the 
sexual  organs.  He  had  two  complete  and  well-formed  penes,  placed 
side  by  side  ;  the  right  somewhat  smaller  than  the  left,  and  both  sub- 
ject to  erection  at  the  same  time.  He  stated  that  he  used  the  left  in 
sexual  intercourse.  On  the  outside  of  each  penis  was  a  scrotum 
witli  one  testicle  fully  developed.  Between  them  was  a  shrunken 
scrotum  which  contained  two  testicles  until  he  was  ten  years  old, 
when  they  ascended  into  the  abdomen.  When  the  bladder  acted, 
urine  issued  from  both  penes.  An  engraving  of  this  remarkable 
malformation  is  given  in  the  history  of  the  case.  ("  Lancet,"  July 
29,  1865,  p.  124.) 

In  some  instances  there  is  an  arrest  of  development  in  the  exter- 
nal organs ;  and  with  this  there  is  generally  an  absence  of  sexual 
desire.  Certain  diseases  of  the  appendages  of  the  testicles  may, 
however,  render  a  person  sterile.  The  spermatic  secretion  is  com- 
monly suspended  in  most  severe  diseases  which  affect  the  bod}^.  A 
frequent  cause  of  impotency  (sterility)  in  the  adult,  when  the  organs 
are  apparently  sound,  is  spermatorrhoea,  arising  from  abuse.  This, 
however,  is  remediable  to  a  greater  or  less  extent  bv  treatment.  (See 
Curling,  "Diseases  of  the  Testis,"  2d  ed.  p.  386;  also  "Med.  Times 
and  Gazette,"  Jan.  23,  1858,  p.  95.)  The  incapacity  for  intercourse 
in  either  sex  may  arise  from  extensive  disease  affecting  parts  in  and 
around  the  organs  of  generation.  The  medical  opinion  here  must 
be  regulated  entirely  by  the  circumstances  attending  each  case. 

On  the  absence  of  the  penis,  as  well  as  on  its  defective  organiza- 
tion, as  causes  of  incapacity,  some  remarks  have  been  already  made. 
Sometimes  the  defect  is  merely  connected  with  the  urethra.  Thus 
the  orifice  may  be  on  the  dorsum  penis,  and  in  other  cases  under- 


IMPOTENCY    FROM    DISEASE.  587 

aeath  the  organ,  so  that  the  urethra  may  terminate  at  a  variable  dis- 
tance from  the  glans  penis.  Those  laboring  under  the  former  defect 
are  said  to  have  epispadia,  and  under  the  latter  hypospadia.  The 
power  to  have  fruitful  intercourse  will  in  either  case  depend  on  the 
situation  of  the  urethral  aperture.  Riittel  knew  an  instance  of  a 
hypospadian  having  several  children.  (Henke's  "Zeitschrift,"  1844, 
p.  258.)  Some  doubt  has  existed  respecting  the  virile  powers  of 
those  who  are  affected  with  hypospadia.  In  September,  1850,  a  lad, 
aged  17,  was  summoned  before  the  magistrates  of  Kidderminster  on 
a  charge  of  affiliation,  in  reference  to  the  pregnancy  of  a  girl  aged 
18.  The  defence  was  that  he  could  not  be  the  father  of  a  child,  be- 
cause there  was  such  a  malformation  of  the  penis  as  to  prevent  pro- 
lific intercourse.  On  examination  the  urethra  was  found  to  termi- 
nate on  the  under  surface  of  the  penis,  about  an  inch  and  a  half 
from  the  glands,  by  a  small  elliptical  orifice,  which  allowed  the 
urine  to  pass,  but  with  some  difficulty.  One  medical  witness  gave 
it  as  his  opinion  that  it  was  not  impossible,  but  highly  improbable, 
that  the  defendant  should  possess  procreative  power ;  another  freely 
admitted  the  boy's  capacity,  and  the  case  was  decided  against  him. 
("Med.  Times,"  Sept,  21,  1850,  p.  321.)  This  decision  was  physio- 
logically correct.  When  the  urine  can  pass,  the  seminal  fluid  can 
pass  ;  and  the  only  question  is,  whether  the  intromission  can  be 
such  as  that  the  misplaced  orifice  should  come  in  contact  with  any 
part  of  the  vagina  ?  This  must  depend  on  the  situation  of  the 
orifice.  [Cases  illustrative  of  the  fully  prolific  powers  of  hypos- 
padias will  be  found  in  the  "  Med.  Times,"  Sept.  14,  1850,  p.  292, 
and  Oct.  12,  1850,  p.  392.  An  instance  of  the  virility  of  an  hypos- 
padian has  also  been  published  by  Mr.  Noble,  of  Manchester,  in  the 
"Assoc.  Med.  Jour.,"  March,  1853,  p.  23(3.]  Similar  remarks  apply 
to  epispadians.  These  malformations  are  sometimes  remediable  ; 
but  whether  remediable  or  not,  they  are  not,  under  any  circum- 
stances, to  be  regarded  as  absolute  causes  of  impotency. 

IrapMency  from  General  Disease. — The  influence  of  local  disease  in 
affecting  virility  has  been  already  considered.  But  there  is  a  class 
of  cases  which  may  come  before  a  practitioner,  in  which,  with  well- 
formed  and  healthy  organs  in  the  male,  there  will  be  a  state  of  im- 
potency. Sometimes  this  may  depend  on  natural  weakness  of  con- 
stitution, or  on  a  want  of  proper  development  of  the  muscular  and 
nervous  systems :  at  other  times  it  is  due  to  certain  diseases,  and  it 
is  then  of  a  temporary  nature — persisting  while  the  body  is  still 
suffering  from  the  disease,  and  disappearing  on  recovery.  As  a  con- 
verse fact,  there  are  some  diseases  which  appear  to  bring  out  the 
dormant  virile  powers  of  persons,  or  to  excite  to  a  higher  degree 
of  intensity  those  which  already  exist.  Thus  it  is  said  that  in  con- 
valescence from  fever  there  is,  occasionally,  extraordinary  salacious- 
ness:  but  this  statement  requires  confirmation.  Again,  there  are 
diseases  which  neither  interrupt  nor  affect  the  exercise  of  the  sexual 
functions.  As  a  general  rule,  diseases  which  do  not  affect  the  brain 
and  spinal  marrow,  and  which  are  not  attended  with  great  debility, 
do  not  prevent  fruitful  intercourse.  On  the  other  hand,  disras^s 
which  are  attended  or  followed  by  great  debility,  suspend  or  do- 


588  IMPOTENCY    FROM    DISEASE. 

stroy  sexual  power.  Among  these  may  be  mentioned  water  in  the 
chest,  general  dropsy,  especially  if  attended  with  effusion  in  the 
sexual  organs — nervous  and  malignant  fevers  which  affect  the 
brain — apoplexy,  palsy,  and  other  diseases  which  directly  attack 
the  brain  or  spinal  marrow.  These  last-mentioned  diseases  proba- 
bly act  by  suspending  the  secretion  or  altering  the  nature  of  the 
prolific  fluid,  as  well  as  by  preventing  that  erection  of  the  male 
organ  without  which  intercourse  cannot  take  place.  The  sexual 
function  is  so  intimately  allied  to  bodily  vigor  and  nervous  energy, 
that  the  integrit}T  of  the  one  may  be  pronounced  to  be  essential  to 
the  integrity  of  the  other.  Habits  of  drunkenness  and  the  abuse 
of  alcoholic  liquids,  tobacco,  or  opium,  may  give  rise  to  impotency 
by  the  injury  done  to  the  brain  and  nervous  system.  (The  reader 
will  find  this  subject  fullv  discussed  by  Mende,  "Ausfuhrl.  Handb. 
der  ger.  Med.,"  vol.  4,  p.  349.) 

In  Wood  v.  Hotham,  Jan.  7,  1864,  the  defendant,  a  surgeon,  was 
sued  for  a  sum  of  money  for  his  wife's  maintenance.  He  alleged,  in 
defence,  that  his  wife  had  been  guilty  of  adultery,  and  that  one  of  two 
children  born  during  the  marriage  was  not  his.  He  gave  as  a  reason 
for  this  that  at  the  time  he  was  so  ill  that  it  was  impossible  he  could 
have  had  connection  with  his  wife.  He,  however,  was  then  in  the 
habit  of  sleeping  with  her,  and  he  was  sufficiently  strong  to  go  his 
round  of  daily  visits.  The  learned  judge,  in  remarking  upon  this 
point,  said  if  such  evidence  were  to  be  held  sufficient  proof  of  ille- 
gitimacy, the  whole  of  the  law  relating  to  the  access  and  non-access 
of  a  husband  must  be  set  aside.  The  jury  returned  a  verdict  for 
the  plaintiff.  [See  the  case  of  Page  v.  Dennison,  5  Casey,  420, 
cited  ante. — P.] 

Diseases  and  injuries  of  the  spinal  cord  producing  paraplegia 
have  no  direct  effect  on  the  testicles,  but  destroy  the  power  to  copu- 
late. (Curling,  Op.  cit.  p.  371.)  When  there  is  a  wasting  of  the 
testicles,  as  a  result  of  general  paralysis  of  long  standing,  there  can 
be  no  doubt  of  impotency ;  but  Mr.  Curling  quotes  a  case  from  a 
foreign  writer,  in  which,  under  paralysis  (paraplegia)  of  some  years' 
duration,  a  man  retained  sufficient  sexual  power  to  have  prolific  in- 
tercourse. When  the  paralytic  person  is  advanced  in  age,  it  is 
highly  probable  that  he  is  impotent.  In  December,  1857,  a  case 
was  referred  to  me,  in  a  question  of  bastardy,  for  my  opinion  on  a 
capacity  for  intercourse  under  the  following  circumstances.  A 
woman  required  an  order  of  affiliation  on  the  putative  father  of 
her  bastard  child.  She  was  a  widow,  and  the  illicit  connection  took 
place  about  two  months  before  her  husband's  death.  The  husband 
was  at  the  time  84  years  of  age  ;  he  was  bedridden,  and  for  many 
weeks  before  his  death  he  could  not  move  in  his  bed,  and  was  un- 
able to  pass  his  urine  without  assistance.  The  medical  opinion  of 
those  who  examined  him  was  that  he  was  impotent  from  physical 
infirmity,  and  in  this  opinion  I  concurred ;  stating,  however,  that 
unless  the  male  organs  were  diseased  or  destroyed,  it  could  not  be 
said  that  intercourse  was  impossible.  It  was,  however,  wholly  im- 
probable that  the  husband  could  have  been  the  father  of  the  child. 


PROCREATIVE    POWER    IN    THE    FEMALE.  589 

Blows  on  the  head  or  spine,  by  affecting  the  brain  and  spinal 
marrow,  may  produce  impotency.  Several  cases  of  impotency  from 
this  cause  are  related  by  Curling  (op.  cit.  p.  362).  It  has  been  noticed 
that  blows  on  the  under  and  back  part  of  the  head,  in  the  region  of 
the  cerebellum,  have  been  followed  by  loss  of  sexual  power  on 
recovery.  Sometimes  this  is  temporary ;  but  at  other  times,  when 
there  is  wasting  of  the  testicles,  it  is  permanent  and  irremediable. 

Of  moral  causes  it  is  unnecessary  to  speak.  The  sexual  desire, 
like  other  animal  passions,  is  subject  to  great  variation;  and  there 
are  instances  on  record  in  which  men,  otherwise  healthy-looking  and 
healthily  formed,  have  experienced  no  desires  of  this  kind.  They 
are  in  a  state  of  natural  impotency — a  condition  which  the  Canon 
Law  designates  as  frigidity  of  constitution.  This  is  not  to  be  dis- 
covered by  external  examination,  but  rather  from  their  own  admission. 
Under  this  head  we  may  class  hypochondriacal  affections. 

Sterility.  Definition. — Sterility  is  usually  denned  to  be  "  the  in- 
ability to  procreate,  or  a  want  of  aptitude  in  the  female  for  impreg- 
nation. It  is  not  usual  to  speak  of  sterility  in  the  male,  although 
there  may  be  procreative  incapacity ;  because  the  defective  condition 
in  this  sex,  from  whatever  cause,  is,  in  a  legal  point  of  view,  included 
under  the  term  "  impotency"  (see  p.  578,  ante).  In  the  strictness  of 
language,  a  male  who  has  been  castrated  is  sterile  ;  but  it  is  commonly 
said  that  he  is  impotent.  Many  apparently  well-formed  males  may 
be  sterile  without  being  impotent,  i.  e.  they  may  have  intercourse 
without  procreating ;  for  the  power  of  copulating  must  not  be  con- 
founded with  that  of  procreation.  Mr.  Curling  has  pointed  out 
that  various  causes  may  render  a  male  sterile,  although  he  may  retain 
a  power  of  sexual  intercourse,  and  thus  cannot  be  regarded  as  im- 
potent in  a  legal  sense.  ("  Diseases  of  the  Testis,"  ed.  2,  p.  216.) 
Some  crypsorchides  may  be  sterile,  or  deficient  in  procreating  power, 
while  at  the  same  time  impotency  or  incapacity  for  intercourse  may 
not  exist.  In  reference  to  women,  sterility  implies  that  condition  in 
which  there  is  an  "inability  to  conceive."  This  appears  to  be  the 
true  meaning  of  the  term,  and  the  sense  in  which  it  is  used  not  only 
by  the  best  writers  but  in  common  phraseology. 

Procreative  Power  in  the  Female.  Puberty. — In  the  female,  the  pro- 
creative  power  is  supposed  not  to  exist  until  after  the  commencement 
of  menstruation,  and  to  cease  upon  the  cessation  of  this  periodical 
secretion.  The  menstrual  function  is  commonly  established  in  females 
in  this  climate  between  the  ages  of  fourteen  and  sixteen ;  but  it  may 
occur  much  earlier — indeed,  in  some  rare  instances,  a  discharge 
resembling  the  menstrual  has  been  known  to  occur  in  mere  infants. 
In  other  cases  its  appearance  has  been  protracted  to  a  much  later 
period.  According  to  Dr.  Eiittel,  the  menstrual  function  appears  in 
the  smallest  number  of  females  at  12,  13,  and  14,  and  in  the  largest 
number  at  16,  17,  and  18  years.  In  some  it  is  only  first  estab- 
lished, at  from  19  to  21  years;  and  he  states  that  at  this  age  he  lias 
often  found  the  uterus  small  and  quite  undeveloped.  The  earliest 
and  latest  periods  in  a  large  number  of  cases  were  respectively  9  and 


590  PREGNANCY    BEFORE    MENSTRUATION. 

23  years.  ("Lancet,"  Nov.  30,  1844,  p.  283.)  Perhaps,  in  this 
country,  the  most  frequent  age  for  the  commencement  of  menstrua- 
tion may  be  taken  at  15  years.  It  is  liable  to  be  accelerated  in  its 
appearance  by  certain  moral  and  physical  conditions  under  which  a 
girl  may  be  placed.  The  most  common  intervals  for  the  appearance 
of  this  function  are  twenty-eight  and  twenty-one  days.  It  sometimes 
does  not  appear  until  late  in  life.  Dr.  Camps  found  it  had  not 
appeared  in  a  married  woman,  set.  30,  who  had  borne  no  children. 
("Med.  Gaz.,"  vol.  32,  p.  409.)  Another  case  is  mentioned  in  the 
same  volume  where  it  appeared  for  the  first  time  at  the  age  of  47 
(p.  567.)  So  soon  as  this  function  commences,  a  woman  may  be 
considered  to  have  acquired  procreative  power ;  but  a  female  may 
conceive  before  the  function  has  commenced,  during  the  time  of  its 
occurrence,  or  after  it  has  ceased.  From  facts  elsewhere  stated  there 
is  some  reason  to  believe  that  the  period  which  immediately  precedes 
or  follows  the  discharge  is  most  favorable  to  conception :  although 
the  experience  of  many  accoucheurs  has  shown  that  impregnation 
may  take  place  at  any  time  between  one  menstruation  and  another. 

It  is  important  to  remember  that  these  changes  in  the  uterus  may 
produce  remarkable  effects  by  sympathy  with  the  brain  and  nervous 
system.  At  or  about  the  time  of  puberty,  especially  if  any  cause  of 
obstruction  exist,  females  become  irritable,  easily  excited,  and  they 
have  been  known  to  perpetrate,  without  motive,  crimes  of  great 
enormity,  such  as  murder  and  arson.  A  propensity  to  steal  is  also 
stated  sometimes  to  manifest  itself,  (see  post,  Kleptomania.)  It 
has  been  remarked  that  acts  of  arson  have  been  frequently  committed 
by  girls  at  this  period  of  life,  and  the  crime  has  spread  by  imitation. 
The  state  of  the  mind  should  be  therefore  carefully  watched  at  this 
time,  and  any  causes  of  violent  excitement  removed.  Irregularity, 
difficulty,  or  suppression  of  the  menstrual  secretion  may  give  rise  to 
temporary  insanity.  Puberty  in  the  male  may  be  attended  with 
similar  morbid  propensities,  but  these  are  not  so  commonly  witnessed 
as  in  the  female  sex. 

Pregnancy  before  Menstruation. — The  previous  occurrence  of  men- 
struation is  not  indispensable  to  pregnancy :  many  cases  are  on 
record  in  which  women  who  had  never  menstruated  have  conceived 
and  borne  children.  One  case  is  reported  in  which  a  woman,  aged 
25,  became  pregnant  and  bore  a  child,  and  menstruation  was  only 
regularly  established  afterwards.  ("Lancet,"  February,  1842.)  Dr. 
Murphy  mentions  another  instance  of  pregnancy  previous  to  men- 
struation in  a  woman  aged  23.  ("  Obstetric  Eeports,"  1844,  p.  7.) 
Numerous  cases  of  conception  without  previous  menstruation  are 
quoted  by  Capuron  ("  Med,  Le"g.  des  Ace,"  p.  96);  and  no  fewer 
than  nine  instances  of  pregnancy  before  menstruation  have  been 
collected  by  Mr.  Whitehead.  The  women  were  all  in  excellent 
health  during  the  whole  time,  and  one  did  not  menstruate  until  more 
than  two  years  after  the  marriage  had  been  consummated.  ("  <  >n 
Abortion,"  p.  223;  see  also  Orflla,  "Med.  Leg."  1848,  vol.  1,  p.  257.) 
Another  case  will  be  found  reported  in  the  "  Medical  Gazette"  (vol. 
44,  p.  969).     Dr.  W.  Taylor  met  with  an  instance  in  which  a  girl  aged 


PREMATUEE    PUBERTY    IN    FEMALES.  591 

13,  bore  a  child  before  menstruation  bad  appeared.  ("  Med.  Times 
and  Gazette,"  March  12,  1858,  p.  277 ;  see  also,  for  remarks  on  this 
subject,  "  Edin.  Monthly  Jour.,"  July,  1850,  p.  73.)  The  late  Dr. 
Reid  has  stated  that  a  patient  of  his  bore  a  child  at  the  age  of  17 
without  having  previously  menstruated  ;  and  he  collected  from  vari- 
ous authorities  a  number  of  cases  of  pregnancy  occurring  in  women 
who  had  not  menstruated.  ("Lancet,"  September  3,  1853,  p.  296.) 
[At  a  recent  meeting  of  the  College  of  Physicians  of  Philadelphia 
(Sept.  4,  1861),  Dr.  R.  P.  Thomas  stated  that  he  had  lately,  for  the 
third  time,  attended  in  confinement  a  lady  who  had  been  married 
about  twelve  years  and  had  given  birth  to  six  healthy  children, 
although  she  had  never  menstruated.  She  was  married  at  22,  and 
had  always  enjoyed  good  health ;  her  labors  were  natural,  with  but 
little  show  and  no  subsequent  lochial  discharge.  Dr.  Hays,  on  the 
same  occasion,  mentioned  the  case  of  a  lady  patient  of  his,  who  had 
menstruated  very  rarely,  not  oftener  than  once  a  year,  and  yet  had 
borne  six  healthy  children  at  intervals  of  fourteen  months,  and  was 
a  healthy  woman. 

The  slight  hemorrhage  and  absence  of  the  lochia  in  the  patient  of 
Dr.  Thomas  reminds  us  of  a  very  curious  observation  reported  by 
Dr.  0.  C.  Gibbs,  in  which  he  found  that  he  had  removed  the  placenta 
from  a  patient  without  encountering  bloody  fluid  enough  to  stain  his 
hand  !— H.] 

Instances  of  premature  puberty  in  the  female  are  now  numerous  : 
they  are  far  more  common  than  in  the  male  sex.  Mr.  Whitmore 
met  with  the  case  of  a  female  child  who,  from  a,  few  days  after  birth 
menstruated  regularly,  at  periods  of  three  weeks  and  two  or  three 
days,  until  she  had  attained  the  age  of  4  years,  when  she  died.  On 
inspection  after  death  she  appeared  like  a  much  older  girl.  The 
breasts  were  unusually  large,  and  the  female  organs  and  lower  limbs 
were  considerably  developed.  ("  North  Jour.  Med.,"  July,  1845,  p. 
70.)  Another  case  is  reported  in  the  "  Lancet"  (January  29,  1848, 
p.  137);  this  was  a  child  aged  3  years.  The  breasts  were  as  healthily 
developed  as  in  an  adult  of  20  years,  and  the  sexual  organs  were 
also  as  much  developed  as  in  a  girl  at  the  age  of  puberty.  It  was 
observed  that  this  child,  who  had  been  regularly  menstruating  for 
twelve  months,  had  the  appearance  of  a  little  old  woman.  (For 
other  cases  of  menstruation  at  5  years,  see  "  Med.  Gaz.,"  vol.  25,  p. 
548 ;  at  3  years,  vol.  47,  p.  244  ;  and  at  3£  years,  "  Med.  Times  and 
Gazette,"  July  24,  1858.)  In  these  instances  there  is  great  reason  to 
believe  that  a  procreative  power  is  also  early  developed ;  but  it  is 
not  common  to  hear  of  such  young  females  becoming  impregnated. 
A  case  is  mentioned  by  Dr.  Beck,  in  which  a  girl  menstruated  at  L 
year ;  she  became  pregnant  and  was  delivered  of  a  child  when  little 
more  than  ten  years  old.  Dr.  Walker  met  with  a  case  in  which  the 
menstrual  function  was  established  at  the  age  of  11|  years,  and  the 
patient  was  delivered  of  a  living  child  when  only  12  years  and  8 
months  old.  ("  Amer.  Jour.  Med.  Sci.,"  October,  1846,  p.  547.)  In 
another,  observed  by  Riittel,  already  referred  to,  a  female  of  the  age 
of  fourteen  became  pregnant  by  a  boy  of  the  same  age.     He  also 


592  MENSTRUAL    CLIMACTERIC. 

quotes  three  other  cases,  where  one  girl  of  the  age  of  nine,  and  two 
of  the  age  of  thirteen,  became  pregnant  (loc.  cit.).  The  first  of  these 
three  cases  represents  the  earliest  age  for  pregnancy  yet  assigned  by 
any  author.  Dr.  Wilson  met  with  an  instance  in  which  a  girl  at  the 
age  of  13  years  and  6  months  gave  birth  to  a  full-grown  child :  con- 
ception must  have  taken  place  when  she  was  12  years  and  9  months 
old.  ("  Ediri.  Med.  Jour.,"  October,  1861.  See  also  Casper's  "  Vier- 
teljahrschrift,"  January,  1863,  p.  180.)  Mr.  Robertson  mentions  the 
case  of  a  factory-girl  who  became  pregnant  in  the  eleventh  year  of 
her  age.  In  a  case  communicated  to  me  a  girl  menstruated  at  ten 
years  and  two  months,  and  became  pregnant  when  eleven  years  and 
eight  months  old. 

Age  at  which  Menstruation  ceases.  Menstrual  Climacteric.  —  The 
average  age  at  which  this  function  ceases  in  women  is  usually  from 
forty  to  fifty  years :  but  as  it  may  commence  early,  so  it  may  con- 
tinue late  in  life.  In  one  case  it  has  been  known  to  cease  at  the  age 
of  23,  and  in  other  instances  it  has  continued  to  the  age  of  66  and 
even  of  75  years.  ("Whitehead,  op.  cit.  p.  145  et  seq.)  Dr.  Royle 
describes  three  cases  in  two  of  which  menstruation  continued  up  to 
the  age  of  67.  ("  Med.  Times  and  Gaz.,"  Nov.  1860.)  Mr.  Thomas 
met  with  a  case  in  which  a  woman  had  ceased  to  menstruate  at  the 
age  of  forty -five,  but  the  discharge  suddenly  reappeared  after  an 
attack  of  illness  when  she  had  reached  the  age  of  sixty-nine.  The 
discharge  appeared  several  times,  but  not  with  monthly  periodicity. 
It  seems  that  her  mother  and  sister  had  also  menstruated  at  the  ages 
of  69  and  60.  ("  Med.  Times  and  Gaz.,"  Aug.  7,  1852,  p.  148.)  In 
a  case  which  occurred  to  Capuron,  it  continued  beyond  the  age  of 
60  (op.  cit.  p.  98);  but  a  more  remarkable  case,  both  of  late  men- 
struation and  late  pregnancy,  is  quoted  by  Orfila  from  Bernstein.  A 
woman  in  whom  the  function  appeared  at  20,  menstruated  until  her 
ninety-ninth  year.  Her  first  child  was  born  when  she  was  47,  and 
her  seventh  and  last  when  she  was  60.  ("Med. Leg."  4eme  ed.,  1848, 
vol.  1,  p.  257  ;  see  also  Briand,  "  Man.  Complet  de  Med.  Leg.,"  1846, 
p.  137.)  From  these  facts,  it  is  clear  that  it  is  impossible  to  fix  the 
age  of  a  woman  by  the  period  at  which  this  "change  of  life"  occurs. 
At  the  best,  it  can  only  be  an  average  of  a  certain  number  of  instances. 

Is  it  possible  for  a  Woman  to  become  Pregnant  after  Menstruation  has 
Ceased? — It  is  commonly  asserted  and  believed  that,  after  the  cessa- 
tion of  menstruation,  a  woman  is  sterile.  This  is  doubtless  the 
general  rule ;  but  in  a  medico-legal  view  it  is  necessary  to  take 
notice  of  the  exceptions.  Mr.  Pearson,  of  Staleybridge,  communi- 
cated to  the  "  Lancet,"  some  years  ago,  the  case  of  a  lady,  aged  44, 
who  up  to  September,  1836,  had  given  birth  to  nine  children.  After 
this  the  menses  appeared  only  slightly  at  the  regular  periods  until 
July,  1838,  when  they  entirely  ceased.  Owing  to  this,  she  supposed 
that  she  was  not  liable  to  become  pregnant ;  but  on  the  31st  Decem- 
ber, 1839 — therefore  eighteen  months  after  the  entire  cessation  of 
the  menses — she  was  delivered  of  her  tenth  child.  Hence  concep- 
tion must  have  taken  place  at  from  eight  to  nine  months  after  the 
final  cessation  of  the  discharge. 


CAUSES    OF    STERILITY.  593 

Latest  Age  for  Pregnancy.  Fecundity. — Numerous  instances  are  on 
record  of  women  advanced  in  life  bearing  children.  A  case  is  re- 
ported in  which  a  well-formed  woman,  who  had  been  married  nine- 
teen years,  did  not  bear  a  child  until  she  had  reached  the  age  of 
fifty.  (Schmidt's  "  Jahrbucher  d.  Med.,"  1838,  S.  65;  Henke's  "Zeit- 
schrift,"  1844,  S.  251.)  In  this  case  it  is  stated  that  menstruation 
had  ceased  two  years  before  conception.  Biittel  observed  in  twelve 
women  that  they  bore  their  last  children  at  ages  varying  from  45  to 
50  years.  Ottinger  met  with  an  instance  of  a  woman  bearing  a  child 
at  50  ;  Cederschjald  with  another,  where  the  woman  was  fifty -three 
and  menstruation  still  continued.  Haller  records  two  cases  in  which 
women  at  sixty-three  and  seventy  respectively  bore  children.  (Briand, 
"  Man.  Complet  de  Med.  Leg.,"  p.  137.)  Nevermann  has  drawn  up  a 
table  in  reference  to  the  late  ages  of  life  in  which  women  have  borne 
children.  Out  of  1000  cases  in  10,000  births,  he  found  that  436 
children  were  borne  by  females  at  the  ages  respectively — 

Of  41  years 101  Of  48  years 8 

42 113  49 t> 

43 70  I  50 9 

44 58  52 1 

45 43  53 1 

46 12  54 1 

47 -13 

A  case  was  communicated  to  the  "  Medical  Gazette"  (vol.  39,  p. 
950)  by  Dr.  Davies,  of  Hertford,  in  which  a  woman  was  fifty-five 
years  of  age  when  her  last  child  was  born;  she  menstruated  up  to 
that  time.  In  Lord  v.  Colvin  (Vice-Chancellor's  Court,  July,  1859), 
one  of  the  questions  raised  was  whether  a  woman  ast.  52,  who  had 
been  married  thirty  years  without  having  children,  had  then  passed 
the  age  of  child-bearing :  her  issue  would  in  that  case  take  the 
benefit  of  certain  property  under  a  will.  It  was  decided  that  the 
woman  had  not  reached  an  age  at  which  it  could  be  said  to  be  im- 
possible that  she  might  bear  children.  In  a  return  of  the  Begistrar- 
(Jeneral  for  Scotland  (Feb.  1862),  it  is  stated  in  the  Table  for  Glas- 
gow, that  one  mother  who  was  only  18,  had  had  four  children,  one 
who  was  22  had  had  seven  children,  and  of  two  who  were  only  34, 
the  one  had  had  thirteen  and  the  other  fourteen  children.  On  the 
other  hand,  two  women  became  mothers  as  late  in  life  as  at  51,  four 
at  52,  and  one  mother  was  registered  as  having  given  birth  to  a  child 
in  the  57th  year  of  her  age.  [Upon  this  point  we  have  the  testi- 
mony of  Sir  Edward  Coke,  who  tells  us  that  in  his  "time  a  woiuim 
above  three-score  yeares  old  hath  had  a  childe."  Co.  Litt.,  40,  a. — 1\] 
We  cannot  therefore  pretend  to  fix  the  age  beyond  which  pregnancy 
may  not  occur.  Questions  of  this  kind  have  an  important  bearing 
on  the  subject  of  legitimacy  ;  and  unless  the  law  looks  to  something- 
more  than  ordinary  professional  experience  in  such  matters,  the 
decisions  of  courts  must  be  inequitable.  In  two  recent  cases,  how- 
ever, it  appears  to  have  been  assumed  that  a  woman  could  not  bear 
;i  child  after  the  age  of  53.  This  was  the  decision  of  the  Master  of 
the  Rolls  in  Price  v.  Bouswd,  and  more  recently  the  decision  lias 
38 


59-i  MEDICO-LEGAL    RELATIONS. 

been  followed  by  Kindersley,  V.  C,  in  Haynes  v.  Haynes.  (Feb.  1866.) 
The  petition  in  this  case  involved  the  question  whether  a  single 
lady,  aged  53  in  December,  1865,  could  be  considered  as  past  child- 
bearing,  and  it  was  decided  in  favor  of  this  assumption.  These 
decisions  are  not  reconcilable  with  the  cases  given  at  p.  592. 

Causes  of  Sterility. — The  causes  of  sterility  in  the  female  system 
are  very  numerous.  Some  of  them  depend  upon  peculiarities  of 
constitution,  the  sexual  organs  being  well  formed  and  developed, 
others  upon  latent  changes  or  congenital  defects  in  the  uterus  and  its 
ap]  lendages,  only  discoverable  by  an  examination  after  death.  Ste 
rility  rarely  becomes  a  medical  question  in  contested  cases  of  legi- 
timacy ;  for  a  claim  on  the  part  of  a  person  to  be  the  offspring  of  a 
particular  woman,  unless  she  were  in  collusion  with  the  claimant, 
could  only  be  made  after  her  death :  and  if  not  disproved  by  medical 
evidence,  showing  that  the  woman  could  not  have  borne  children, 
it  would  in  general  be  easily  set  aside  by  circumstances.  It  may  be 
most  important  to  prove  that  a  woman  was  in  such  a  bodily  condi- 
tion that  she  never  could  have  conceived  or  borne  a  child.  If  the 
uterus,  ovaries,  or  other  parts  were  congenitally  defective  or  absent, 
or  if  there  were  external  sexual  malformation,  accompanied  by 
occlusion  or  obliteration  of  the  vagina,  a  medical  witness  could  have 
no  difficulty  in  saying  that  the  woman  must  have  been  sterile.  ("  Med. 
Times  and  Gazette,"  Jan.  28,  1858,  p.  96.)  A  mere  occlusion  of  the 
vagina,  removable  by  operation,  does  not  necessarily  indicate 
sterility,  for  the  internal  parts  may  be  healthy  and  sound. 

Medico-Legal  Relations  of  the  Subject.  Divorce. — Sexual  malforma- 
tion, involving  impotency  or  sterility,  constitutes  one  of  the  canoni- 
cal impediments  to  marriage,  and  if  matrimony  be  contracted  by  a 
party  laboring  under  such  malformation,  the  contract  is  voidable. 
The  impediment  constituting  impotency  may  arise  either  from  mal- 
formation, from  that  which  the  law  calls  frigidity  of  constitution,  or 
any  physical  cause  of  whatever  nature  which  may  render  intercourse 
impossible.  When  the  physical  defect  is  not  apparent  and  irreme- 
diable, a  continued  cohabitation  of  three  years  is  required  before  a 
suit  can  be  entertained  (Ayliff's  "  Parergon") ;  but  according  to 
Oughton — "haec  triennalis  expectatio  non  est  necessaria  ubi  statim 
possit  constare  de  impotentia  coeundi."  A  suit  for  a  sentence  of  nul- 
lity may  be  promoted  by  either  party,  and  the  medical  proof  required 
to  found  a  sentence  must  be  such  as  to  satisfy  the  court  that  the  in- 
capacity pleaded  was  in  existence  at  the  time  of  the  marriage,  and 
that  it  still  remained  without  remedy.  There  should  be  no  dekry  in 
instituting  the  suit,  and  there  should  be  proof  that  the  impediment 
was  not  known  to  the  complaining  party  at  the  time  of  the  contract. 
A  longer  delay  in  making  the  complaint  is  allowed  to  a  female, 
without  prejudicing  her  case,  than  to  a  male,  by  reason  of  the  modesty 
of  her  sex.  In  a  suit  which  came  before  the  ecclesiastical  courts  in 
1845,  a  singular  question  arose,  whether,  when  there  was  a  capacity 
for  sexual  intercourse  on  the  part  of  a  woman,  with  a  certainty  that 
from  physical  defect  it  could  never  be  prolific,  this  was  sufficient  to 
entitle  the  husband  to  a  divorce.    On  the  part  of  the  woman  it  was  in- 


SUITS    FOR    DIVORCE.  595 

sisted  that  in  order  to  entitle  a  party  to  a  sentence  of  divorce,  there 
must  be  an  utter  impossibility  of  sexual  intercourse.  The  cast',  it 
was  argued,  was  one  of  mere  sterility,  which  was  no  ground  for  a 
sentence.  Dr.  Lushington,  in  pronouncing  sentence,  said  that  mere 
incapability  of  conception  is  not  a  sufficient  ground  whereon  to  found 
a  decree  of  nullity.  The  only  question  is,  whether  a  female  is  or  is 
not  capable  of  sexual  intercourse;  or,  if  at  present  incapacitated, 
whether  that  incapacity  admits  of  removal ;  a  power  of  sexual  in- 
tercourse is  necessary  to  constitute  the  marriage-bond ;  and  this 
intercourse  must  be  ordinary  and  complete,  not  partial  and  imper- 
fect ;  yet  it  would  not  be  proper  to  say  that  every  degree  of  imper- 
fection would  deprive  it  of  its  natural  character.  If  it  be  so  imper 
feet  as  to  be  scarcely  natural,  it  is,  legally  speaking,  no  intercourse 
at  all.  As  to  conception,  there  is  no  doubt  that  the  malformation  is 
incurable.  If  there  was  a  reasonable  probability  that  the  female 
could  be  made  capable  of  natural  coitus,  the  marriage  could  not  be 
pronounced  void ;  if  she  could  not  be  made  capable  of  more  than  an 
incipient,  imperfect,  and  unnatural  coitus,  then  it  would  be  void. 

From  cases  hitherto  decided,  it  appears  that  in  order  to  justify  a 
decree  of  divorce  on  the  ground  of  impotency  or  sterility,  the  im- 
pediment to  intercourse  or  procreation  should  be  established  by  good 
medical  evidence,  and  it  must  be  apparent  and  irremediahle ;  it  must 
also  have  existed  before  the  marriage  of  the  parties,  and  have  been 
entirely  unknown  to  the  person  suing  for  the  divorce ;  if  it  has  super- 
vened after  the  marriage,  this  is  no  ground  for  a  suit.  The  nature 
of  the  impediment  is  to  be  determined  by  private  medical  opinions 
or  affidavits,  based  on  an  examination  of  both  parties.  There  is  one 
remarkable  circumstance  with  respect  to  these  cases ;  namely,  that 
in  nearly  all  of  them  the  suit  is  by  the  woman  against  the  man  ; 
although  there  is  no  reason  whatever  to  suppose  that  impotency  and 
sexual  malformation  are  more  common  in  males,  than  malformation 
and  sterility  in  females.  We  rarely  hear  of  a  husband  instituting  a 
suit  of  divorce  on  the  ground  of  sterility  (incapacity  of  procreation) 
in  the  wife ;  it  is,  I  believe,  in  most  instances,  that  the  wife  promotes 
the  suit  on  the  ground  of  impotency  or  incapacity  of  intercourse  in 
the  husband.  The  difficulty  of  establishing  incapacity  in  the  female, 
and  the  facility  of  proving  impotency  from  physical  causes  in  the 
male,  may  probably  account  for  this  difference.  Suits  of  this  kind 
are  sometimes  instituted  many  months  and  years  after  the  union  of 
the  persons ;  but  it  is  pretty  certain  that  the  desire  for  separation 
in  these  cases  often  depends  on  some  other  cause,  which  the  law 
would  not  recognize  as  sufficient  of  itself,  while  it  would  admit  the 
plea  of  impotency.  The  French  law  very  judiciously  applies  the 
principle  of  condonation  to  such  cases,  so  that  no  suit  for  nullity  of 
marriage  can  be  entertained,  if  cohabitation  has  continued  for  six 
months  alter  the  discovery  of  the  personal  defect.  This  appears  to 
be  more  consistent  with  justice  than  our  own  law,  but  practically 
these  suits,  alter  protracted  cohabitation,  are  always  regarded  with 
great  suspicion. 


596  DEFINITION    OF    EAPE. 


RAPE. 


CHAPTEE    LVI. 

Sources  of  medical  evidence. — rape  on  infants  and  children. — 

marks  of  violence. purulent  discharges  from  the  vagina. 

— -evidence  from  gonorrhoea  and  syphilis. rape  on  girls 

after  puberty. — defloration. — signs  of  virginity. 

Rape  is  defined  in  law  to  be  the  carnal  knowledge  of  a  woman  by 
force,  and  against  her  will.  Medical  evidence  is  commonly  required 
to  support  a  charge  of  rape,  but  it  is  seldom  more  than  corrobora- 
tive; the  facts  are,  in  general,  sufficiently  apparent  from  the  statement 
of  the  prosecutrix.  There  is,  however,  one  case  in  which  medical 
evidence  is  of  some  importance — namely,  when  a  false  accusation  is 
made.  In  some  instances,  as  in  respect  to  rape  on  infants  and  chil- 
dren, the  charge  may  be  founded  on  mistake ;  but  in  others  there  is 
little  doubt  that  it  is  often  wilfully  and  designedly  made  for  motives 
into  which  it  is  here  unnecessary  to  inquire.  The  late  Professor 
Amos  remarked,  that  for  one  real  rape  tried  on  the  circuits,  there 
were  on  the  average  twelve  pretended  cases !  In  some  few  instances 
these  false  charges  are  at  once  set  aside  by  medical  evidence — in 
others,  medical  men  may  be  sometimes  the  dupes  of  designing  per- 
sons; but  in  the  majority,  the  falsehood  of  the  charge  is  proved  by 
inconsistencies  in  the  statement  of  the  prosecutrix  herself.  I  am  in- 
formed that  in  Scotland,  where  there  is  a  public  prosecutor,  and  a 
careful  preliminary  inquiry,  false  charges  of  rape  are  exceedingly 
rare.  The  consent  of  the  girl  does  not  excuse  or  alter  the  nature  of 
the  crime  when  she  is  under  ten  years  of  age,  since  consent  at  this 
period  of  life  is  invalid ;  and  the  carnal  knowledge  of  such  a  girl  is 
rape  in  law,  and  is  made  a  felony  by  the  24  &  25  Vict.  c.  100,  s.  50. 
Even  the  solicitation  of  the  act  on  the  part  of  a  child  does  not 
excuse  it. 

[The  provisions  of  the  Revised  Criminal  Code  of  Pennsylvania, 
Act  of  81st  March,  1860,  §§  91,  92,  93  upon  this  subject,  are  as  fol- 
lows : — 

§  91.  If  any  person  shall  have  unlawful  carnal  knowledge  of  a 
woman,  forcibly  and  against  her  will,  or  who  being  of  the  age  of 
fourteen  years  and  upwards,  shall  unlawfully  and  carnally  know  and 
abuse  any  woman  child  under  the  age  of  ten  years,  with  or  without 
her  consent:  such  person  shall  be  adjudged  guilty  of  felonious  rape, 
and  on  conviction,  be  sentenced  to  pay  a  line  not   exceeding  one 


EAPE    ON    INFANTS    AND    CHILDREN.  597 

thousand  dollars,  and  to  undergo  an  imprisonment,  by  separate  or 
solitary  confinement  at  labor,  not  exceeding  fifteen  years. 

§  92.  It  shall  not  be  necessary,  in  any  case  of  rape,  sodomy,  or 
carnal  abuse  of  a  female  child  under  the  age  of  ten  years,  to  prove 
the  actual  emission  of  seed,  in  order  to  constitute  a  carnal  knowledge, 
but  the  carnal  knowledge  shall  be  complete  upon  proof  of  penetra- 
tion only. 

§  98.  If  any  person  shall  be  guilty  of  committing  an  assault  and 
battery  upon  a  female,  with  intent,  forcibly  and  against  her  will,  to 
have  unlawful  carnal  knowledge  of  such  female,  every  such  person 
shall  be  guilty  of  a  misdemeanor,  and,  on  conviction,  be  sentenced 
to  pay  a  fine  not  exceeding  one  thousand  dollars,  and  to  undergo  an 
imprisonment,  by  separate  or  solitary  confinement  at  labor,  not  ex- 
ceeding five  years. — P.] 

The  duty  of  a  medical  witness  on  these  occasions  is  very  simple; 
and  perhaps  this  will  be  best  understood  by  considering  the  subject 
in  relation  to  females  at  different  ages.  On  being  called  to  examine 
a  person  on  whom  a  rape  is  alleged  to  have  been  committed,  the  first 
circumstance  which  a  practitioner  should  notice  is  the  precise  time 
and  date  at  which  he  is  summoned,  taking  an  early  opportunity  of 
comparing  his  watch  with  some  neighboring  clock.  This  ma)-  ap- 
pear a  trivial  matter,  and  one  wholly  irrelevant  to  the  duties  of  a 
medical  practitioner ;  but  it  is  to  be  observed  that  the  time  at  which 
a  surgeon  is  required  to  examine  a  prosecutrix  may  form  a  material 
part  of  the  subsequent  inquiry.  It  will  be  highly  important  to  the 
defence  of  a  person  accused,  if  it  can  be  proved  that  the  female  did 
not  take  the  earliest  opportunity  to  complain;  and  it  may  be  also 
the  means  of  defeating  an  alibi  falsely  set  up  for  the  defence.  Medi- 
cal evidence  in  cases  of  rape  may  be  derived  from  four  sources :  1. 
Marks  of  violence  about  the  genitals.  2.  Marks  of  violence  on  the 
person  of  prosecutrix  or  prisoner.  3.  The  presence  of  stains  of  the 
spermatic  fluid  or  of  blood,  on  the  clothes  of  the  prosecutrix  or  pri- 
soner. 4.  The  existence  of  gonorrhoea  or  syphilis  in  one  or  both. 
This  evidence  will  vary  according  to  the  following  circumstances : — 

Rape  on  Infants  and  Children. 

The  sexual  organs  should  in  these  cases  present  marks  of  injury 
if  the  crime  has  been  completed,  and  there  lias  been  any  resistance  on 
the  part  of  the  chill;  for  it  is  impossible  to  conceive  that  forcible  in- 
tercourse should  take  place  without  the  production  of  ecchymosis, 
the  effusion  of  blood,  or  a  laceration  of  the  pudendum.  Even  with- 
out reference  to  manual  violence  on  the  part  of  the  assailant  it  an 
adult,  the  size  of  the  male  organ  must  generally  cause  much  local 
injury  in  the  attempt  to  enter  the  vagina  of  a  child.  If  the  viola  I  ioj] 
has  taken  place  within  two  or  three  days,  the  appearances  presented 
by  the  parts  may  be  as  follows:  1.  Inflammation,  with  more  or  [ess 
abrasion  of  the  lining  membrane.  2.  A  mueo-punilent  discharge 
IV' nil  the  vagina,  of  a  ropy  consistency  and  of  a  yellowish  or  greenish- 
yellow  color,  staining  and  stiffening  the  linen  worn  by  the  girl;  the 


598  MEDICAL    EVIDENCE. 

mucous  membrane  of  the  urethra  is  inflamed,  rendering  the  dis- 
charge of  urine  painful.  3.  In  recent  cases  blood  may  be  oozing 
from  the  abraded  membrane,  or  clots  of  blood  maybe  found  de- 
posited in  the  vulva.  4.  The  hymen  may  be  entirely  destroyed,  or 
( what  is  more  commonly  observed)  it  may  present  on  careful  exami- 
nation one  or  more  slight  cuts  or  lacerations.  Owing  to  the  inflamed 
state  of  the  parts,  the  proper  examination  of  the  hymen  is  rendered 
difficult — any  attempt  to  separate  the  thighs  for  this  purpose  causing 
great  pain.  For  this  reason,  also,  the  child  walks  with  difficulty 
and  complains  of  pain  in  walking.  5.  Lastly,  the  vagina  may  be 
unnaturally  dilated. 

It  has  been  propounded  as  a  serious  question,  whether  a  rape  can 
be  perpetrated  on  children  of  tender  age  by  an  adult  man;  and  medi- 
cal witnesses  at  trials  have  adopted  conflicting  opinions.  Some  are 
inclined  to  regard  all  such  charges  as  unfounded,  and  to  seek  for 
other  medical  explanations  of  the  symptoms  above  described.  This 
practice  has  been  carried  of  late  years  to  an  undue  extent,  simply 
because  many  of  these  charges  have  been  proved  to  be  false;  but 
common  experience,  supported  as  it  is  by  the  accurate  observations 
of  Casper  ("Ger.  Med.,''  vol.  2,  p.  130),  show  that  there  is  too  fre- 
quently a  real  foundation  for  the  charge  in  reference  to  children, 
and  that  a  girl  is  not  to  be  discredited  merely  because  of  her  tender 
age.  This  would  be  conferring  impunity  on  the  acts  of  a  vile  class 
of  offenders.  In  all  cases  there  should  be  good  medical  evidence 
and  a  corroboration  from  circumstances. 

For  the  legal  establishment  of  the  crime,  proof  of  penetration 
only  is  demanded  (24  &  25  Vict.  c.  100,  s.  63),  and  a  sufficient  de- 
gree of  penetration  to  constitute  rape  in  law  may  take  place  with- 
out necessarily  rupturing  the  hymen.  There  must  be  medical  evi- 
dence to  show  that,  in  a  special  case,  there  was  actual  penetration — 
the  degree  of  penetration  being  quite  immaterial.  It  is  true  that 
there  could  not  be  a  complete  introduction  of  the  adult  male  organ 
into  the  vagina  of  a  child  without  a  rupture  or  laceration  of  the  soft 
parts  ;  but  the  absence  of  such  marks  of  violence  would  not  justify 
a  medical  witness  in  denying  the  perpetration  of  the  crime,  since 
the  law  does  not  require  proof  either  of  a  complete  or  of  a  violent 
introduction.  It  has  been  decided  that  penetration  to  the  vulva 
alone,  is  sufficient  to  constitute  this  crime.  Medical  men  have  some- 
times fallen  into  an  error  on  this  point,  considering  that  when  the 
hymen  was  entire,  rape  could  not  have  been  committed ;  but  the 
Statute  Law  says  nothing  about  the  rupture  of  the  hymen  as  a 
necessary  part  of  the  medical  evidence ;  it  merely  requires  from 
the  medical  witness  proof  of  vulval  penetration — this  may  occur 
and  the  hymen  remain  intact. 

In  Scotland  this  question  came  formally  before  the  judges  in  the 
case  of  Macrae  (High  Court  of  Justiciary,  1841).  It  was  insisted  by 
the  prisoner's  counsel,  that  there  should  be  proof  of  full  and  com- 
plete penetration;  and  there  was  no  sufficient  evidence  to  show  that 
penetration  had  taken  place  into  the  canal  of  the  vagina  beyond  the 
vulva.     Lord  Meadowbank  charged  the  jury  to  the  effect,  that  the 


EXAMINATION    OF    CHILDREN".  599 

evidence  of  the  prisoner's  guilt  was  complete;  that  scientific  and 
anatomical  distinctions  as  to  where  the  vagina  commenced,  were 
worthless  in  a  charge  of  rape;  and  that  by  the  law  of  Scotland  it 
was  enough  if  the  woman's  body  was  entered.  In  a  case  like  this, 
where  there  was  no  evidence  of  emission,  and  the  girl  was  young, 
he  did  not  consider  it  necessary  to  show  to  what  extent  penetration 
of  the  parts  had  taken  place — or  to  prove  that  it  had  gone  either 
past  the  hymen,  into  what  was  anatomically  called  the  hymen,  or 
even  so  far  only  as  to  touch  the  hymen.  The  prisoner  was  con- 
victed. ("Cormack's  Edin.  Jour.,"  January,  1846,  p.  48.)  I  am  in- 
formed that  up  to  the  date  of  the  case  of  Macrae,  it  had  been  the 
practice  with  the  Scotch  judges  to  require  proof  of  full  and  complete 
penetration.  See  on  this  question  a  paper  by  the  late  Dr.  Easton 
("Glasgow  Med.  Jour.,"  July,  1859,  p.  129).  ["In  this  country  the 
rule  that  there  must  be  some  entrance  proved  of  the  male  within  the 
female  organ,  but  that  neither  rupture  of  the  hymen  nor  emission 
need  be  proved,  has  been  universally  followed."  Wharton  &  Stille, 
Med.  Juris.,  p.  471. — II.] 

Marks  of  Violence  on  the  Pudendum. — When  there  are  no  marks 
of  violence  or  physical  injury  about  the  pudendum  of  a  child, 
whether  because  none  originally  existed,  or  they  existed  and  had 
disappeared  in  the  course  of  time,  a  medical  witness  must  leave  the 
proof  of  rape  to  others.  He  can  only  answer  questions  of  possi- 
bility or  probability,  according  to  the  special  facts  proved.  It  is, 
however,  in  all  cases  his  duty  to  be  guarded  in  giving  an  opinion 
that  a  rape  has  been  perpetrated,  when  there  is  a  total  absence  of 
marks  of  violence  on  the  genitals.  It  is  true  that  rape  in  a  legal 
sense  may  be  perpetrated  without  necessarily  producing  such  marks 
on  a  child,  but  then  the  proof  of  the  crime  will  not  depend  on  medi- 
cal evidence  only.  The  absence  of  marks  of  violence  on  the  geni- 
tals, when  an  early  examination  has  been  made,  furnishes  a  strong 
presumption  that  rape  has  not  been  committed  on  these  young  per- 
sons. It  is  obvious  that  a  false  charge  might  be  easily  made  and 
sustained,  if  medical  opinions  were  hastily  given  on  the  statements 
of  a  mother  and  child,  when  there  was  no  physical  appearance  to 
corroborate  the  accusation.  See  on  this  subject  a  paper  by  M. 
Toulmouche,  "Ann.  d'llyg."  October  1  (8,  p.  338). 

Supposing  at  the  period  of  examination  no  marks  exist,  it  may 
be  necessary  to  consider  whether  there  has  been  time  for  them  to 
disappear  since  the  alleged  perpetration  of  the  offence;  but  in  such 
cases  it  is  rarely  in  the  power  of  a  medical  witness  to  express  an 
affirmative  opinion  of  the  perpetration  of  the  crime :  he  should 
leave  this  to  be  proved  by  the  general  and  circumstantial  evidence. 
Casper  met  with  a  case  in  whirl)  a  man  get.  37  committed  a  rape  on 
a  girl  only  eight  years  of  age:  he  was  seen  in  tin'  act,  and  defended 
himself  on  the  plea  of  drunkenness.  The  girl  was  examined  by  a 
medical  man  on  the  day  following — -the  labia  were  then  reddened, 
and  there  was  injection  of  the  membrane  at  the  entrance  of  the 
vagina  which  was  very  sensitive.  As  an  illustration  of  the  rapidity 
with  which  the  marks  of  rape  disappear  in  young  children,  when 


600  EAPE.      APPEARANCES    IN    CHILDREN. 

not  attended  with  great  physical  injury,  it  may  be  stated  that  this 
girl  was  carefully  examined  by  Casper  eleven  days  after  the  assault. 
The  sexual  organs  were  then  in  their  natural  state ;  there  was  not 
the  least  appearance  of  local  injury,  and  no  inference  could  have 
been  drawn  at  this  date,  that  the  girl  had  been  subjected  to  any 
violence. 

Medical  practitioners  are  not  always  sufficiently  careful  in  the  in- 
ferences which  they  draw  from  an  examination  of  children  at  dis- 
tant periods  after  an  alleged  rape.  They  allow  themselves  to  be 
deceived  by  a  plausible  story,  apparently  consistent,  and  thus  see, 
or  think  they  see,  proofs  of  rape  on  examining  the  sexual  organs  of  a 
girl  many  weeks  after  the  alleged  perpetration  of  the  crime ;  whereas, 
had  the  girl  been  brought  before  them  as  a  casual  patient,  and  no 
suggestion  of  violent  intercourse  had  been  made,  they  would  have 
probably  ridiculed  the  idea  of  basing  a  charge  of  rape  on  so  slender  a 
foundation.  The  delay  in  having  the  examination  made,  unless  satis- 
factorily explained,  is  in  itself  always  a  suspicious  circumstance.  In 
one  case  sent  for  trial  to  the  assizes,  but  rejected  by  the  Grand  Jury, 
a  medical  man  gave  strong  evidence  that  a  rape  had  been  committed 
on  a  girl  seven  years  of  age,  although  he  did  not  examine  her  until 
six  weeks  had  elapsed  from  the  date  assigned  by  the  parents ! 

On  the  other  hand,  when  marks  of  violence  on  the  genitals  are  pre 
sent,  they  must  not  be  hastily  assumed  as  furnishing  proofs  of  rape; 
for  cases  are  recorded  in  which  such  injuries  have  been  purposely 
produced  on  young  children  by  women,  as  a  foundation  for  false 
charges  against  persons  with  a  view  of  extorting  money.  The  proof 
or  disproof  of  facts  of  this  kind  must  rest  more  upon  general  than 
on  medical  evidence,  unless  the  injuries  obviously  indicate  the  use 
of  some  weapon  or  instrument.  It  should  be  remembered  that  the 
hymen  is  not  always  present  in  young  children:  it  may  be,  according 
to  some,  congenitally  deficient,  or,  what  is  more  probable,  it  may 
have  been  destroyed  by  ulceration  or  suppurative  inflammation  of 
the  parts,  a  disease  to  which  female  infants  of  a  scrofulous  habit  are 
very  subject.  The  mere  absence  of  this  membrane,  therefore,  can 
afford  no  proof  of  the  perpetration  of  the  crime,  unless  we  find 
traces  of  its  having  been  recently  torn  by  violence. 

Other  and  more  important  deductions  may,  however,  be  drawn 
from  the  presence  of  severe  injuries  on  the  genitals,  i.  e.  of  rupture, 
or  laceration  of  the  vagina  or  perimeum.  It  is  difficult  to  obtain 
accurate  medical  reports  of  these  cases  as  they  occur  in  England: 
but  it  is  quite  clear  that  the  male  organ  may  produce  much  physical 
injury  whether  the  child  does  or  does  not  resist  the  attempt.  (Cas- 
per's "Vierteljahrschrift,"  April,  1863,  p.  337.)  Dr.  Chevers,  in  referring 
to  Indian  experience,  says  that  in  a  large  proportion  of  rapes  on  chil- 
dren, it  was  very  clearly  proved  that  rather  severe  injuries  had  been 
inflicted  on  them.  In  the  "  Nizamut  Adawlut  Eeports"  (1853-5)  there 
are  several  instances  recorded  in  which  the  vagina  was  lacerated. 
Out  of  QQ  trials  for  rape,  there  were  25  convictions :  and  in  one-half  of 
these,  the  females  were  under  the  age  of  twelve  years.  In  one  case 
of  a  girl,  set.  12,  there  was  a  rupture  of  the  lower  part  of  the  vagina 


APPEARANCES    OF    GENITAL    ORGANS    IN    CHILDREN.      601 

to  the  extent  of  half  an  inch.  In  another,  a  child  of  six,  but  appa- 
rently much  younger,  had  suffered  as  a  result  of  rape,  from  rupture 
of  the  hymen  and  laceration  of  the  perinseum  and  vagina.  In  one 
instance  the  violence  proved  fatal,  but  the  medical  particulars  were 
not  given.  ("Med.  Jur.  for  India,"  p.  468.)  When  it  is  alleged  that 
injuries  have  been  intentionally  produced  on  the  genitals  of  a  child 
by  mechanical  means,  with  a  view  of  extorting  money  in  laying  a 
false  charge  of  rape,  the  medical  evidence  can  do  no  more  than  show 
that  a  girl  with  such  appearances  about  her  sexual  organs  has  suf- 
fered from  some  violence  applied  to  the  part,  but  whether  by  the 
human  member,  or  any  other  physical  means,  it  would  be  impossible 
to  say.  The  only  chance  of  getting  at  the  truth  in  such  a  case  is  by 
a  rigorous  cross-examination  of  the  mother  and  child  in  the  absence 
of  each  other. 

In  January,  1858,  a  girl  seven  years  old  was  brought  into  Guy's 
Hospital,  owing  to  injuries  resulting  from  a  perpetration  of  rape  by 
a  boy  under  seventeen  years  of  age.  About  half  an  hour  had 
elapsed;  she  was  then  examined  by  Mr.  Hicks,  the  house-surgeon, 
and  he  found  that  there  was  a  complete  destruction  of  the  hymen 
with  a  laceration  of  about  one-eighth  of  an  inch  extending  into  the 
perinaeum.  There  had  been  profuse  bleeding,  as  the  clothes  were 
saturated  with  blood.  There  was  then  no  complaint  of  pain,  and 
there  were  no  scratches  or  marks  of  violence  on  any  part  of  the  body. 
There  was  no  discharge  of  a  purulent  kind.  The  child  was  of  a  scro- 
fulous habit:  but  she  was  not  suffering  from  vaginitis,  and  appeared 
in  other  respects  perfectly  healthy.  I  saw  the  girl  with  Mr.  Hicks 
about  forty-eight  hours  after  the  occurrence;  the  bleeding  had  then 
ceased,  and  the  extent  of  the  lacerations  was  very  perceptible.  There 
was  no  discharge  of  any  kind  from  the  vagina,  and  no  inflamed  or 
swollen  condition  of  the  parts.  The  boy  was  examined  by  Mr. 
Hicks  about  an  hour  after  the  perpetration  of  the  rape,  and  although 
he  had  been  under  strict  custody,"  and  had  no  opportunity  of  chang- 
ing his  clothes,  there  was  no  blood  found  about  his  private  parts,  or 
on  his  clothing.  It  is  probable,  as  the  boy  was  interrupted  in  the 
act  by  the  screaming  of  the  girl,  that  he  suddenly  withdrew  after 
having  caused  the  laceration,  and  that  the  bleeding  was  an  after  effect 
of  oozing  from  the  ruptured  vessels.  This  is  an  important  fact,  be- 
cause, had  not  the  circumstances  been  known,  the  absence  of  blood 
on  his  person  might  have  been  construed  into  a  strong  proof  of  inno- 
cence. Dr.  Sawyer  met  with  a  case  in  which  a  rape  was  committed 
on  a  girl  get.  5.  There  was  a  bruised  and  swollen  state  of  the  geni- 
tals: the  hymen  was  not  ruptured,  and  there  was  no  laceration  of 
parts.  In  spite  of  this  a  large  amount  of  blood  had  been  lost.  This 
bleeding,  he  considers,  took  place  from  the  hymen,  Avhich  was  in  a 
highly  congested  state.  The  man  who  had  perpetrated  the  crime 
was  examined  soon  afterwards,  but  no  appearance  of  blood  was 
found  on  his  organs:  there  were  a  few  stains  only  on  the  front  of  his 
clothing.  ("New  Orleans  Med.  Cum."  1858,  p.2  88.)  A  case  occurred 
to  Mr.  Sells,  of  Guildford,  in  1868,  in  which  he  found  on  examining 
the  person  of  a  girl  said  to  have  been  violated,  laceration  of  the 


602      APPEARANCES    OF    GENITAL    ORGANS    IN    CHILDREN. 

hymen,  a  clot  of  blood  recently  effused  lying  on  the  vulva,  and  the 
thighs  of  the  child  smeared  with  blood,  quite  fresh;  there  was  also 
blood  on  the  sheets  of  the  child's  bed.  The  next  morning  he 
examined  the  accused,  but  he  could  find  no  trace  of  blood  upon  him 
or  on  the  clothing  which  he  wore  at  the  time  of  the  alleged  assault. 
In  this  case,  as  there  was  a  failure  of  identity,  the  accused  was  dis- 
charged. 

Sometimes,  owing  to  the  violence  used,  the  parts  are  much  lace- 
rated ;  and  inflammation,  followed  by  sloughing  or  mortification, 
may  set  in  and  destroy  life,  especially  in  children  of  an  unhealthy 
habit.  Care  should  be  taken  that  the  symptoms  of  a  malignant  form 
of  disease  (noma),  to  which  female  children  when  in  a  dirty  or  neg- 
lected state  are  liable,  are  not  mistaken  for  the  results  of  criminal 
violence. 

Some  cases  are  reported,  from  which  it  would  appear  that  men 
have  narrowly  escaped  conviction  for  a  crime  which  had  really  not 
been  perpetrated.  Dr.  Percival,  in  his  "  Medical  Ethics"  (3d  ed., 
1849,  p.  117),  has  related  a  case  which  has  been  the  subject  of  fre- 
quent quotation  and  comment  in  reference  to  false  charges  of  rape. 
A  girl  aet.  1  was  admitted  into  the  Manchester  Infirmary,  in  Feb- 
ruary, 1791,  on  account  of  a  mortification  of  the  female  organs  and 
general  depression  of  strength.  She  had  been  in  bed  with  a  boy 
fourteen  years  old,  and  it  was  supposed  that  he  had  taken  criminal 
liberties  with  her.  The  mortification  increased,  and  the  child  died. 
The  bov  was  tried  on  a  charge  of  rape  at  the  Lancaster  Assizes,  but 
ac<  [uitted  on  evidence  being  adduced  that  several  instances  of  a  simi- 
lar disease  had  appeared  among  girls  about  the  same  period  of  time, 
in  which  there  was  no  reason  to  suspect  injury  or  guilt.  In  one  of 
these  cases  there  was  typhus  fever  with  a  modification  of  the  geni- 
tals. There  was  no  cause  of  death  discoverable  on  inspection ;  the 
lumbar  glands  were  of  a  dark  color,  but  all  the  viscera  were  sound. 
This  case,  with  the  whole  of  Mr.  Kinder  Wood's  paper  on  the  sub- 
ject,  has  been  republished  by  Mr.  Kesteven.  ("Med.  Times  and 
Gaz.,"  1859,  April  23  and  30.)  A  case  of  this  disease  {noma  pudendi), 
but  in  which  no  charge  of  rape  was  made,  was  referred  to  me  in 
December,  1865.  E.  A.  E.,  a  girl  ast.  5,  died  suddenly  under  circum- 
stances which  led  to  a  suspicion  that  poison  had  been  administered 
to  her.  There  was  congestion  of  the  lining  membrane  of  the  stomach, 
but  no  poison  was  found  in  the  body,  and  there  was  no  trace  of  the 
action  of  poison.  "When  the  body  was  inspected,  the  genitals  exter- 
nally and  the  skin  around  and  beyond  the  anus  were  intensely  in- 
flamed, swollen,  and  ulcerated,  and  in  an  approaching  state  of  gan- 
grene or  slough.  The  hymen  at  the  entrance  was  ruptured,  and  the 
lining  membrane  of  the  vagina  and  uterus  was  highly  inflamed,  of 
a  dark  purple  color,  with  softening  and  disorganization  of  substance. 
The  inguinal  glands  were  enlarged  on  both  sides.  The  child  was  in 
a  neglected  and  dirty  state,  and  died  from  the  exhaustion  produced 
by  the  disease  and  want  of  proper  food  and  support.  Deceased  was 
seen  by  a  medical  man  shortly  before  her  death,  and  the  state  of  the 
genitals  was  only  discovered  by  accident,  the  mother  having  made 


APPEARANCES    OF    GENITAL    ORGANS    IN    CHILDREN.      603 

no  observation  about  it.  When  questioned  on  the  subject,  she  said 
the  girl  had  been  blown  down  about  a  fortnight  before  and  had  in- 
jured herself  by  falling  on  some  thorns.  This  was  quite  inadequate 
to  account  for  the  condition  of  the  parts.  There  was  no  doubt  that 
this  was  a  case  of  noma  rendered  fatal  by  neglect  in  an  unhealthy 
child.  Had  any  man  been  seen  noticing  this  child,  a  charge  of  rape 
might  easily  have  been  founded  upon  the  state  of  the  genital  organs. 

On  the  other  hand,  fatal  injury  may  be  done  to  these  organs  in 
criminal  assaults.  Mr.  Colles  has  reported  a  case  in  which  a  rape 
was  committed  by  an  adult  on  a  child  eight  years  old ;  it  terminated 
fatally  from  peritonitis,  as  a  result  of  the  violence,  six  days  after  the 
assault.  The  child  stated  that  the  accused  had  had  forcible  connec- 
tion with  her,  causing  much  pain  and  loss  of  blood.  There  were  no 
marks  of  violence  (bruises?)  externally,  but  the  orifice  of  the  vagina 
was  lacerated  in  its  entire  circumference  and  the  perimeum  was  nearly 
torn  through.  It  was  found,  on  inspection,  that  the  orifice,  as  well  as 
the  whole  of  the  vagina,  was  in  a  state  of  gangrene,  and  its  posterior 
wall  had  been  lacerated  at  its  line  of  junction  with  the  uterus  to  the 
extent  of  an  inch.  There  was  no  ulceration  ;  the  labia  and  clitoris 
had  not  undergone  any  change.  ("Med.  Times  and  Gaz.,"  June  2, 
1860,  p.  560.)  The  prisoner  subsequently  confessed  his  guilt.  A 
case  was  communicated  by  Dr.  M'Kinlay  to  the  "  Glasgow  Medical 
Journal"  (July,  1859,  p.  140),  which  proves  that  extensive  injuries 
may  be  produced  on  a  child  by  the  act  of  violation.  The  girl  in 
this  instance  was  about  six  years  of  age, and  very  intelligent.  From 
her  description  of  the  assault,  it  appears  that  she  fainted,  probably 
owing  to  the  severity  of  the  pain.  When  examined,  it  was  found 
that  the  vagina  was  ruptured  in  various  directions.  One  laceration 
extended  from  the  lower  part  downwards,  dividing  the  recto- vaginal 
septum  and  perinasum  down  to  the  verge  of  the  anus.  There  was  a 
lacerated  opening  in  the  coats  of  the  rectum ;  the  orifice  of  the  va- 
gina was  lacerated  upwards  as  well  as  laterally;  the  parts  were  raw, 
swollen,  and  very  tender.  When  the  child  was  first  seen,  there  was 
blood  on  the  limbs  and  clothes;  she  recovered  from  these  ser.ous 
in  juries  in  about  two  months.  In  a  case  of  alleged  rape,  it  was  a 
question  raised  in  favor  of  the  prisoner,  whether  rupture  of  the  pe- 
rinaeum  could  or  could  not  be  effected  in  rape  on  a  girl.  Some  emi- 
nent members  of  the  profession  appear  to  have  doubted  the  possibility 
of  rupture  being  produced  under  these  circumstances  (see  Sir  W. 
Wilde's  paper,  "  Dub.  Med.  Journal,"  February,  1859) ;  but  the  facts 
here  recorded  show  that  such  an  opinion  is  erroneous. 

Purulent  Discharges  from  the  Vagina.  Vaginitis.  Infantile  Leu- 
corrhaea. — The  existence  of  a  purulent  discharge  from  the  vagina  as 
a  result  of  vaginitis  or  Inflammation  of  the  vagina,  has  boon  fre- 
quently adduced  as  a  sign  of  rape  in  young  children.  The  parents, 
or  other  ignorant  persons  who  examine  the  child,  often  look  upon 
this  disease  as  a  positive  proof  of  impure  intercourse;  and  perhaps 
lay  a  charge  against  an  innocent  person,  who  may  have  been  ob- 
served to  take  particular  notice  of  the  child.  A  purulent  discharge 
with  aphthous  ulceration  of  the  mucous  membrane  is  occasionally  a 


604  MISTAKES    FROM 

result  of  vaginitis  (inflammation  of  the  vagina)  in  young  children. 
It  may  arise  from  dentition,  or  local  causes  of  irritation — as  worms 
or  uncleanly  habits — and  is  observed  especially  in  children  of  a 
scrofulous  habit.  It  is  frequently  met  with  in  girls  up  to  six  or 
seven  years  of  age;  and  children  thus  affected  have  been  tutored  to 
lay  imputations  against  innocent  persons  for  the  purpose  of  extorting 
money.  This  state  may  commonly  be  distinguished  from  the  effects 
of  violence,  either  by  the  hymen  being  entire,  or  by  the  non-dilata- 
tion or  laceration  of  the  vagina  or  perinasum  ;  by  the  red  and  inflam- 
matory condition  of  the  mucous  membrane ;  and  the  abundance  of 
the  purulent  discharge,  which  is  commonly  much  greater  than  that 
which  takes  place  as  a  mere  result  of  violence.  Capuron  mentions 
two  cases  in  which  charges  of  rape  on  children  were  falsely  made 
against  innocent  persons,  on  account  of  the  existence  of  a  purulent 
discharge  the  nature  of  which  had  been  mistaken.  ("  Med.  Leg.  des 
Accouchemens,"  p.  41.)  Sir  Charles  Locock  observes  that  the  puru- 
lent discharges  of  female  children  are  attended  with  redness  and 
swelling  of  the  sexual  organs,  and  are  sometimes  accompanied  with 
excoriation  and  slouahino;  of  the  skin,  owing  to  the  irritating  nature 
of  the  matter.  They  are  so  connected  with  dentition,  that  they  not 
only  appear  with  the  first  and  second  set  of  teeth,  but  even  when  the 
wisdom-teeth  are  irritating  the  system  at  a  mature  age.  Mr.  South, 
commenting  on  this  statement  ("  Chelius's  Surgery,"  vol.  1,  p.  161), 
justly  remarks  that  a  knowledge  of  these  facts  "  is  highly  neces- 
sary, and  is  very  properly  insisted  on,  as  there  is  no  doubt  that  many 
men  have  suffered  capital  punishment  from  the  ignorance  of  practi- 
tioners on  this  point ;  and  even  now,  with  our  better  knowledge,  it 
is  by  no  means  unfrequent  to  hear  of  medical  men  giving  a  decided 
opinion  which  is  almost  certainly  erroneous  upon  the  gonorrhceal 
character  of  pudendal  discharges,  and  thus  jeopardizing  the  charac- 
ter if  not  the  life  of  an  innocent  man.  In  giving  his  opinion  or 
evidence  in  such  cases,  a  practitioner  is  bound  to  speak  with  extreme 
caution,  and  only  on  the  most  incontestable  proof  (which  by  a  mere 
examination  of  parts  it  is  almost  impossible  for  him  to  attain),  be- 
fore he  makes  a  positive  statement  as  to  the  gonorrhoeal  character  of 
a  discharge."  Although  the  facts  are  or  ought  to  be  well  known  to 
medical  men,  there  is  still  much  popular  ignorance  in  reference  to 
this  disease,  and  false  charges  of  rape  on  children  are  now  not  un- 
frequently  made.  Mr.  Kesteven  met  with  a  case  in  which  a  discharge 
from  the  vagina  of  a  child  nine  years  of  age  was  considered  by  the 
parents  to  indicate  that  intercourse  had  been  had  with  her.  There 
was  no  mark  of  contusion  or  violence  on  or  about  the  pudendum  or 
in  the  vagina,  and  the  case  was  very  properly  pronounced  to  be  one 
of  vaginitis.  ("Med.  Gaz.,"  vol.  47,  p.  372.)  A  similar  case  was 
referred  to  me  in  which  a  soldier  was  supposed  to  have  infected  a 
child ;  but  an  investigation  showed  that  it  was  a  purulent  discharge 
depending  on  inflammation  of  the  vagina. 

A  gonorrhceal  discharge  is  generally  very  profuse — much  more 
profuse  than  that  purulent  discharge  which  is  simply  the  result  of 
such  violence  as  is  produced  in  the  commission  of  rape.     There  is 


PURULENT    DISCHARGES    IN    CHILDREN.  605 

another  fact  worthy  of  notice,  namely,  that  the  last-mentioned  dis- 
charge, besides  being  less  profuse,  lasts  for  a  much  shorter  time. 
Casper  has  recommended  that  in  doubtful  cases  another  examina- 
tion of  the  sexual  organs  should  be  made  in  ten  or  twelve  claj's. 
If  the  purulent  discharge  has  then  ceased,  or  is  ceasing,  there  is 
good  reason  to  believe  that  it  was  not  the  result  of  gonorrhoea,  but 
of  some  temporary  cause  of  inflammation  in  the  mucous  membrane. 
("Klinische  Novellen,"  1863,  p.  10.)  Of  false  charges  of  rape  aris- 
ing from  mistakes  on  the  subject,  he  furnishes  various  instances 
(p.,19). 

Assuming  that  the  surgeon  is  satisfied,  from  a  careful  examina- 
tion, that  the  purulent  discharge  must  have  existed  before  the  al- 
leged assault,  and  that  it  is  of  the  ordinary  inflammatory  character 
with  which  young  girls  are  liable  to  be  attacked,  this  would  not 
justify  him  in  affirming  that  no  rape  had  been  attempted  or  perpe- 
trated on  the  child.  Girls  laboring  under  this  disease  may  be  the 
subjects  of  rape,  and  it  will  then  be  necessary  to  seek  for  further 
evidence  on  the  condition  of  the  hymen,  the  lining  membrane  of 
the  vagina,  and  the  vulva.  If  nothing  is  found  beyond  what  is  con- 
sistent with  disease,  there  is  an  absence  of  medical  evidence  to 
prove  that  any  rape  has  been  committed.  An  aphthous  state  of  the 
membrane  of  the  vagina  must  not,  under  these  circumstances,  be 
ascribed  to  injury  caused  by  mechanical  violence.  (Casper's  "Ge- 
richtliche  Medicin,"  vol.  2,  p.  148.) 

Infantile  leucorrhcea  has  been  fully  investigated  by  Sir  W.  Wilde, 
of  Dublin.  ("  Medico-legal  Observations,"  &c,  1853.)  This  gen- 
tleman has  collected  numerous  instances  illustrating  in  a  remark- 
able manner  the  great  danger  to  which  innocent  persons  are  exposed 
by  reason  of  false  charges  of  rape  on  children.  Two  of  these  are 
especially  noticed  in  his  essay.  A  charge  was  raised  against  a 
respectable  man,  that  he  had  had  intercourse  with,  and  produced 
disease  in,  two  children.  The  day  and  hour  were  circumstantially 
given,  extorted  as  it  appears  from  the  children  by  the  parent,  and 
the  man  was  put  upon  his  trial.  The  appearances  were  such  as  are 
usual  in  these  cases — a  purulent  discharge  from  the  vagina  with 
some  excoriation,  but  no  bruise,  laceration,  or  mark  of  violence  on 
the  pudendum.  There  had  not  been  any  penetration  of  the  vagina. 
The  charge  against  the  prisoner,  although  unsupported  by  any  affir- 
mative circumstances,  received  some  strength  from  the  admission 
made  by  one  medical  witness  for  the  prosecution — namely,  that  the 
appearances  might  have  been  the  result  of  violence,  and  that  the 
discharge  might  have  been  produced  by  friction  with  the  member 
of  a  healthy  man.  (Wilde,  op.  cit.  p.  li.)  It  was  proved  that  the 
prisoner  was  not  affected  either  with  gonorrhoea  or  syphilis.  Drs. 
Geoghegan,  Churchill,  and  other  medical  witnesses  of  repute,  gave 
testimony  to  the  effect  that  the  child  was  laboring  under  an  ordi- 
nary form  of  disease,  and  that  there  was  no  medical  indication  that 
it  had  been  subjected  to  any  kind  of  violence.  This  testimony  was 
not  considered  by  the  court  to  furnish  a,  complete  answer  to  the 
charge,  since  it  was  inferred  that  the  appearances  on  the  child  might 


606  LEUCORRHCEAL    DISCHARGES    IN    CHILDREN". 

have  been  caused  by  the  accused,  without  any  marks  of  violence 
being  left  on  the  pudendum  !  So  strong  was  this  feeling  that,  had 
the  case  rested  here,  it  is  probable  the  accused  would  have  been 
convicted  upon  the  unsupported  statement  of  the  child.  An  alibi 
was,  however,  clearly  proved,  and  the  man  was  acquitted.  In  this 
instance,  it  will  be  perceived,  it  was  alleged  that  a  man  who  labored 
under  this  disease  had  caused  a  purulent  discharge  in  a  child  !  At 
the  same  time,  it  was  admitted  that  the  pudendum  had  sustained  no 
violence  whatever.  Medically  speaking,  there  appears  to  have 
been  not  the  slightest  pretence  for  charging  the  accused  with  the 
perpetration  of  rape ;  the  appearances  might  or  might  not  have  been 
caused  in  the  manner  suggested.  Under  such  loose  medical  evi- 
dence as  this  no  person  would  be  safe.  An  acquittal  from  an  un- 
founded charge  would  depend  upon  the  man  who  is  accused  being 
able  to  prove  a  distinct  alibi,  i.  e.  he  must  prove  his  innocence. 
The  statement  of  the  child  may  be  simple  and  artlessly  made.  At 
this  tender  age  a  girl  may  be  easily  induced,  by  the  fear  of  punish- 
ment, and  by  the  aid  of  leading  questions  put  by  a  parent,  to  admit 
that  some  one  had  committed  an  assault  upon  her.  The  statement 
once  made  may  be  persevered  in,  and  its  inconsistency  may  not 
always  be  brought  out  by  cross-examination. 

If  the  child  is  really  laboring  under  syphilis  or  gonorrhoea,  this  is, 
casteris  paribus,  evidence  of  impure  intercourse,  either  with  the 
ravisher  or  some  other  person ;  but  we  should  be  well  assured,  before 
giving  an  opinion,  that  the  discharge  is  really  of  a  gonorrhceal  and 
not  simply  of  a  common  inflammatory  (purulent)  character.  The 
party  accused  may  have  been  at  the  time  free  from  the  disease,  or, 
if  laboring  under  it,  then  we  should  expect  to  find  that  the  discharge 
had  suddenly  made  its  appearance  in  the  child,  with  its  usual  severe 
symptoms,  at  a  certain  interval  of  time  after  the  alleged  intercourse — ■ 
i.  e.  from  the  third  to  the  eighth  day.  When  these  conditions  do  not 
exist,  it  is  extremely  difficult  to  form  a  medical  opinion  on  the  sub- 
ject ;  since  there  are  no  certain  means,  by  the  microscope  or  other- 
wise, of  distinguishing  common  purulent  discharges  from  those  which 
are  gonorrhceal  or  syphilitic.  A  case  occurred  to  M.  Biessy,  in  which 
a  merely  mucous  discharge  in  a  girl  was  pronounced  to  be  syphilitic, 
and  the  person  who  was  falsely  accused  of  rape  narrowly  escaped 
conviction.  (Briang,  "  Man.  Complet.  de  Med.  Leg.,';  1846,  p.  81.) 
The  purulent  matter  of  gonorrhoea  does  not  differ  microscopically 
from  that  produced  in  other  forms  of  disease. 

We  should  further  distinctly  satisfy  ourselves  that  gonorrhoea  in 
a  child,  if  it  exist,  could  not  have  arisen  from  infection  by  any  acci- 
dent irrespective  of  intercourse.  This  limitation  is  rendered  neces- 
sary by  the  publication  of  a. report  of  two  cases  by  Dr.  W.  B.  Evan 
("  Med.  Graz.,"  vol.  47,  p.  741),  in  which  two  sisters,  one  of  one  year 
and  the  other  of  four  years  of  age,  received  the  infection  by  reason 
of  their  being  washed  in  a  vessel  of  water  with  a  sponge  used  by  a 
young  woman  affected  with  profuse  gonorrhceal  discharge.  Dr, 
Kvan  clearly  traced  the  origin  of  the  discharge  to  this  unexpected 
accident.     Had  an  accusation  of  rape  been  made  against  a  man  labor- 


RAPE    OX    YOUNG    FEMALES    AFTER    PUBERTY.  607 

ing  under  gonorrhoea,  it  is  not  at  all  improbable  that  this  condition 
of  the  children,  resulting  from  an  unsuspected  accident,  would  have 
been  taken  as  an  unanswerable  proof  of  his  guilt.  Cases  of  this  kind, 
thus  accurately  observed,  convey  an  important  caution  to  medical 
witnesses :  i.  e.  that  they  should  not  infer  criminal  intercourse  merely 
from  the  existence  of  a  gonorrhceal  discharge  in  the  absence  of  marks 
of  violence  to  the  genitals  or  of  other  strong  corroborative  proofs. 

As  a  summary  of  these  remarks  with  respect  to  purulent  discharges, 
we  may  observe  that  they  should  not  be  admitted  as  furnishing 
corroborative  evidence  of  rape,  except — 1st,  when  the  accused  party 
is  laboring  under  gonorrhceal  discharge ;  2dly,  when  the  date  of  its 
appearance  in  a  child  is  from  the  third  to  the  eighth  day  after  the 
alleged  intercourse ;  and  3dly,  when  it  has  been  satisfactorily  estab- 
lished that  the  child  had  not  suffered  from  any  such  discharge  pre- 
viously to  the  assault.  It  may  be  said,  however,  that  all  these  conditions 
ma}'-  exist,  and  yet  the  accused  be  innocent;  for  a  child  may,  either 
through  mistake  or  design,  accuse  an  innocent  person.  This,  how- 
ever, removes  the  case  entirely  from  the  hands  of  a  medical  jurist. 
(The  reader  will  find  much  useful  information  on  this  subject  in  a 
paper  by  Dr.  Penard,  "  Ann.  d'Hyg.,"  1860,  vol.  2,  pp.  130,  315.) 

With  respect  to  marks  of  violence  on  the  body  of  a  child,  these  are 
seldom  met  with,  because  no  resistance  is  commonly  made  by  mere 
children.  Bruises  or  contusions  may,  however,  be  found  occasionally 
on  the  legs. 

Eape  on  Young  Females  after  Puberty. 

When  the  crime  is  committed  on  a  girl  from  the  age  of  ten  to 
twelve  years,  the  facts  are  much  the  same  as  those  already  referred 
to  with  respect  to  children  below  the  age  of  ten  years.  There  is, 
however,  some  difference  in  the  legal  complexion  of  the  offence.  If 
carnal  intercourse  be  had  with  the  consent  of  a  female  between  the 
ages  of  ten  and  twelve  years,  the  offender  is  guilty  of  a  misdemeanor 
only  (24  &  25  Vic.  c.  100,  s.  51) ;  above  the  age  of  twelve  years,  the 
consent  of  the  girl  does  away  with  any  imputation  of  a  legal  offence. 
Girls  who  have  passed  this  age  are  considered  to  be  capable  of  offering 
some  resistance  to  the  perpetration  of  the  crime ;  and  therefore,  in  a 
true  charge,  we  should  expect  to  find  not  only  marks  of  violence 
about  the  pudendum,  but  also  injuries  of  greater  or  less  extent  upon 
the  body  and  limbs.  It  is  probable  that  in  these  cases,  if  the  charge 
were  well-founded,  the  hymen  would  be  ruptured,  as  the  intercourse 
is  always  presumed  to  be  violent:  but  there  might  be  some  degree 
of  penetration  without  this  being  a  necessary  result,  especially  if  the 
membrane  were  small,  or  placed  far  up.  At  any  rate,  a  girl  at  this 
age  may  sustain  all  the  injury,  morally  and  physically,  which  the 
perpetration  of  the  crime  can  possibly  bring  down  upon  her,  what- 
ever may  have  been  the  degree  of  pnirtriition ;  and  for  this  reason, 
it  *s  very  properly  laid  down  by  our  law,  that  the  crime  consists  in 
the  mere  proof  of  penetration.  The  fact,  however,  is  generally 
clearly  made  out  by  the  statement  of  a  girl.     Girls  of  tender  age  are 


60S  EAPE    ON    YOUNG    FEMALES    AFTER    PUBERTY. 

sometimes  violated  by  boys ;  the  amount  of  physical  injury  inflicted 
in  such  cases  is  less  than  when  the  assailant  is  an  adult. 

With  respect  to  marks  of  violence  on  the  person,  the  exact  form, 
position,  and  extent  of  these  should  be  noticed,  also  their  appearance 
whether  recent  or  of  old-standing.  A  false  accusation  of  rape  may 
be  sometimes  detected  by  the  violence  being  in  a  situation  in  which 
it  was  not  probable  that  the  ravisher  would  have  produced  it.  When 
bruises  are  found,  the  presence  or  absence  of  the  usual  zones  of  color 
may  occasionally  throw  light  upon  the  time  at  which  the  alleged 
assault  was  committed.  As  these  marks  of  violence  on  the  person  are 
not  likely  to  have  been  produced  with  the  concurrence  of  the  girl, 
they  are  considered  to  furnish  some  proof  of  the  intercourse  having 
been  against  her  will.  But  the  physical  appearances  of  rape  about 
the  genital  organs  may  be  found,  whether  the  connection  has  been 
voluntary  or  involuntary.  Thus  rupture  of  the  hymen,  laceration 
of  the  vagina  with  effusion  of  coagula  of  blood,  swelling  and  inflam- 
mation of  the  vulva,  and  stains  of  blood  upon  the  person,  dress,  or 
furniture,  may  be  met  with  in  both  eases.  In  making  an  examina- 
tion, the  greatest  care  should  be  taken  by  the  practitioner  to  fix,  at 
the  time  of  examination,  a  probable  date  for  the  marks  of  injury  to 
the  genitals  or  other  parts  of  the  body,  as  it  is  by  the  aid  of  such 
observations  that  the  truth  or  falsity  of  a  charge  may  be  sometimes 
clearly  established. 

Girls  and  unmarried  young  women  are  liable  to  miico-purulent  dis- 
charges from  the  vagina,  as  a  result  of  which  the  hymen  may  be 
destroyed.  This  kind  of  discharge  arises  from  inflammation  of  the 
vagina  (vaginitis),  and  it  has  been  observed  to  follow  an  attack  of 
scarlatina.  When  it  exists,  its  real  cause  requires  the  closest  scrutiny. 
At  a  more  advanced  age,  young  women  are  frequently  subject  to 
leucorrhcea.  These  cases  are  not  likely  to  be  mistaken  for  gonorrhcea ; 
as  here  the  female  has  it  in  her  power  to  give  some  account  of  the 
circumstances,  from  which  a  medical  opinion  may  be  easily  formed. 
It  is  possible,  however,  that  a  woman  laboring  under  leucorrhcea 
may  charge  a  man  with  the  crime  of  rape,  and  affirm  that  this  dis- 
charge had  arisen  from  the  act  of  the  man.  An  inflamed  and  partially 
ulcerated  (aphthous)  state  of  the  lining  membrane  of  the  vulva  may 
apparently  give  support  to  the  accusation.  The  discharge  in  leucor- 
rhcea is  of  a  mucous  nature — that  of  gonorrhcea  is  of  a  purulent 
character — but  purulent  discharges  may  take  place  from  the  vagina 
as  the  result  of  intense  inflammation,  and  quite  irrespective  of  impure 
intercourse.  ("Chelius's  Surgery,"  by  South,  vol.  1,  p.  160.)  It 
would  be  impossible  to  distinguish  such  discharges  from  those  of 
gonorrhcea;  while  a  leucorrhceal  discharge  under  great  inflammatory 
action  may  also  resemble  that  of  gonorrhcea. 

Defloration.  Signs  of  Virginity. — It  will  be  necessary  to  say  a  few 
words  respecting  the  signs  of  virginity — a  subject  upon  which,  in 
some  medico-legal  works,  a  great  amount  of  poetical  discussion  ap- 
pears to  me  to  have  been  wasted.  Independently  of  cases  of  rape, 
this  question  may  occasionally  assume  a  practical  bearing  in  relation 
to  the  siens  of  defloration.     In  civil  cases  a  medical  witness  may  be 


SIGNS    OF    VIRGINITY.  609 

asked  whether  a  woman  has  ever  had  intercourse  or  not ;  and  proof 
of  the  fact  may  be  necessary  in  order  to  confirm  or  rebut  statements 
made  by  her  in  evidence.  The  question  may  be  not  whether  a  fe- 
male has  had  a  child,  for  this  would  resolve  itself  into  a  proof 
whether  delivery  had  or  had  not  taken  place — it  may  be  limited  to 
the  probability  or  possibility  of  intercourse  on  her  part  at  some 
antecedent  period.  Now,  a  medical  jurist,  when  consulted  in  such  a 
case,  can  be  guided  only  by  the  presence  or  absence  of  the  external 
signs  of  virginity.  The  hymen  may  be  intact,  but  this  does  not 
prove  non-intercourse,  because  females  have  been  known  to  conceive 
with  the  hymen  uninjured ;  and  an  operation  for  a  division  of  this  mem- 
brane has  been  actually  rendered  necessary  before  delivery  could  take 
place.  (Henke's  "Zeitschrift  der  S.  A.,"  1843,  vol.  ii.  p.  149.)  Two 
cases  of  impregnation  without  rupture  of  the  hymen  are  reported  in 
the  "New  Orleans  Medical  Gazette"  for  June,  1858  (pp.  217,  220). 
The  hymen  in  each  case  required  to  be  divided  to  allow  of  the  de- 
livery of  the  child.  Another  case  is  reported  in  the  "American 
Jour.  Med.  Sciences"  for  April,  1859  (p.  576).  These  facts  may  be 
explained  by  the  membrane  being  hard  and  resisting  and  at  the  same 
time  small  in  extent,  i.  e.,  only  partially  closing  the  vagina.  Under 
opposite  conditions,  the  persistence  of  this  membrane  might  fairly 
lead  to  the  inference  that  the  female  was  chaste,  and  that  there  had 
been  no  intercourse ;  but  the  hymen  may  be  destroyed  by  ulceration, 
as  a  result  of  inflammation  of  the  genital  organs.  When  the  mem- 
brane has  been  thus  destroyed  by  disease  or  other  causes,  or  when 
it  is  congenitally  absent,  a  medical  opinion  must  be  more  or  less 
conjectural:  for  one  intercourse  could  hardly  so  affect  the  capacity 
of  the  vagina,  as  to  render  the  fact  evident  through  life,  and  there  is 
no  other  datum  upon  which  an  opinion  could  be  based.  The  pre- 
sence of  the  hymen  is  of  course  quite  incompatible  with  the  assump- 
tion that  the  female  has  borne  a  child.  A  question  of  this  kind  inci- 
dentally arose  in  Frazer  v.  Bagley"  (Common  Pleas,  Feb.  1844).  It 
was  alleged  by  defendant  that  the  plaintiff,  a  married  man,  hact  had 
adulterous  intercourse  with  a  young  woman,  and  that  at  an  antece- 
dent period  she  had  left  her  home  for  the  purpose  of  giving  birth  to 
a  child  privately.  The  late  Dr.  Ashwell  was  called  upon  to  examine 
the  woman,  and  he  deposed  that,  in  his  opinion,  she  was  a  virgin, 
and  had  never  had  a  child.  In  spite  of  this  evidence,  the  jury 
returned  a  verdict  for  the  defendant.  It  is  possible,  however,  that 
abortion  may  take  place  at  the  early  periods  of  pregnancy,  without 
the  necessary  destruction  of  the  hymen.  (See  Ilenke,  "Zeitschrift," 
1844,  vol.  i.  p.  259.) 

The  question  is  of  importance  not  only  as  it  may  affed  the  repu- 
tation of  a  woman,  but  the  credibility  and  character  of  the  person 
who  makes  the  imputation  of  a  want  of  chastity.  In  L845,  a  •  i 
tleman,  then  assistant-surgeon  in  the  Bombay  Army,  was  broi 
to  a  court-martial  on  a  charge  of  having  deliberately  and  falsely 
ted  that  on  several  occasions  he  had  had  connection  with  a 
native  woman.  This  was  denied  by  the  woman,  and  evidence  was 
adduced  to  show  that  she  had  still  what  is  commonly  >  id  as 

39 


610  ALLEGED    UXC  II A  STITY.      MEDICAL    PROOFS. 

tlie  main  sign  of  virginity,  namely,  an  unruptured  hymen.  In  con- 
sequence of  this  the  medical  officer  was  found  guilty  and  cashiered. 
The  woman  was  at  the  time  about  to  be  married,  and  this  rendered 
the  investigation  all  the  more  important  to  her.  An  assistant-sur- 
geon, who  examined  the  girl,  deposed  that  he  found  the  membrane 
of  a  semilunar  form,  and  tensely  drawn  across  the  vagina  ;  and  his 
evidence  was  corroborated  by  that  of  a  midwife.  The  inculpated 
person  took  up  a  double  line  of  defence — 1st,  that  the  examination 
of  the  woman  was  incomplete ;  and  2dly,  that  the  hymen,  if  present, 
would  not  justify  the  witnesses  in  saying  that  intercourse  could  not 
possibly  have  taken  place.  On  the  first  point,  it  is  unnecessary  here 
to  make  a  remark ;  but  it  appeared  from  their  own  admissions,  that 
the  witnesses  had  never  before  examined  women  with  this  particu- 
lar object.  Assuming  that  there  was  no  mistake,  it  becomes  a  ques- 
tion whether  non-intercourse  could  in  such  a  case  be  inferred  from 
the  presence  of  the  membrane.  Fruitful  intercourse,  it  is  well 
known,  may  take  place  without  rupture  of  the  hymen.  Some  in- 
stances of  this  kind  were  referred  to  at  the  court-martial ;  but  such 
cases  may  be  regarded  as  of  an  exceptional  nature.  The  real  ques- 
tion is,  whether,  unless  the  hymen  be  in  an  abnormal  state,  inter- 
course can  possibly  occur  between  young  and  active  persons  without 
a  rupture  of  this  membrane.  Intercourse  is  not  likely  to  be  con- 
fined, under  these  circumstances,  to  a  mere  penetration  of  the  vulva.. 
The  membrane  in  this  woman  is  stated  to  have  been  intensely  drawn 
across  the  canal,  and  it  was  not  tough ;  it  was  therefore  in  a  condi- 
tion to  render  it  most  easy  for  rupture.  In  the  case  of  an  old  man, 
or  one  of  Aveak  virile  power,  vulval  intercourse  might  be  had  with- 
out destroying  the  membrane ;  but  such  a  case  could  only  be  de- 
cided by  the  special  circumstances  which  accompanied  it.  The 
presence  of  an  unruptured  hymen  affords  a  presumptive  but  not  an 
absolute  proof  that  the  woman  is  a  virgin ;  and  if  of  the  ordinary 
size  and  shape,  and  in  the  ordinary  situation,  it  shows  clearly  that, 
although  attempts  at  intercourse  may  have  been  made,  there  can 
have  been  no  vaginal  penetration.  Admitting  the  statements  of  the 
examiners  to  have  been  correct,  it  is  improbable  that  this  woman 
had  had  sexual  intercourse  several  times,  or  even  on  one  occasion ; 
hence  the  imputation  on  her  chastity  was  unfounded. 

In  the  case  of  Delafosse  v.  Fortescue  (Exeter  Lent  Ass.  1853),  which 
involved  an  action  for  defamation  of  character,  the  plaintiff,  a  mar- 
ried man,  ast.  6±,  had  been  charged  with  committing  adultery  with 
a  certain  woman.  Several  witnesses  for  the  defendant  positively 
swore  that  they  had  seen  these  persons  in  carnal  intercourse.  This 
was  denied  by  the  plaintiff;  and,  as  an  answer  to  the  case,  medical 
evidence  was  tendered  to  the  effect  that  the  woman  with  whom  the 
adulterous  intercourse  was  alleged  to  have  taken  place  had  been 
examined,  and  the  hymen  was  found  intact.  In  cross-examination 
this  was  admitted  not  to  be  a  conclusive  criterion  of  virginity.  A 
verdict  was  returned  for  the  defendant.  The  form  and  situation  of 
the  hymen  in  this  case  were  not  described ;  but  it  is  to  be  presumed 
that  these  were  not  such  as  to  constitute  a  physical  bar  to  inter- 


ALLEGED    UNCH ASTITY.      MEDICAL    PROOFS.  611 

course,  or  this  would  have  been  stated  by  the  medical  witness. 
Hence  the  existence  of  the  membrane  was  not  considered  to  dis- 
prove the  allegations  of  eye-witnesses.  A  somewhat  similar  case 
{Howes  v.  Barber)  was  tried  in  the  Common  Pleas  in  June,  1865. 
Defendant  alleged  that  he  had  seen  plaintiff,  as  he  believed,  in  in- 
tercourse with  an  unmarried  lady.  This  was  denied  by  the  plain- 
tiff and  the  lady,  and  to  support  this  denial,  medical  evidence  was 
called  to  show  that  there  had  been  no  intercourse.  Drs.  Oldham 
and  Barnes  examined  the  lady,  and  deposed  that  the  hymen  was 
entire,  and  that  she  was  virgo  intacla.  In  Scotland  this  kind  of 
medical  evidence  is  not  admissible.  I  am  indebted  to  Mr.  Trayner, 
a  member  of  the  Scotch  Bar,  for  the  subjoined  case,  in  which  a  wife 
sued  the  husband  for  divorce,  on  the  ground,  inter  alia,  that  he  had 
committed  adultery  with  C.  In  defence,  the  defendant  denied  the 
adultery,  and  adduced  C.  as  a  witness,  who  swore  that  such  connec- 
tion had  never  taken  place.  She  also  swore  that  she  had  submitted 
to  an  inspectio  corporis  by  Sir  I.  Simpson.  The  defendant  then  pro- 
posed to  examine  this  gentleman,  that  he  might  speak  to  the  result 
of  his  examination.  He  argued  that  this  was  the  best  evidence  that 
he  could  adduce  in  support  of  his  innocence,  as  if  the  girl  was  still 
a  virgin,  the  adultery  alleged  could  not  have  been  committed.  The 
court  refused  to  admit  the  evidence,  on  the  ground  that  it  was 
•merely  in  the  form  of  an  opinion  from  the  learned  professor  ;  that 
other  medical  men  might  differ  from  him,  even  from  the  same  ob- 
servations ;  and  that,  as  the  court  could  not  compel  C.  to  submit  to 
another  examination,  the  proposed  evidence  must  be  considered 
ex  parte  and  inadmissible.  (Session  Cases,  Edinburgh,  Feb.  11, 
1860.)  In  Hunt  v.  Hunt  a  verdict  was  obtained  at  common  law 
against  the  alleged  paramour  in  a  case  of  adultery,  and  the  dam- 
ages were  assessed  at  601.  It  was  subsequently  proved  that  the 
lady  was  virgo  intacta  I  So  long  as  there  are  facts  which  show  that 
women  have  actually  conceived" with  the  hymen  still  in  its  normal 
state,  it  is  inconsistent  to  apply  the  term  "virgo  intacta"  to  women 
merely  because  this  membrane  is  entire.  A  woman  may  assuredly 
have  an  unruptured  hymen,  and  yet  not  be  a  virgo  intacta.  This 
can  only  be  decided  by  the  special  circumstances  proved  in  each 
case.  Such  virgines  intactee  have  frequently  required  the  assistance 
of  accoucheurs,  and  in  due  time  have  been  delivered  of  children  ! 


612  EAPE  ON  ADULT  WOMEN. 


CHAPTER    LVII. 

Rape  on  married  and  adult  women. — circumstances  under 
which  it  may  be  perpetrated  on  adult  women. — loss  of 
physical  evidence. — pregnancy  following  rape. — microsco- 
pical evidence. — sodomy. 

On  Married  and  Adult  Women. — The  remarks  already  made  apply 
generally  to  married  women,  with  this  difference — that  when  a 
woman  has  already  been  in  habits  of  sexual  intercourse,  there  is 
commonly  much  less  injury  done  to  the  genital  organs.  The  hymen 
will,  in  these  cases,  be  found  destroyed  and  the  vulva  dilated.  Still, 
as  the  intercourse  is  presumed  to  be  against  the  consent  of  the  woman, 
it  is  most  likely  that  when  there  has  been  a  proper  resistance  some 
injury  will  be  apparent  on  the  pudendum ;  and  there  will  be  also, 
probably,  extensive  marks  of  violence  on  the  body  and  limbs. 
Such  cases  are  generally  determined  without  medical  evidence,  by  • 
the  deposition  of  the  woman,  corroborated,  as  it  should  always  be, 
by  circumstances.  An  experienced  barrister  has  suggested  to  me 
that  this  statement  regarding  the  presence  of  marks  of  violence  on  the 
pudendum  of  a  married  woman,  on  whom  a  rape  is  alleged  to  have 
been  committed,  requires  some  qualification.  He  informed  me  that 
he  was  engaged  in  the  prosecution  of  two  cases  of  rape  on  married 
women,  in  which  the  crime  was  completed  in  spite  of  the  resistance 
of  the  women,  and  there  were  no  marks  of  violence  on  the  genital 
organs  in  either  case.  {Reg-  v.  Oiven  and  others,  Oxford  Circuit, 
1839.)     This  may  happen  when  the  assailant  is  aided  by  accomplices. 

On  the  other  hand,  the  vagina  alone  may  be  the  seat  of  violence, 
and  no  marks  to  indicate  a  struggle  or  the  application  of  force  be 
found  on  the  body.  I  was  consulted  in  April,  18(32,  on  a  case  of 
this  description.  A  woman  was  knocked  down,  her  clothes  were 
pulled  over  her  face,  and  the  crime  of  rape  was  perpetrated  by  the 
assailant.  In  the  position  in  which  she  was  held,  with  her  arms 
and  hands  covered  over,  she  Avas  half  suffocated  and  unable  to  offer 
any  effectual  resistance.  She  Avas  examined  on  the  evening  of  the 
day  of  the  assault,  by  Dr.  Mayne.  He  found  no  marks  of  violence 
on  her  body,  but  the  mucous  membrane  of  the  vagina  at  its  com- 
mencement wo",  contused  and  some  portions  lacerated:  blood  was 
oozing  from  these  parts.  It  was  properly  considered  that,  under 
these  circumstances,  the  statement  of  the  woman  was  consistent  with 
the  fact  that  there  were  no  marks  of  violence  on  her  body.  There 
was  no  reason  to  suppose  that  the  injury  to  the  vagina  had  been 
caused  in  any  other  way  than  by  a  criminal  assault. 

When  a  charge  of  rape  is  made  by  a  prostitute,  it  is  justly  re- 


RAPE  ON  ADULT  WOMEN.  613 

ceivecl  with  suspicion,  and  the  case  is  narrowly  scrutinized.  Some- 
thing more  than  medical  evidence  would  be  required  to  establish,  a 
charge  under  these  circumstances.  The  question  turns  here,  as  in 
all  cases  of  rape  upon  adult  women,  on  the  fact  of  consent  having 
been  previously  given  or  not.  This  is  the  point  at  which  the  greater 
number  of  these  cases  of  alleged  rape  break  down ;  and  it  need 
hardly  be  observed  that  this  question  has  no  relation  to  the  duties 
of  a  medical  witness :  all  that  he  can  do  is  to  establish,  occasion- 
ally, whether  or  not  sexual  intercourse  has  been  had  with  or  with- 
out some  violence.  It  is  obvious  that  there  may  be  marks  of  vio- 
lence about  the  pudendum,  or  on  the  person,  and  yet  the  conduct  of 
the  woman  may  have  been  such  as  to  imply  consent  on  her  part : 
Ave  must  not  suppose  that  medical  proof  of  intercourse  is  tanta- 
mount to  legal  proof  of  rape. 

[While  it  is  no  defence  that  a  woman  was  a  common  strumpet, 
or  even  that  she  was  the  defendant's  mistress,  the  question  of  prior 
chastity  is  always  a  material  one  to  be  considered  by  the  medical 
examiner,  since  unchastity  can  be  shown  by  the  defendant,  not  as 
an  excuse  or  justification,  but  as  a  fact  throwing  much  light  on  the 
subject.     (Wharton  &  Stille,  p.  4:66.) 

In  England,  and  in  many  of  the  States  of  the  United  States, 
general  evidence  of  reputation  may  be  shown,  but  not  particular 
acts  of  unchastity.  lb.  McCombs  v.  State,  8  Ohio  (N.  S.)  643; 
People  v.  Jackson",  3  Parker,  C.  R.  (N.  Y.)  391. 

It  has  been  held,  however,  that  it  is  competent  to  inquire  of  the 
prosecutrix,  on  cross-examination,  as  to  particular  acts  before  and 
after,  at  specified  times  and  places,  with  specified  men.  Stale  v. 
Johnson,  2  Wms.  (Vermont)  512.  In  California,  where  the  prosecu- 
trix was  the  only  witness,  it  was  held  that  evidence  that  she  had 
committed  acts  of  lewdness  with  other  men  is  admissible,  and  that 
it  is  immaterial  by  whom  these  acts  are  proved,  and  that  the  prose- 
cutrix need  not  be  questioned  about  them.  People  v.  Benson.  6 
Cal.  221. 

"The  object  of  such  testimony  is  twofold  :  1st,  in  making  the  fact 
of  coercion  less  likely ;  and,  2d,  in  diminishing  the  witness'  weight 
as  respects  credibility  generally.  It  is  less  likely  that  a  strumpet, 
or  one  holding  herself  out  as  submitting  to  illicit  intercourse,  though 
on  special  inducements  or  occasions  alone,  would  resist  to  the  ex- 
tremity which  a  prosecution  for  rape  requires,  than  would  a  chaste 
woman.  And  although,  under  ordinary  circumstances,  it  is  inad- 
missible to  impeach  veracity  by  attacking  chastity,  yet,  in  such  an 
issue  as  the  present,  this  seems  but  proper.1  Such  being  the  case, 
it  will  be  seen  that  medical  testimony  as  to  the  prosecutrix's  prior 
condition  is  of  peculiar  value.  Evidence  of  any  prior  venereal 
complaints,  or  of  any  other  facts  tending  to  prove  previous  illicit 

['  Want  of  chastity  was  formerly  a  ground  of  excommunioation,  and  as  suoh  a 
cause  of  disqualification  as  a  witness:  upon  which  Mr.  Capel  Loft  (Law  of  Evidence, 
2(H)  comments  as  follows:  "As  if  being  unguardedly  awake  to  the  impressions  of 
nature,  demonstrated  an  insensibility  to  the  voice  of  truth"! — P.] 


614  MEDICAL    PROOFS. 

intercourse,  it  is  always  proper  under  such  circumstances  to  re- 
ceive." (Wharton  &  Stills',  p.  467.)— P.] 

Possibility  of  Perpetrating  Rape  on  Adult  Women. — Some  medical 
jurists  have  argued  that  a  rape  cannot  he  perpetrated  on  an  adult 
woman  of  good  health  and  vigor ;  and  they  have  treated  all  accusa- 
tions made  under  these  circumstances  as  false.  Whether,  on  any 
criminal  charge,  a  rape  has  been  committed  or  not,  is  of  course  a 
question  of  fact  for  a  jury  and  not  for  a  medical  witness.  The  fact  of 
the  crime  having  been  actually  perpetrated,  can  be  determined  only 
from  the  evidence  of  the  prosecutrix  and  of  other  witnesses ;  still 
a  medical  man  may  be  able  to  point  out  to  the  court  circumstances 
which  might  otherwise  escape  notice.  Setting  aside  the  cases  of 
infants,  idiots,  lunatics,  and  weak  and  delicate  or  aged  women,  it 
does  not  appear  probable  that  intercourse  could  be  accomplished 
against  the  consent  of  a  healthy  adult,  except  under  the  following 
conditions : — ■ 

1.  When  narcotics  or  intoxicating  liquids  have  been  administered 
to  her,  either  by  the  prisoner  or  through  his  collusion.  It  matters 
not,  in  a  case  of  this  kind,  whether  the  narcotics  have  been  given 
merely  for  the  purpose  of  exciting  the  female,  or  with  the  deliberate 
intention  of  having  intercourse  with  her  while  she  was  intoxicated 
— the  prisoner  is  equally  guilty.  (See  Reg.  v.  Camplin,  "Law 
Times,"  June  28,  1845 ;  also  "  Med.  Gaz.,"  vol.  36,  p.  443.)  The 
nature  of  the  substance  whereby  insensibility  is  produced  is  of 
course  unimportant.  Thus  the  vapors  of  ether  and  chloroform  have 
been  criminally  used  in  attempts  at  rape.  In  a  case  which  occurred 
in  France,  a  dentist  was  convicted  of  a  rape  upon  a  woman,  to  whom 
he  had  administered  the  vapor  of  ether.  The  prosecutrix  was  not 
perfectly  unconscious,  but  she  was  rendered  wholly  unable  to  offer 
any  resistance.  ("  Med.  Gaz.,"  vol.  40,  p.  865.)  A  dentist  was  re- 
cently convicted  of  rape  under  somewhat  similar  circumstances  in 
the  United  States,  but  it  was  thought  that  the  woman  had  made  the 
charge  under  some  hallucination  or  delusion.  [The  American  case 
here  referred  to  is  that  of  Beale,  the  dentist,  convicted  on  extremely 
vague  and  inconsistent,  and  entirely  uncorroborated  evidence  of  the 
complainant,  of  violating  a  young  lady  while  she  was  stupefied  and 
disabled  by  the  inhalation  of  ether.  This  case  was  generally  be- 
lieved to  be  one  of  anaesthetic  illusion,  similar  to  many  which  have 
since  been  clearly  testified  to  as  having  occurred  in  the  experience 
of  different  operators.  See  the  "  Philada.  Med.  Exam.,"  Dec.  1854, 
for  a  full  review  of  the  case;  also  Wharton  and  Stille,  "Med. 
Jurisp.,"  §§  443,  445,  459.  See  also  the  same  authors  for  a  report 
of  the  case  of  Dr.  Davis  Green,  of  Mercer  Co.,  Ohio,  convicted  of 
rape  on  a  young  girl  while  partially  affected  by  chloroform  adminis- 
tered to  her  while  asleep. — H.]  In  Reg.  v.  Snarey  (Winchester  Lent 
Assizes,  1859),  there  Avas  a  clear  attempt  at  fraud.  The  prosecu- 
trix asserted  that  she  was  instantly  rendered  insensible  by  the  pri- 
soner forcibty  applying  a  handkerchief  to  her  face,  and  she  accused 
him  of  having  committed  a  rape  on  her.    The  charge  was  dispn 


RAPE    ON    WOMEN    WHILE    UNCONSCIOUS.  615 

by  a  distinct  alibi,  as  well  as  by  the  improbability  of  all  the  circum- 
stances. 

When  the  state  of  unconsciousness  arises  from  natural  infirmity, 
as  in  idiocy  or  insanity,  carnal  intercourse  with  a  woman  is  regarded 
as  rape.  {Reg.  v.  Ryan,  Cent.  Crim.  Court,  September,  1846.)  The 
woman  was  in  this  ca  ;e  an  idiot,  and  it  was  proved  that  her  habits 
were  not  loose  or  indecent.  Piatt,  B.  held  that  if  she  was  in  a  state 
of  unconsciousness  at  the  time  the  connection  took  place,  whether  it 
was  produced  by  any  act  of  the  prisoner  or  by  any  act  of  her  own(  ?), 
any  one  having  intercourse  with  her,  would  be  guilty  of  rape.  The 
prisoner  was  convicted.  [See  also  the  case  of  State  v.  Crow  (Com- 
mon Pleas  of  Athens  Co.,  Ohio)  "  Western  Law  Journal,"  vol.  x.  p. 
501. — P.]  In  Reg.  v.  White  (Northampton  Winter  Assizes,  1S56), 
the  learned  judge,  in  charging  the  jury,  stated  that  some  doubts  were 
entertained  whether  the  crime  of  rape  could  be  committed  (in  law) 
on  the  person  of  a  woman  who  had  rendered  herself  perfectly  in- 
sensible by  drink,  so  as  to  be  unable  to  make  any  resistance :  he 
thought  it  could  not  be  alleged  as  an  excuse  for  the  man  The  ques- 
tion was  not  reserved,  as  the  prisoner  was  acquitted  of  rape,  and 
found  guilty  of  an  indecent  assault. 

It  may  be  a  question  whether  a  man  can  have  intercourse  with  a 
woman  without  her  knowledge  while  thus  in  a  state  of  unconscious- 
ness from  natural  sleep.  Casper  met  with  a  solitary  case  in  which  a 
girl  aged  16  accused  a  man  of  having  had  intercourse  with  her 
while  she  was  sleeping  in  her  bed,  of  which  she  was  not  conscious 
until  he  was  in  the  act  of  withdrawing  from  her.  On  her  own  state- 
ment she  was  virg'o  intacta.  up  to  the  date  of  this  occurrence.  Upon 
the  facts  of  the  case,  Casper  came  to  the  conclusion  that,  if  her 
statement  was  true,  the  man  could  not  have  had  intercourse  with  her 
without  causing  pain  and  rousing  her  to  a  consciousness  of  her  posi- 
tion. The  hymen  was  not  destroyed,  but  presented  lacerations  in 
two  places.  This  and  other  facts  showed  that  there  had  been  inter- 
course, but  did  not  prove  that  this  had  taken  place  without  the  con- 
sciousness of  the  woman.  ("  Klinische  Novellen,"  1863,  p.  31.)  A 
man  was  charged  with  rape  before  a  police  magistrate,  and  the  pros- 
ecutrix swore  that  he  had  effected  his  purpose  during  her  sleep.  The 
bare  possibility  of  the  offence  being  perpetrated  under  these  circum- 
stances cannot  be  denied ;  but  this  admission  could  only  apply  to  a 
case  in  which  the  woman  had  been  accustomed  to  sexual  intercourse, 
and  in  which  the  sleep  was  preternatural  or  lethargic.  In  this  in- 
stance the  woman  was  a  prostitute,  and  the  charge  improbable.  A 
respectable  married  woman  who  had  had  children,  the  wife  of  an  inn- 
keeper, threw  herself  on  her  bed  with  her  clothes  on,  late  one  eve- 
ning, and  fell  fast  asleep.  She  was  first  awakened  by  finding  a  man 
"i  her  body,  in  the  act  of  withdrawing  from  her.  This  man, 
William  McEwan,  a  servanl  in  the  house,  was  given  into  custody  on 
a  charge  of  rape.  In  the  first  instance  he  did  not  deny  the  act,  and 
there  was  no  reason  to  believe  that  the  prosecutrix  was  aware  of  l  he 
prisoner's  conduct  until  the  crime  was  completed,  and  she  was 
awakened  in  the  manner  described — apparently  by  the  weight  of 


616  RAPE    OX    ADULT    WOMEN". 

the  prisoner's  body.  The  prisoner  was  convicted  and  sentenced  to 
ten  years'  penal  servitude.  ("  Bdin.  Month.  Jour."  December,  1862, 
p.  570.)  A  case  which  may  serve  to  throw  a  little  light  upon  this 
question  occurred  to  Casper.  ("  Gerichtliche  Medicin,"  vol.  2,  p. 
57-4.)  A  married  woman  alleged  that  a  man  had  had  intercourse 
with  her  while  in  bed,  and  when  she  was  asleep.  In  her  deposition, 
however,  she  admitted  she  was  conscious  that  some  one  was  lying 
upon  her,  and  that  she  asked  Avho  it  was  ;  showing,  as  Casper  re- 
marks, that  she  had  a  knowledge  of  what  was  going  on,  and  some 
doubt  whether  the  person  was  her  husband. 

In  reference  to  the  question  whether  it  is  possible  to  commit  a 
rape  upon  a  woman  while  asleep,  a  majority  of  the  Scotch  judges 
decided,  in  the  case  of  Sweenie  (Irvine's  "  Judiciary  Keports,"  vol. 
8,  p.  109),  that  the  feloniously  having  connection  with  a  woman 
while  asleep  was  not  indictable  under  the  name  of  rape,  inasmuch 
as,  apart  from  the  force  implied  in  the  act  of  connection,  there  was 
no  force  used  to  overcome  the  will  of  the  woman.  But  they  held, 
however  improbable  it  might  be,  it  was  quite  possible  that  a  man 
mi<j;ht  have  connection  with  a  woman  while  asleep.  ("  Edin.  Month. 
Jour.,"  December,  1862,  p.  570.) 

[We  are  indebted,  for  a  case  in  point,  to  our  friend  Dr.  D.  F.  Lewis, 
formerly  of  London,  and  now  librarian  to  the  Pennsylvania  Hos- 
pital of  Philadelphia.  While  practising  in  London,  in  1858,  he  was 
called  to  attend  a  young  woman  previously  well  known  to  him  as  of 
excellent  character,  and  found  her  in  a  violent  hysterical  paroxysm, 
brought  on  by  the  discovery  that  she  had  been  violated,  during  sleep, 
by  her  accepted  admirer.  She  had  returned  to  her  mother's  home 
with  him,  from  a  long  walk,  very  much  fatigued,  and  after  having 
drank  a  glass  of  ale,  had  sunk  into  a  profound  slumber,  during  which 
the  act  had  been  perpetrated  without  the  slightest  evidence  of  con- 
sciousness on  her  part.  This  was  admitted  by  her  companion;  and 
her  prompt  discovery  of  her  wrong,  and  immediate  alarm  and  agita- 
tion, as  well  as  her  known  liability  to  unusually  heavy  sleep,  fully 
established  the  truth  of  her  assertion.  The  usual  physical  signs  of 
recent  defloration  were  presented  on  her  person. — H.] 

The  condition  of  the  so-called  magnetic  or  unnatural  sleep  has 
given  rise  to  a  question  connected  with  the  alleged  perpetration  of 
rape.  A  girl  (aged  18)  consulted  a  therapeutic  magnetizer  as  to  her 
health.  She  visited  him  daily  for  some  daj's.  Four-and-a-half 
months  afterwards  she  discovered  that  she  was  pregnant,  and  made 
a  complaint  to  the  authorities  against  the  magnetizer.  They  dirt 
a  physician  and  surgeon  to  determine  the  date  of  her  pregnancy,  and 
whether  complainant  might  have  then  been  violated  and  rendered 
pregnant  contrary  to  her  will,  i.  e.,  whether  her  volition  could  have 
been  completely  or  partially  annihilated  by  magnetism.  The  medi- 
cal inspectors  were  satisfied  that  the  pregnancy  did  not  extend  further 
back  than  four-and-a-half  months ;  and  founding  their  opinion  on 
M.  Husson's  report,  made  to  the  Academy  in  1831,  concluded  that 
as  a  person  in  magnetic  sleep  is  insensible  to  every  kind  of  torture, 
sexual  intercourse  might  then  take  place  with  a  young  woman  with- 


EAPE  ON  ADULT  WOMEN.  617 

out  the  participation  of  her  will ;  without  consciousness  of  the  act, 
and  consequently  without  the  power  to  resist  the  act  consummated 
on  her.  This  opinion  was  confirmed  by  that  of  Devergie.  ("  Ga- 
zette Medicale  de  Paris,"  and  "  Edin.  Month.  Jour."  December,  1860, 
p.  566.)  There  is  another  view  of  this  case  which  does  not  seem  to 
have  occurred  to  the  French  medical  experts,  namely:  "Kon  omhes 
dormiunt  qua?  clausos  habent  oculos."  [Where  the  testimony  was 
to  the  effect  that  the  person  alleged  to  be  ravished  was  awakened  by 
the  act  of  the  prisoner,  to  which  she  made  no  resistance  or  outcry, 
when  there  was  another  person  in  the  room  who  could  have  heard 
her,  it  was  held  not  to  be  a  case  of  rape.  Pollard  v.  The  State,  2 
Clarke  (Iowa),  567.— P.] 

2.  A  rape  may  be  committed  on  an  adult  woman  if  she  falls  into 
a  state  of  syncope,  or  is  rendered  powerless  by  terror  and  exhaustion 
from  long  struggling  with  her  assailant.  An  eminent  judicial  au- 
thority has  suggested  to  me  that,  in  his  opinion,  too  great  distrust  is 
commonly  shown  in  reference  to  the  amount  of  resistance  offered  by 
women  of  undoubted  character.  Inability  to  resist  from  terror,  or 
from  an  overpowering  feeling  of  helplessness,  as  well  as  horror  at 
her  situation,  may  lead  a  woman  to  succumb  to  the  force  of  a  rav- 
isher,  without  offering  that  degree  of  resistance  which  is  generally 
expected  from  a  woman  so  situated.  As  a  result  of  long  experience, 
he  thinks  that  injustice  is  often  done  to  respectable  women  by  the 
doctrine  that  resistance  was  not  continued  long  enough. 

3.  When  several  are  combined  against  the  female,  in  which  case 
we  may  expect  to  find  some  marks  of  violence  on  her  person,  if  not 
on  the  genital  organs. 

4.  A  woman  may  yield  to  a  ravisher,  under  threats  of  death  or 
duress :  in  this  case  her  consent  does  not  excuse  the  crime,  but  this 
is  rather  a  legal  than  a  medical  question.  An  aged  woman  can 
scarcely  be  expected  to  resist  a  strong  man.  Dr.  Chevers  mentions 
a  case  in  which  a  man  was  convicted  of  rape  and  aggravated  assault 
on  a  woman  of  seventy  years  of  age. 

[Wharton  (Wh.  and  Stille,  "  Med.  Jur."  p.  351,  et  seq.)  states  the 
points  to  which  medical  testimony  is  most  likely  to  be  invited,  in 
prosecutions  for  rape,  to  be  the  following :  "First,  submission  of 
prosecutrix;  (1),  from  artificial  stupefaction;  (2),  from  ignorance  of 
the  nature  of  the  act;  (3),  from  mistake  of  person;  (-1),  from  fear. 
Second,  prior  want  of  character  of  prosecutrix.  Third,  subsequent 
suppression  of  the  facts  by  prosecutrix.  Fourth,  extent  to  which 
coition  was  carried.  Fifth,  want  of  age  of  defendant.  Sixth,  want 
of  sexual  capacity  of  defendant." 

Under  the  head  of  "  Tgnarance  of  the  Nature  of  the  Act"  this  au- 
thority refers,  among  others,  to  the  case  of  an  imbecile  girl  who  was 
totally  unable  to  account  for  her  pregnancy,  exec  pi  by  the  statement 
that  her  cousin  had  played  with  berori  the  sofa  (p.  345,  from  "Henke's 
Zeits.,"  1839,  p.  294,  Fleischmann).  Also  to  that  of  a  young  girl 
who  permitted  sexual  intercourse  with  a  physician,  solely  from  a 
belief  that  the  defendant  was,  as  he  represented,  treating  her  medi- 


618  EAPE.      LOSS    OF    PHYSICAL    EVIDENCE. 

cally.     This  case  was  held  by  all  the  judges  to  be  rape.     R.  v.  Case, 
1  "Bng.  Rep."  54-4;  "Wh.  Cr.  Law,"  (3d  ed.)  519.) 

From  Mistake  of  Person. — Under  this  caption  Wharton  says  (Joe. 
cit.),  "Very  early  in  the  judicial  history  of  this  country,  a  convic- 
tion of  rape  was  sustained  in  New  York,  by  a  very  eminent  judge — 
Thomson,  C.  J., — upon  evidence  showing  that  the  prosecutrix  mis- 
took the  defendant  for  her  husband,  and  permitted  his  embraces 
under  that  impression.  (1  "  Wheel.  C.  C."  381.)  The  same  point 
was  again  taken  in  subsequent  cases;  one  in  New  York  (People  v. 
Metca\r\  1  "  Wheel.  C.  C."  378),  and  the  other  in  Connecticut  (State 
v.  Shephard,  7  "Conn."  54).  In  England  it  was  at  first  thought  that 
evidence  would  not  sustain  a  conviction  (R.  v.  Jackson,  R.  & 
487),  though  afterwards,  convictions  of  the  assault  with  the  in- 
cut were  ordered  (R.  v.  Saunders,  3  C.  &  P.  265;  R.  v.  Williams, 
id.,  286).  The  intimation,  at  the  same  time,  was  thrown  out,  that  if 
the  question  arose  again  it  would  be  reconsidered  ;  and,  indeed,  it  is 
difficult  to  reconcile  an  acquittal  under  such  circumstances,  with  a 
conviction  upon  evidence  that  consent  was  given  under  the  impression 
that  the  act  was,  as  it  was  represented  to  be  by  the  aggressor,  an  ap- 
plication in  the  course  of  medical  treatment.  (See  "  Wharton's 
Cr.  Law,"  3d  ed.,  512.)  [In  Alabama,  it  is  held,  that  force,  actual  or 
constructive,  is  a  necessary  ingredient  in  the  crime  of  rape;  and 
that  sexual  intercourse  with  a  female,  with  her  consent,  does  not  con- 
stitute the  offence,  although  her  consent  was  procured  by  a  fraudu- 
lent personation  of  her  husband.  Leivis  v.  The  State,  30  Alabama, 
54. — P.]  See  "  Association  Medical  Journal,"  1855,  loc.  cit.,  for  a 
notice  of  some  English  and  Scotch  cases  of  "  fraud,"  in  which  carnal 
connection  was  had,  through  mistake  of  the  complainants,  with  the 
defendants  instead  of  their  husbands.  One  delinquent,  who  was 
tried  in  Scotland,  was  found  guilty  of  the  special  offence,  and  sen- 
tenced to  twenty  years'  transportation.  This  course,  which  is  the 
most  rational,  seems  to  be  the  one  which  the  English  courts  are  in- 
clined to  take. — H.] 

Loss  of  Physical  Evidence. — It  is  necessary  to  observe,  in  relation 
to  the  examination  of  married  women,  that  the  indications  of  rape 
on  the  genitals,  however  well-marked  they  may  be  in  the  first  in- 
stance, either  soon  disappear  or  become  obscure,  especially  in  those 
who  have  been  already  habituated  to  sexual  intercourse.  After  two, 
three,  or  four  days,  unless  there  has  been  an  unusual  degree  of  vio- 
lence, no  traces  of  the  crime  may  be  found  about  the  genital  organs. 
In  the  case  of  an  adult  married  woman  examined  by  Dr.Mayne,  the 
appearances  of  injury  which  he  discovered  in  and  about  the  vagina 
had  begun  to  heal  in  less  than  forty-eight  hours;  but  in  a  case  ex- 
amined by  Casper,  on  the  ninth  day  the  lining-membrane  of  the 
vagina  was  still  reddened,  and  the  parts  were  painful.  In  this  ease 
the  hymen  was  completely  torn  through.  ("  Gerichtliche  Medic  in." 
vol.  2,  p.  157.)  In  married  women,  or  in  those  accustomed  to  sexual 
intercourse,  no  inference  can  be  drawn  fropi  a  dilated  state  of  the 
vagina.  In  unmarried  women,  and  in  children  when  there  has  been 
much  violence,  these  marks  may  persist  and  be  apparent  for  a  week 


PREGNANCY  FOLLOWING  RAPE.  619 

or  longer.  If  there  has  been  great  laceration  of  the  sexual  organs, 
then  certain  appearances  in  the  form  of  cicatrices  may  remain ;  but 
in  all  cases  great  caution  should  be  observed  in  giving  an  opinion  of 
rape  having  been  perpetrated,  from  an  examination  even  two  or 
three  weeks  after  the  alleged  commission  of  the  offence.  Marks  of 
violence  on  the  person  can  never  establish  a  rape ;  they  merely  indi- 
cate, cseteris  paribus,  that  the  crime  may  have  been  attempted. 

Pregnancy  Following  Rape. — It  has  been  a  question,  whether  when 
intercourse  has  taken  place  against  the  will  of  a  woman,  i.  e.,  in  the 
perpetration  of  rape  by  violence,  pregnancy  could  possibly  follow. 
It  was,  at  one  time,  thought  that  the  will  of  a  woman  was  always 
necessary  to  the  act  of  impregnation,  and  therefore  if  she  became 
pregnant,  she  must  have  consented  to  the  act,  and  that  the  charge  of 
rape  was  unfounded.  Such  a  defence  would  not  be  admitted  as  an 
answer  to  a  charge  of  rape,  or  to  show,  under  any  circumstances, 
that  intercourse  had  been  had  with  consent.  Conception,  it  is  well 
known,  does  not  depend  on  the  consciousness  or  volition  of  a  female. 
If  the  state  of  the  uterine  organs  be  in  a  condition  favorable  to  im- 
pregnation, this  may  take  place  as  readily  as  if  the  intercourse  was 
voluntary  ;  even  penetration  to  the  vagina  is  not  absolutely  neces- 
sary for  impregnation.  (See  case  by  Dr.  Oldham,  "  Med.  Gaz."  vol. 
44,  p.  48.)  In  a  case  communicated  to  me  by  the  late  Mr.  Carring- 
ton,  a  woman  became  pregnant,  after  a  rape  committed  on  her  by  a 
man  who  subsequently  married  her  ;  the  date  of  intercourse  was 
accurately  fixed,  and  a  child  was  born  after  263  days'  gestation. 

It  has  been  supposed,  that  in  cases  of  pregnancy  following  rape, 
in  spite  of  resistance  at  first,  a  woman  may  in  the  end  have  volun- 
tarily joined  in  the  act.  I  know  of  no  ground  for  adopting  this 
theory  ;  the  general  opinion  is,  that  conception  may  occur,  and  is 
neither  accelerated  nor  prevented  by  the  volition  of  the  sexes.  Many 
women  in  married  life  who  anxiously  wish  for  children  have  none, 
and  vice  versa;  and  physical  impediments  do  not  suffice  in  all  cases 
to  explain  these  facts.  Women  are  reported  to  have  conceived  dur- 
ing the  states  of  asphyxia,  intoxication,  and  narcotism.  Dr.  Ryan 
mentions  a  case  in  which  a  young  woman  became  unconsciously 
pregnant  from  intercourse  had  with  her  by  a  man  while  she  was  in  a 
state  of  intoxication,  and  in  which  it  was  clearly  impossible  that  her 
volition  could  have  taken  any  share.  ("  Med.  Juris."  p.  245.)  In 
married  life  there  is  no  doubt  that  women  frequently  become  preg- 
nant against  their  will,  and  in  a  great  number  of  cases  without  any 
consciousness  of  their  condition  until  pregnancy  is  far  advanced. 
Those  who  affirm  that  without  the  active  will  of  the  woman  there 
can  be  no  conception,  must  deny  the  existence  of  cases  of  impreg- 
nation in  a  state  of  unconsciousness  (p.  426 ;)  but  the  facts  are  too 
strong  and  too  numerous  to  be  met  with  a  single  denial.  A  medical 
jurist,  therefore,  who  relied  upon  pregnancy  following  alleged  rnpe, 
as  a  proof  of  consent  on  the  pari  of  the  woman,  and  who  would  infer 
from  this  result  that  the  intercourse  musl  have  been  voluntary  on 
her  part,  would  inflict  great  injustice  by  such  an  opinion.     The  ex- 


620  RAPE.      MICROSCOPICAL    EVIDENCE. 

trusion  of  an  ovum  does  not  depend  on  the  will  of  a  woman,  but  is 
a  periodical  condition ;  the  action  of  the  spermatozoa  on  this  ovum 
is  as  much  removed  from  the  will  of  the  woman  as  it  is  from  that 
of  the  man. 

This  subject  would  have  hardly  required  so  much  notice,  but  for 
the  fact  that  in  some  recent  trials  it  has  been  put  forward  with  a  view 
to  discredit  the  evidence  of  a  woman,  where  pregnancy  has  followed 
intercourse  in  a  state  of  alleged  unconsciousness.  Any  statement  of 
this  kind  certainly  requires  a  close  examination,  because,  generally, 
there  is  a  strong  motive  for  falsehood  on  the  part  of  a  woman.  In 
the  case  of  Bromivich  v.  Waters  (p.  549),  the  }Toung  woman  Whalley 
had  had  a  child,  but  stated  that  she  had  not  been  conscious  of  any 
intercourse.  Ttfe  fact  that  she  had  borne  a  child  did  not  prove  that 
her  statement  was  false,  although  a  suggestion  to  this  effect  was  made. 
We  may  fairly  doubt  whether  a  woman  could  have  intercourse  un- 
consciously, but  because  impregnation  follows,  this  is  no  proof  that 
she  is  guilty  of  falsehood  or  perjury. 

Microscopical  Evidence. — As  part  of  the  medical  evidence  in  cases 
of  rape,  it  may  be  necessary  to  examine  spots  or  stains  on  the  linen  of 
the  prosecutrix  and  the  accused.  Cases  of  rape  are,  however,  com- 
monly tried  in  this  country  without  reference  to  this  species  of  evi- 
dence ;  and  it  is  not  easy  to  perceive  how  this  can  be  necessary  to 
the  proof  of  the  crime  in  the  living,  when  the  present  law  of  England 
demands  only  proof  of  penetration,  and  not  of  emission.  (24  and  25 
Vict.  c.  100,  s.  63.)  Thus,  a  rape  may  be  legally  completed  without 
reference  to  emission;  and,  medically  speaking,  it  appears  quite 
possible  that  there  might  be  marks  of  emission  without  any  penetra- 
tion. Admitting  that  certain  stains  of  this  description  are  found  on 
the  clothes  of  an  accused  person, — Are  these  to  be  taken  as  furnish- 
ing undeniable  proof  of  the  legal  completion  of  rape  ?  It  appears 
to  me  that  without  corroborative  evidence  from  the  state  of  the 
female  organs  they  cannot  be  so  taken;  and  therefore  the  affirmative 
evidence  from  the  microscope,  under  these  circumstances,  is  as  liable 
to  lead  to  error  as  that  which  is  purely  negative.  The  fact  that  sper- 
matic stains  are  found  on  the  linen  of  the  prosecutrix  may,  however, 
become  occasionally  of  importance  in  charges  of  assault  with  intent. 
(A'"/,  v.  Hamilton),  Edinburgh,  Nov.  27,  1843. 

Examinaion  of  Stains. — There  are  no  chemical  tests  on  which  we 
can  safely  rely  for  the  detection  of  spermatic  stains.  The  appearance 
produced  by  a  dried  spermatic  stain  on  linen  or  cotton  is  like  that 
produced  by  a  diluted  solution  of  albumen.  The  fibre  of  the  stuff  is 
stiffened,  and  the  stain,  particularly  at  the  margin,  has  a  slightly 
translucent  appearance,  as  if  the  stuff  had  been  wetted  by  diluted 
gum  or  albumen,  but  without  any  shining  lustre.  In  the  dry  state 
the  stain  presents  no  well-marked  color  or  odor.  Slips  of  the  stained 
linen,  when  soaked  in  a  small  quantity  of  distilled  water,  yield  a 
muco-albuminous  liquid  slightly  alkaline.  It  was  long  since  noticed 
by  Orfila  that  this  liquid,  unlike  a  solution  of  albumen,  was  rendered 
rather  strongly  yellow  by  diluted  nitric  acid.     By  the  action  of  warm 


EXAMINATION    OF    STAINS.  621 

water,  the  stained  linen,  even  although  it  may  have  been  kept  dry 
for  a  considerable  period,  has  been  observed  to  evolve  the  peculiar 
faint  odor  of  the  spermatic  secretion. 

The  stained  linen,  or  a  portion  of  it,  should  be  cut  out,  taking 
care  that  it  is  not  roughly  handled.  It  should  be  in  a  small  porcelain 
capsule,  with  a  sufficiency  of  cold  distilled  water  (eight  or  ten  drops) 
to  soak  it  thoroughly,  and  to  allow  the  fibre  of  the  stuff  to  become 
quite  penetrated  by  the  liquid.  Unless  the  stained  stuff  is  very 
coarse,  or  is  not  easily  penetrable  by  water,  the  necessary  digestion 
will  be  completed  in  a  quarter  of  an  hour.  The  stained  linen  may 
then  be  removed,  and  any  water  loosely  adhering  to  it  allowed  to 
drain  from  it.  The  soaked  portion  of  the  stain  should  then  be 
squeezed,  so  that  some  drops  of  the  liquid  may  be  collected  on  several 
glass  slides,  already  well  cleaned  and  prepared  for  the  purpose.  The 
liquid  thus  obtained  by  squeezing  the  stained  linen  is  slightly  opaline. 
It  should  now  be  covered  with  thin  microscopic  glass,  and  examined 
by  a  microscope.  The  spermatozoa  are  best  seen  in  a  good  light, 
with  a  power  of  500  diameters;  the  head  is  ovoid  and  flattened — some- 
times rather  pointed ;  the  tail  is  from  nine  to  twelve  times  the  length 
of  the  head :  they  are  usually  associated  with  granular  bodies,  and 
with  epithelial  scales.  Fibres  of  cotton,  linen,  or  wool  may  be  also 
mixed  with  them :  and  they  may  be  mixed  with  pus,  mucus,  and 
blood-globules.  Their  form  is  so  peculiar  that,  when  once  well  seen 
and  examined,  they  cannot  be  confounded  with,  any  other  substance, 
vegetable  or  animal,  nor  with  ordinary  care,  can  any. vegetable  fibres 
be  mistaken  for  them,  although  these  may  be  mistaken  for  their  tails, 
or  filaments.  Hence  the  microscopical  evidence  is  not  satisfactory 
unless  it  is  based  on  the  detection  of  at  least  one  perfect  spermatozoa. 
Dr.  Koblanek  expresses  the  opinion  that  when  they  are  not  dis- 
covered by  the  process  above  described,  the  stains  cannot  be  due  to 
the  spermatic  secretion :  in  this,  however,  he  is  in  error.  When  the 
stained  article  of  dress  is  of  very  coarse  texture,  when  it  has  been 
much  rubbed,  much  worn,  or  wetted  by  urine,  blood,  mucus,  or  ]>us, 
it  will  be  a  matter  of  considerable  difficulty  to  discover  these  bodies, 
although  there  may  really  have  been  spermatic  stains  upon  it.  M  ost 
of  these  foreign  substances,  however,  may  be  removed  by  the 
addition  of  one  or  two  drops  of  diluted  acetic  acid,  which  exerts  no 
dissolving  action  on  the  bodies  of  the  spermatozoa.  As  it  has  been 
elsewhere  stated,  these  bodies,  although  peculiar  to  the  seminal  fluid, 
are  not  found  in  the  very  young,  the  very  old,  or  in  those  who  are 
laboring  under  long-standing  disease  of  the  testicles  (p.  5SO).  Even 
in  the  cases  of  healthy  married  men,  who  have  had  children,  sperma- 
tozoa are  not  always  found  in  the  spermatic  secretion;  their  presence, 
size,  and  number  are  subject  to  great  uncertainty.  Exhaustion  from 
frequent  intercourse,  or  constitutional  causes  without  actual  bodily 
disease,  appear  to  influence  their  production.  There  are  also  various 
other  conditions  in  which  they  are  aol  found  ;  these  have  been  fully 
examined  by  Casper  ("  Gerichtliche  Medicin,"  vol.  2,  p.  141).  Hence 
the  discovery  of  spermatozoa  in  stains  on  articles  of  clothing  demon- 
strates that  they  have  been  produced   by  the  spermatic  liquid;   bul 


622  RATE.      MICROSCOPICAL    EVIDENCE. 

their  non-discovery,  under  these  circumstances,  does  not  prove  that 
the  stains  have  not  1  >een  caused  by  this  liquid.  Dr.  Koblanek's  con- 
clusions on  this  subject  are  therefore  not  borne  out  by  facts. 

The  detection  of  dead  or  motionless  spermatozoa  in  stains  may 
be  made  at  long  periods  after  emission,  when  the  fluid  has  been 
allowed  to  dry.  In  three  cases,  at  intervals  of  from  one  week  to 
seven  weeks  after  the  perpetration  of  the  crime,  Casper  was  enabled 
to  demonstrate  the  presence  of  spermatozoa  od  articles  of  clothing. 
and  thus  to  furnish  strong  corroborative  evidence.  (Op.  cit.,  vol.  2, 
p.  161.)  Dr.  Koblanek  made  experiments  on  this  subject,  in  reference 
to  different  periods  of  time ;  he  found  these  bodies  distinctly,  after 
three  days,  one  month — three,  four,  six,  nine,  and  even  twelve  months. 
The  number  of  distinct  and  perfect  bodies  diminished  according  to  the 
length  of  the  period  at  which  the  examination  was  made.  Thus,  at  the 
end  of  a  year,  only  two  perfect  specimens  could  be  perceived ;  but  it  may 
be  stated,  that  the  discovery  of  one  distinct  and  entire  body  is  cpiite 
sufficient  to  justify  a  medical  opinion  of  the  spermatic  nature  of  the 
stain.  M.  Bayard  states  that  he  had  been  able  to  detect  spermatozoa 
in  stains  after  the  long  period  of  six  years!  ("Man.  Prat,  de  Med. 
Leg."  p.  277.) 

A  medical  witness  must  be  prepared  to  consider  the  precise  value 
of  evidence  furnished  by  the  microscope  in  the  examination  of  stains 
on  the  dress  of  a  man  accused  of  rape.  A  shirt  may  present  stains 
of  blood,  urine,  mucus,  or  gonorrheal  discharge,  some  of  which,  but 
for  the  microscope,  might  be  mistaken  for  spermatic  stains.  Admit- 
ting that,  by  the  process  above  described,  the  microscrope  enables 
an  examiner  to  affirm  that  the  stains  have  really  been  caused  by  the 
spermatic  secretion,  this  does  not  prove  that  a  rape  has  been  com- 
mitted, or  even  that  intercourse  has  been  necessarily  had  with  a 
woman.  Such  stains  may  arise  from  spontaneous  natural  discharge, 
or  from  disease  (spermatorrhoea),  and  therefore  in  themselves  they 
afford  no  proof  of  intercourse.  If,  from  other  circumstances  in  the 
case,  it  should  be  clearly  and  satisfactorily  proved  that  there  has 
been  intercourse,  then  the  presence  of  blood  mixed  with  the  sperm- 
atic stains  might,  in  certain  cases,  justify  an  opinion  that  violence 
had  been  used.  The  discovery  of  spermatic  stains  on  the  dress  of  a 
woman  furnishes  stronger  evidence  of  intercourse,  attempted  or 
perpetrated,  than  their  discovery  on  the  dress  of  a  man ;  but  admit- 
ting that  intercourse  is  thus  proved,  it  may  still  have  taken  place 
with  the  consent  of  the  woman.  These  stains,  when  found  on  the 
clothing  of  girls  and  infants,  afford  a  strong  corroborative  proof  of 
the  perpetration  of  the  crime. 

Microscopical  Evidence  from  the  Woman. — It  may  become  necessary 
to  determine,  in  reference  to  a  woman,  whether  intercourse  has 
has  not  recently  taken  place.  All  observers  agree  that,  within  a 
certain  period  after  connection,  the  fact  may  be  established  by  the 
examination  of  .the  vaginal  mucus.  A  small  quantity  of  this  mucus 
placed  upon  glass,  and  diluted  with  water,  will  be  found  to  contain 
spermatozoa,  if  the  suspicion  be  correct.  In  addition  to  other  charac- 
ters, it  may  be  remarked  that  the  living  spermatozoa  move  for  many 


BLOOD-STAINS.  623 

hours  out  of  the  body  when  kept  at  a  temperature  of  98°,  and  they 
even  retain  their  rapid  motions  when  the  spermatic  liquid  is  mixed 
with  water ;  but  these  motions  cease  immediately  on  the  addition  of 
urine  or  chemical  re-agents.  According  to  Midler,  the  spermatozoa 
may  retain  vitality  (or  free  motion)  in  the  body  of  a  woman  for  the 
period  of  seven  or  eight  days,  and  even  longer.  M.  Bayard  states 
that  he  has  thus  detected  them  in  the  vaginal  mucus  of  females  not 
subject  to  morbid  discharges,  at  various  intervals  up  to  three  days 
after  intercourse  (op.  cit.,  p.  277) ;  and  Donne  found  them  under 
similar  circumstances  in  a  woman  who  had  been  admitted  into  the 
hospital  the  day  before  (op.  cit.,  p.  305.)  This  evidence  may  become 
of  value  in  a  charge  of  rape,  but  it  may  be  easily  destroyed  by  the 
presence  of  leucorrhcea :  and  it  is  open  to  an  objection,  that,  in  certain 
morbid  states  of  the  vaginal  mucus  of  the  human  female,  there  is 
fount!  in  it  a  microscopic  animalcule,  called  by  Donne  the  Trichomonas 
vaginas;  but  this  has  a  much  larger  body  and  a  shorter  tail  than  the 
spermatozoon.  Other  substances  may  be  sometimes  found  in  the 
vaginal  mucus;  see  case  by  Dr.  Lender  (Horn's  "  Vierterjahrschrift," 
April,  1865,  p.  355). 

Marks  of  Blood  on  Clothing. — Marks  of  blood  upon  the  linen  can, 
of  coarse,  furnish  no  evidence  unless  taken  with  other  circumstances. 
The  linen  may  be  intentionally  spotted  or  stained  with  blood  for  the 
purpose  of  giving  apparent  support  to  a  false  accusation.  Dr.  Bay- 
ard met  with  a  case  of  this  kind,  in  which  a  woman  charged  a  youth 
with  having  committed  a  rape  upon  her  infant  child.  On  examina- 
tion, the  sexual  organs  were  found  uninjured ;  and  on  inspecting  the 
marks  of  blood  on  the  clothes  of  the  child,  it  was  observed  that  the 
stains  were  produced  on  the  outside  of  the  stuff,  and  bore  the  ap- 
pearance of  smearing ;  the  wdiole  fibre  had  not  even  been  com- 
pletely penetrated  by  the  liquid.  The  falsehood  of  the  charge  was 
thus  established.  ("Ann.  d'Hyg.,"  1847,  vol.  2,  p.  219.)  A  case 
involving  a  false  charge  of  rape  Was  tried  at  the  Glasgow  Autumn 
Circuit  in  1859.  One  of  the  witnesses,  an  accomplice,  proved  that 
she  had  purchased  some  blood  and  handed  it  to  the  woman  who 
made  the  charge,  and  she  saw  her  smear  it  over  her  person  and  on 
some  sheets  on  which  it  was  alleged  the  rape  was  perpetrated.  The 
woman  (Boyle)  and  her  husband,  who  made  tins  false  charge,  were 
convicted  of  conspiracy. 

It  may  be  a  question  whether  marks  of  blood  on  the  linen  of  a 
prosecutrix  were  caused  by  effusion  as  a  result  of  violence  or  by  the 
menstrual  fluid.  In  its  normal  state  this  fluid  is  said  to  contain  no 
fibrin  ;  but  in  respect  to  the  presence  of  red  corpuscles  and  of  serum, 
it  resembles  blood.  That  fibrin  is,  however,  frequently  present, 
and  in  large  quantity,  is  obvious  from  its  being  occasionally  dis- 
charged in  a  clotted  state:  hence  the  discovery  of  fibrin  in  a  stain 
would  by  no  means  necessarily  imply  that  the  blood  was  not  derived 
from  the  menstrual  fluid.  Supposing  the  blood-stain  to  have  h 
caused  by  imbibition  from  another  article  of  dress  already  stained, 
the  secondary  stain  would  be  free  from  fibrin,  which  would  remain 
in  the  stuff  originally  wetted.     A  man  might  thus  wrongly  pro- 


62-i       RAPE.   EVIDENCE  IN  THE  DEAD  BODY. 

nounce  this  secondary  stain  to  be  due  to  menstrual  blood.  Even  the 
presence  of  epithelial  scales  and  mucus  would  not  prove  the  stain  to 
be  menstrual,  unless  it  could  be  shown  that  the  mucus  was  actually 
effused  with  the  blood  which  caused  the  stain.  The  epithelial  scales 
naturally  found  in  vaginal  mucus  are  fiat  nucleated  cells,  oval,  round, 
or  polygonal  in  shape,  and  varying  in  size.  They  are  spread  over 
the  mucous  membrane  not  only  of  the  vagina,  but  of  the  mouth, 
pharynx,  oesophagus  (gullet),  conjunctiva,  and  the  serous  and  synovial 
membranes.  ("  Kirkes'  Physiology,"  p.  30-1.)  There  must  be  great 
caution  in  relying  upon  this  microscopical  evidence. 

It  may  be  right  to  state,  for  the  information  of  medical  practi- 
tioners who  have  hitherto  thought  that  they  could  easily  distinguish 
menstrual  blood,  and  swear  to  it,  on  charges  of  rape,  that  a  few 
years  since  the  French  Academy  of  Medicine  appointed  as  a  com- 
mittee MM.  Adelon,  Moreau,  and  Le  Canu,  to  examine  this  question 
in  the  most  comprehensive  manner.  These  gentlemen  reported  that, 
in  the  present  state  of  science,  there  is  no  certain  method  by  which 
menstrual  blood  can  be  distinguished  from  that  effused  from  the 
bloodvessels  in  a  case  of  child-murder  or  abortion.  ("Ann.  d'Hyg.," 
1846,  vol.  1,  p.  181 ;  see  ante,  p.  592.) 

Evidence  of  Violation  in  the  Dead. — The  body  of  a  child  or  woman 
is  found  dead,  and  a  medical  witness  may  be  required  to  determine 
whether  her  person  has  or  has  not  been  violated  before  death.  There 
is  here  some  difficulty,  because  there  will  be  no  statement  from  the 
prosecutrix  herself.  The  witness  can  seldom  do  more  than  express 
a  conjectural  opinion,  from  the  discovery  of  marks  of  violence  on 
the  person  and  about  the  genital  organs.  Even  if  spermatozoa  were 
detected  in  the  liquid  mucus  of  the  vagina,  or  on  the  dress  of  a 
woman,  this  would  merely  prove  that  there  had  been  intercourse : 
whether  it  had  been  violent  or  not,  and  against  the  will  of  the 
woman,  would  depend  on  the  circumstantial  evidence.  In  a  case  of 
murder  tried  in  Edinburgh  some  years  ago,  the  first  point  to  deter- 
mine in  the  dead  body  was,  whether  a  rape  had  or  had  not  been 
committed.  The  examination  of  the  stains  on  the  dress  was  con- 
clusive, when  taken  in  conjunction  with  the  other  evidence.  The 
jury  convicted  the  man  of  a  rape,  but  acquitted  him  of  the  murder. 
For  a  case  in  which  evidence  was  obtained  on  the  examination  of  a 
dead  body,  see  Casper's  "  Klinische  ISTovellen,"  p.  17. 

Rape  by  Females  on  Males. — So  far  as  I  can  ascertain,  this  crime 
is  unknown  to  the  English  law.  Several  cases  of  this  kind  have, 
however,  come  before  the  French  Criminal  Courts.  In  18-15,  a 
female,  aged  eighteen,  was  charged  with  having  been  guilty  of  an  act 
of  indecency,  with  violence,  on  the  person  of  Xavier  T.,  a  boy  under 
the  age  of  fifteen  years.  She  was  found  guilty,  and  condemned  to 
ten  3rears'  imprisonment.  In  another  case,  which  occurred  in  1^12. 
a  girl,  aged  eighteen,  was  charged  with  rape  on  two  children — the 
one  eleven,  and  the  other  thirteen  years  of  age.  It  appeared  in  evi- 
dence that  the  accused  euticed  the  two  boys  into  a  field,  and  there 
had  forcible  connection  with  them.  This  female  was  proved  to  have 
had  a  preternatural  contraction  of  the  vagina,  which  prevented  in- 


SODOMY.      BESTIALITY.  625 

tercourse  with  adult  males.  She  was  found  to  be  laboring  under 
syphilitic  disease,  and  the  proof  of  her  offence  was  completed  by  the 
disease  having  been  communicated  to  the  two  boys.  She  was  con 
demned,  by  the  Court  of  Assizes  of  the  Seine,  to  fifteen  years'  hard 
labor  at  the  galleys.  ("Ann.  d'Hyg.,"  1847,  vol.  1,  p.  463.)  Casper 
describes  cases  of  this  description  which  have  fallen  under  his  ob- 
servation. ("  Handbuch  der  Gerichtlichen  Medicin,"  vol.  2,  p.  129  ; 
and  "Klinische  Novellen,"  1863,  p.  15.)  By  the  Penal  Code  of 
France,  it  is  a  crime  in  either  sex  to  attempt  intercourse  with  the 
other,  whether  with  or  without  violence,  when  the  child  is  under 
eleven  years  of  age.  That  this  offence  is  perpetrated  in  England 
cannot  be  doubted.  It  is  by  no  means  unusual  to  find,  in  the  wards 
of  hospitals,  mere  boys  affected  with  the  venereal  disease.  In  some 
instances  this  may  be  due  to  precocious  puberty  ;  but  in  others,  it 
can  only  be  ascribed  to  that  unnatural  connection  of  adult  females 
with  male  children,  which  is  punished  as  a  crime  in  the  other  sex. 
The  only  accessible  medical  proof  would  consist  in  the  transmission 
of  gonorrhoea  or  syphilis  from  the  woman  to  the  child. 

[Rape  on  Slaves. — Before  the  abolition  of  slavery  in  the  United 
States,  it  was  decided,  in  Mississippi,  that  the  carnal  knowledge  of 
a  slave  girl,  under  the  age  of  ten  years,  by  a  slave,  was  not  rape 
under  the  laws  of  that  State.  That  the  common  law  had  no  applica- 
tion to  slaves  either  for  protection  or  punishment,  and  that  the  offence 
therefore  was  not  punishable  by  that  law.  That  statutes  did  not 
apply  to  slaves  either  for  protection  or  punishment,  unless  they  be 
expressly  named;  and  that  consequently  the  statute  did  no"t  cover 
the  case.     George  v.  Stale,  37  Miss.  (8  George),  316. — P.] 

Sodomy.    Bestiality. 

Sodomy  is  defined  to  be  the  unnatural  connection  of  a  man  with 
mankind,  while  the  term  bestiality- is  applied  to  a  similar  connection 
with  an  animal.  The  evidence  required  to  establish  this  crime  is 
the  same  as  in  rape,  and  therefore  penetration  alone  is  sufficient  to 
constitute  it.  There  are,  however,  two  exceptions:  1st,  it  is  not 
necessary  to  prove  the  offence  to  have  been  committed  against  the 
consent  of  the  person  upon  whom  it  was  perpetrated ;  and  2dly, 
both  agent  and  patient  (if  consenting)  are  equally  guilty ;  but  the 
guilty  associate  is  a  competent  witness.  In  one  case  (Bex  v.  Wise- 
man), a  man  was  indicted  for  having  committed  this  offence  with  a 
woman,  and  a  majority  of  the  judges  held  that  this  was  within  the 
statute.  Unless  the  person  is  in  a  state  of  insensibility,  it  is  not 
possible  to  conceive  that  this  offence  should  be  perpetrated  on  an 
adult  of  either  sex  against  Ins  or  her  will;  the  slightest  resistance 
would  suffice  to  prevent  its  perpetration.  In  August,  1849,  a  ques- 
tion on  this  point  was  referred  to  me  from  Kingston,  Jamaica.  A 
man  was  convicted,  and  sentenced  to  transportation  for  life,  for  the 
crime  of  sodomy,  alleged  to  have  been  committed  on  the  complain- 
ing party  while  he  was  asleep.  The  only  evidence  against  him  was 
the  statement  of  the  complainant.  The  opinion  given  was  in  con- 
40 


626  SODOMY. 

formity  with  that  of  Dr.  J.  Ferguson,  who  referred  the  case  to  me, 
namely,  that  the  perpetration  of  the  act  during  a  state  of  natural 
sleep  was  contrary  to  all  probability.  The  remarks  already  made 
in  reference  to  rape  during  sleep  may  be  applied  with  greater  force 
to  acts  of  this  nature,  (p.  615.)  If  this  crime  be  committed  on  a 
boy  under  fourteen  years,  it  is  felony  in  the  agent  only ;  and  the 
same,  it  appears,  as  to  a  girl  under  twelve.  ("  Archbold,"  p.  409.) 
The  act  must  be  in  the  part  where  it  is  usually  committed  in  the 
victim  or  associate  of  the  crime,  and  if  done  elsewhere  it  is  not 
sodomy. 

The  facts  are  commonly  sufficiently  proved  without  medical  evi- 
dence, except  in  the  cases  of  young  persons,  when  marks  of  physi- 
cal violence  will  in  general  be  sufficiently  apparent.  In  some  in- 
stances proof  of  the  perpetration  of  the  crime  may  be  obtained  by 
resorting  to  microscopical  evidence.  (See  Donne,  op.  cit.  p.  305.) 
Stains  upon  the  linen  of  young  persons  may  thus  furnish  evidence 
that  the  crime  has  been  attempted,  if  not  actually  perpetrated.  For 
a  case  of  this  kind  see  p.  585. 

Trials  for  sodomy  and  bestiality  are  very  frequent,  and  convic- 
tions of  men  and  boys  have  taken  place  for  unnatural  connection 
with  cows,  mares,  and  other  female  animals.  It  is  punishable  by 
penal  servitude  for  life,  under  the  24th  &  25th  Yict.  c.  100,  s.  61. 
There  cannot  be  the  slightest  doubt  that  false  charges  of  sodomy 
are  more  numerous  than  those  of  rape,  and  that  this  is  too  often  a 
successful  mode  of  extortion.  This  is  rather  a  legal  than  a  medical 
question ;  but  it  is  especially  deserving  of  notice,  that  these  accu- 
sations are  very  frequently  made  by  soldiers  and  a  bad  class  of 
policemen ! 


[It  is  a  remarkable  fact,  that  in  cases  of  trials  for  rape,  the  maxim 
of  the  law  that  innocence  is  to  be  presumed  until  guilt  is  proved,  is 
often  reversed.  The  most  glaring  inconsistencies  and  contradictions 
on  the  part  of  the  prosecution  seem  to  escape  the  notice,  or  to  make 
no  impression  upon  the  mind  of  the  jury.  The  remarks  of  Sir 
Matthew  Hale,  so  often  quoted  that  they  have  become  trite,  contain 
nevertheless  a  truth  that  cannot  be  controverted:  "It  is  true,"  he 
says  (1  Hal.  P.  C.  635)  "that  rape  is  a  most  detestable  crime,  and 
therefore  ought  severely  and  impartially  to  be  punished  with  death  ; 
but  it  must  be  remembered  that  it  is  an  accusation  easy  to  be  made, 
hard  to  be  proved,  but  harder  to  be  defended  by  the  party  though 
innocent."  He  then  mentions  some  cases  within  his  own  observa- 
tion of  malicious  prosecution  for  this  crime,  and  adds:  "I  mention 
these  instances  that  we  may  be  the  more  cautious  upon  trials  of 
offences  of  this  nature,  wherein  the  court  and  jury  may  with  so 
much  ease  be  imposed  upon,  without  great  care  and  vigilance,  the 
heinousness  of  the  offence  many  times  transporting  the  judge  and 
jury  with  so  much  indignation,  that  they  are  over-hastily  carried  on 
to  the  conviction  of  the  persons  accused  thereof  by  the  confident 
testimony  of  sometimes  false  and  malicious  witnesses." 


EAPE.  627 

Many  cases  might  be  cited  to  illustrate  these  remarks:  the  books 
are  full  of  them,  however,  and  it  would  be  unnecessary  to  occupy 
space  by  doing  so.  The  conviction  of  Dr.  Beale,  for  instance,  was 
a  surprise  to  the  legal  and  medical  professions,  and  could  only  be 
accounted  for  by  this  remarkable  tendency  on  the  part  of  the  jury. 
In  allusion  to  this  case,  Mr.  Wharton,  in  treating  of  what  de- 
gree of  penetration  is  required  to  complete  the  offence  of  rape,  s; 
("Med.  Juris."'  §  471):  "Perhaps  the  furthest  limit  to  which  the  rule 
has  reached,  is  in  a  recent  case  in  Philadelphia,  where,  though  there 
was  no  medical  examination,  it  was  held  that  proof  by  the  prose- 
cutrix of  pain  in  the  sexual  organ,  and  of  the  juxtaposition  at  the 
time  of  the  defendant's  face  to  her  own — she  at  the  time  being  in  a 
dentist's  chair,  under  the  influence  of  ether — was  enough  to  justify 
a  jury  in  pronouncing  that  there  was  penetration,  and  that  the 
penetration  was  sexual.  The  general  result  of  both  medical  and 
legal  opinion,  however,  is,  that  while  the  learned  and  able  judge 
who  tried  the  case,  properly  left  it  to  the  jury  as  a  question  of  fact 
as  he  was  obliged  to  do,  to  determine  whether  penetration  had  then 
taken  place,  the  verdict  was  not  sustained  by  the  evidence,  and  forms 
an  unsafe  precedent  for  the  future."  And  in  a  note  to  section  443 
of  the  same  work,  the  following  remarks  are  added:  "We  sincerelv 
believe  that  a  great  wrong  may  have  been  inflicted  upon  an  innocent 
man,  which  can  only  be  compensated  by  the  probability  that  the 
fallible  nature  of  the  evidence  upon  which  he  was  convicted,  will 
hereafter  render  it  difficult  to  sustain  an  accusation  upon  similar 
proof."  In  the  same  note  is  mentioned  the  case  of  a  dentist  in  Mon- 
treal, who  was  indicted  in  1858,  for  attempting  to  commit  a  rape 
upon  one  of  his  patients  under  the  influence  of  chloroform.  At  the 
trial,  a  witness  testified  that  his  wife  was  under  the  strongest  im- 
pression that  she  had  been  violated  by  the  prisoner  while  under  the 
influence  of  chloroform ;  yet  her  husband  was  present  during  the 
whole  time  she  was  unconscious.  The  verdict  of  the  jury  was. 
"  Guilty  of  an  attempt  to  commit  rape,  with  a  recommendation  to 
mercy" !' 

In  the  case  of  People  v.  Benson,  6  Cal.  221,  the  court  say  that  "no 
case  of  this  class  (rape)  should  go  to  the  jury  on  the  sole  testimony 
of  the  prosecutrix,  unsustained  by  facts  and  circumstances,  without  t  he 
court  warning  them  of  the  danger  of  conviction  on  such  testimony." 
-P.] 

1  Sanclio  Panza's  judgment,  in  the  case  of  rape  which  was  heard  before  him  daring 
his  brilliant,  though  brief,  administration  as  governor  of  Barataria,  was  certainly 
more  creditable  to  the  cause  of  justice.  The  historian  tlius  reports  it :  "This  cause 
was  no  sooner  ended,  than  there  came  into  court  a  woman  keeping  fast  hold  of  a 
man,  clad  like  a  rich  herdsman.  She  came,  crying  aloud:  '.Justice,  my  Lord- 
governor,  justice!  If  I  cannot  find  it  on  earth,  I  will  seek  it  in  heaven!  Lord- 
governor  of  my  soul,  this  wicked  man  surprised  me  in  the  middle  of  a  field,  and 
made  use  of  my  person  as  if  it  had  been  a  dish-clout.  Woe  is  me  !  he  has  robhed  me 
of  what  I  have  kept  above  these  three-and-twenty  years,  defending  it  against  .Moms  and 
Christians,  natives  and  foreigners.  Have  I  been  as  hard  as  a  cork-tree,  ami  picserved 
myself  as  entire  as  a  salamander  in  the  fire,  or  as  wool  among  briers,  that  this  honest 
man  shall  come  with  his  clean  hands  to  handle  me  ?'  'That  remains  to  be  inquired 
into,'  said  Sancho :  '  let  us  now  proceed  to  see  whether  this  gallant's  hands  are  clean 


628  RAPE. 

or  not ;'  and  turning  to  the  man,  he  asked  him  what  he  had  to  say  in  answer  to  this 
woman's  complaint.  The  man,  all  in  confusion,  replied:  'Sir,  I  am  a  poor  herds- 
man, and  deal  in  swine  ;  and  this  morning  I  went  out  of  this  town,  after  having  sold, 
under  correction,  he  it  spoken,  four  hogs,  and  what  between  dues  and  exactions,  the 
officers  took  from  me  little  less  than  they  were  worth.  As  I  was  returning  home,  by 
the  way  I  lighted  upon  this  good  dame,  and  the  devil,  the  author  of  all  mischief, 
yoked  us  together.  I  paid  her  handsomely:  but  she,  not  contented,  laid  hold  of 
me,  and  has  never  let  go  of  me  until  she  has  dragged  me  to  this  place.  She  says  I 
forced  her  ;  but  by  the  oath  I  have  taken,  or  am  to  take,  she  lies.  This  is  the  whole 
truth.'  Then  the  governor  asked  him  if  he  had  any  silver  money  about  him.  The 
man  answered  that  he  had  about  twenty  ducats  in  a  leathern  purse  in  his  bosom. 
Sancho  ordered  him  to  produce  it,  and  deliver  it  just  as  it  was  to  the  plaintiff.  He 
did  so  trembling :  the  woman  took  the  purse,  and  making  a  thousand  curtsies,  and 
praying  to  God  for  the  life  and  health  of  the  lord-governor,  who  took  such  care  of 
poor  orphans  and  maidens,  out  of  the  court  she  went,  holding  the  purse  with  both 
hands,  taking  care  first  to  see  if  the  money  that  was  in  it  was  silver. 

"  She  had  no  sooner  left  the  room  than  Sancho  said  to  the  herdsman,  who  was  in 
tears,  and  whose  eyes  and  heart  were  gone  after  his  purse:  '  Honest  man,  follow  that 
woman,  and  take  away  the  purse  from  her,  whether  she  will  or  not,  and  come  back 
hither  with  it.'  This  was  not  said  to  one  deaf  or  stupid,  for  the  man  instantly  flew 
after  her  like  lightning,  and  went  about  what  he  was  bidden. 

"  All  present  were  in  great  suspense,  expecting  the  issue  of  this  suit.  In  a  few 
minutes  came  in  the  man  and  woman,  clinging  together  closer  than  the  first  time, 
she  with  her  petticoat  tucked  up,  and  the  purse  lapped  up  in  it,  and  the  man  strug- 
gling to  take  it  from  her,  but  in  vain,  she  defended  it  so  stoutly.  '  Justice  from  God  and 
the  world  !'  cried  she  at  the  top  of  her  lungs  ;  'see,  my  lord-governor,  the  impudence 
and  want  of  fear  of  this  varlet,  who,  in  the  midst  of  the  town  and  of  the  street,  would 
take  from  me  the  purse  your  worship  commanded  to  be  given  to  me.'  '  And  has  he  got 
it?'  demanded  the  governor.  'Got  it!'  answered  the  woman:  'I  would  sooner  let 
him  take  away  my  life  than  my  purse.  A  pretty  baby  I  should  be  indeed!  Other- 
guise  cats  must  claw  my  beard,  and  not  such  pitiful,  sneaking  tools  as  this.  Pincers 
and  hammers,  crows  and  chisels,  shall  not  get  it  out  of  my  clutches,  nor  even  the  paws 
of  a  lion.  My  soul  and  body  shall  sooner  part.'  'She  is  in  the  right,'  added  the 
man;  '  I  yield  myself  worsted  and  spent,  and  confess  I  have  not  strength  to  take  it 
from  her.'  That  said  he  left  her.  Then  said  the  governor  to  the  woman:  'Give 
me  that  purse,  chaste  and  valiant  heroine.'  She  presently  delivered  it,  and  the 
governor  returned  it  to  the  man,  and  said  to  the  violent  but  not  violated  damsel : 
'  Sister  of  mine,  had  you  shown  the  same,  or  but  half  so  much,  courage  and  resolu- 
tion in  defending  your  chastity,  as  you  have  done  in  defending  your  purse,  the 
strength  of  Hercules  could  not  have  forced  you.  Begone,  in  God's  name,  and  in  an 
ill  hour,  and  be  not  found  in  all  this  island,  nor  in  six  leagues  round  about  it,  upon 
pain  of  two  hundred  stripes.  Begone,  instantly.  I  say,  thou  prating,  shameless, 
cheating  hussy  !'  The  woman  was  confounded  and  went  away,  drooping  her  head, 
and  discontented  :  and  the  governor  said  to  the  man  :  '  Honest  man,  go  home,  in  the 
name  of  God,  with  your  money,  and  henceforward,  unless  you  have  a  mind  to  lose  it, 
take  care  not  to  yoke  with  any  body.' 

"The  countryman  gave  him  thanks  as  clownishly  as  he  could,  and  went  his  way. 
The  bystanders  were  in  fresh  admiration  at  the  decisions  and  sentences  of  their  new 
governor,  all  which,  being  noted  dowu  by  his  historiographer,  were  immediately  trans- 
mitted to  the  duke,  who  waited  for  them  with  great  impatience."  (Don  Quixote, 
vol.  ii.  289.) 


DEFINITION    OF    INSANITY.  629 


INSANITY. 


CHAPTER    LVIII. 

What  is  insanity? — medical  definitions. — distinction  of  sane 

from  insane  persons. moral  insanity. — legal  definitions 

"non  compos  mentis." symptoms  of  incipient  insanity — 

hallucinations  and  illusions — lucid  intervals. 

What  is  Insanity  f  Medical  Definitions. — The  terms  insanity,  lu- 
nacy, unsoundness  of  mind,  mental  derangement,  madness,  and  men- 
tal alienation  or  aberration,  have  been  indifferently  applied  to  those 
states  of  disordered  mind  in  which  a  person  loses  the  power  of  regu- 
lating his  actions  and  conduct  according  to  the  ordinary  rules  of 
society.  In  all  cases  of  real  insanity,  the  intellect  is  more  or  less 
affected — hence  the  term  intellectual  insanity.  In  a  medical  sense 
this  implies  a  deviation  of'  the  mental  faculties  from  an  assumed 
normal  or  healthy  standard.  In  an  insane  person  there  may  be  no 
bodily  disease,  but  his  language  and  habits  are  changed — -the  rea- 
soning power  which  he  may  have  enjoyed  in  common  with  others 
is  lost  or  perverted,  and  he  is  no  longer  fitted  to  discharge  those 
duties  which  his  social  position  demands.  Further,  from  perversion 
of  reason,  he  may  show  a  disposition  to  commit  acts  which  may 
endanger  his  oavii  life  or  the  lives  of  those  around  him.  It  is  at 
this  period  that  the  law  interferes  for  his  own  protection,  and  for 
that  of  society. 

Many  attempts  have  been  made  by  psychologists  to  define  insa- 
nity :  but  the  definitions  hitherto  given  are  so  imperfect  that  it 
would  be  difficult  to  find  one  which  includes  all  who  are  insane, 
and  excludes  all  who  are  sane.  This  difficulty  is  fully  accounted 
for  by  the  fact  that  mental  disorder  varies  in  its  degree  as  well  as 
in  its  characters;  and  the  shades  of  disordered  intellect  in  the  early 
stages  are  so  blended,  as  to  be  scarcely  distinguishable  from  a  state 
of  sanity.  It  is  this  twilight  condition  of  the  mind,  when  it  is  fluc- 
tuating between  sanity  and  insanity,  which  no  definition  can  com- 
prise, especially  as  the  mind  differs  in  its  power  and  manifestations 
in  most  persons,  and  it  is  therefore  difficult  to  fix  upon  a  standard 
by  which  a  fair  comparison  can  be  made.  The  vulgar  notion  of 
insanity  is,  that  it  consists  in  an  entire  deprivation  of  reason  and 
consciousness;  but  the  slightest  acquaintance  with  the  insane,  proves 
that  they  are  not  only  perfectly  conscious  of  their  actions  in  gene- 
ral, but  that  they  reason   upon  their  feelings  and  impressions.     The 


630  INTELLECTUAL    AXD    MORAL    INSANITY. 

Dr.  Abercromby  considered  insanity  to  consist  in  a  loss  of  the 
faculty  of  attention — the  power  by  which  we  are  capable  of  chang- 
ing, controlling,  arresting,  or  fixing  the  current  of  our  thoughts. 
Dr.  Conolly  regards  it  as  a  disorder  of  the  power  of  comparison  or 
judgment,  and  Professor  Marc  as  a  loss  of  the  faculty  of  volition;  so 
that,  in  the  latter  point  of  view,  the  acts  of  the  insane  are  involun- 
tary,  and  depend  upon  impulses  which  they  cannot  control. 

These  definitions  are  defective,  inasmuch  as  they  are  not  adapted 
to  the  various  forms  of  the  disease.  In  some  cases  of  insanity,  as 
in  confirmed  idiocy,  there  is  no  evidence  of  any  exercise  of  the  in- 
tellectual faculties  ;  but  in  most  instances  these  faculties  and  the 
moral  feelings  are  partially  diseased,  or  partially  destroyed,  in  every 
variety  and  degree.  Thus  we  may  meet  with  cases  in  which  the 
faculties  of  attention,  comparison,  and  volition  are  more  or  less  im- 
paired or  absent,  or,  if  present,  they  are  never  perfect,  although 
each  may  not  be  equally  affected.  When  no  two  cases  are  precisely 
similar,  no  definition  can  include  all  varieties  of  the  disorder.  A 
medical  witness  who  ventures  upon  a  definition,  will  generally  find 
himself  involved  in  numerous  inconsistencies,  for  no  words  can  pos- 
sibly comprise  the  variable  characters  which  this  malady  is  liable 
to  assume.  Those  who  take  an  interest  in  definitions  of  insanity 
and  who  think  they  can  defend  them  from  the  critical  acumen  of 
lawyers,  will  find  them  fully  set  forth  in  their  medical  and  medico- 
legal aspects  in  a  paper  by  Dr.  Eorie.  ("Ed.  Monthly  Journal,'7 
July,  1865,  p.  13.)  There  are,  however,  cases  in  which  a  medical 
man  may  find  himself  compelled,  if  not  to  define  insanity,  at  least 
to  show  some  clear  distinction  between  a  sane  and  insane  person. 
Thus  in  cases  in  which  there  has  been  an  alleged  breach  of  the  law 
regarding  the  custody  of  lunatics,  it  may  be  pleaded  that  the  per- 
son is  sane,  and  a  medical  expert  must  then  be  prepared  to  say 
whether  the  person  concerning  whom  the  question  is  raised,  is 
idiotic,  lunatic,  or  of  unsound  mind,  and  to  assign  satisfactory  rea- 
sons for  his  opinion. 

[The  difficulty  of  definition  is  thus  expressed  in  a  leader  in  the 
"London  Times"  of  July  22,  1854,  cited  in  Dr.  Bucknill's  Prize 
Essay  on  Criminal  Lunacy  (Law  Library,  vol.  92) :  "Nothing  can 
be  more  slightly  defined  than  the  line  of  demarcation  between  sanity 
and  insanity.  Physicians  and  lawyers  have  vexed  themselves  with 
attempts  at  definition  in  a  case  where  definition  is  impossible. 
There  has  never  yet  been  given  to  the  world  anything  in  the  shape 
of  a  formula  upon  this  subject,  which  may  not  be  torn  to  shreds  in 
five  minutes  by  any  ordinary  logician.  Make  the  definition  too  nar- 
row, it  becomes  meaningless  ;  make  it  too  wide,  the  whole  human 
race  are  involved  in  the  drag-net.  In  strictness,  we  are  all  mad 
when  we  give  way  to  passion,  to  prejudice,  to  vice,  to  vanity ;  but 
if  all  the  passionate,  prejudiced,  vicious,  and  vain  people  in  this 
world  are  to  be  locked  up  as  lunatics,  who  is  to  keep  the  key  of  the 
asylum?  As  was  very  fairly  observed,  however,  by  a  learned 
Baron  of  the  Exchequer,  when  lie  was  pressed  by  this  argument, 
if  we  are  all  mad,  being  all  madmen,  we  must  do  the  best   we  can 


MORAL    INSANITY.  631 

under  such  untoward  circumstances.  There  must  be  a  kind  of  rough 
understanding  as  to  the  forms  of  lunacy  which  can't  be  tolerated. 
We  will  not  interfere  with  the  spendthrift,  who  is  flinging  his  patri- 
mony away  upon  swindlers,  harlots,  and  blacklegs,  until  he  has  de- 
nuded himself  of  his  possessions  and  incurred  debt.  We  have  no- 
thing to  say  to  his  brother  madman,  the  miser,  who  pinches  his  belly 
to  swell  the  balance  at  his  bankers — being  73  years  of  age,  and 
without  family — -but  if  he  refuses  to  pay  taxes,  society  will  not  ac- 
cept his  monomania  as  pleadable  in  bar." 

Perhaps  the  definitions  of  sanity  and  insanity  by  Dr.  Bucknill 
are  as  accurate  as  the  subject  admits  of.  Sanity,  he  defines  to  be, 
"that- condition  of  the  mind  in  which  the  emotions  and  instincts  are 
all  in  such  a  state  of  subordination  to  the  will,  that  the  latter  can 
direct  and  control  their  manifestations;  in  which,  moreover,  the 
intellectual  faculties  are  capable  of  submitting  to  the  will  sound 
reasons  for  its  actions.  Such  co-ordinate  action  of  the  faculties  is 
termed  sanity;  a  condition  in  which  that  is  lost  is  termed  insanity, 
or  derangement,  or  alienation,  or  unsoundness,  all  terms  having 
reference  to  the  deprivation  of  the  power  of  the  will  so  directed." 
"It  is  evident,"  he  adds,  "that  in  this  definition  of  sanity  there  are 
three  terms,  the  subjected  emotions,  the  directing  intellect,  and  the 
middle  term  of  free  will.  Supposing  our  nature  to  be  fallible 
throughout  its  composition,  it  is  evident  that  erroneous  action  may 
originate  at  any  of  these  points ;  the  mutinous  emotions  may  be 
indomitable,  the  power  of  the  will  may  be  abortive,  or  the  intellect- 
may  mislead  by  false  guidance.  Insanity  may  thus  be  Intellectual, 
Emotional,  or  Volitional,  and  though  in  the  concrete  it  is  not  easy 
to  find  pure  and  unmixed  cases  under  either  of  these  heads,  such 
cases  do  occasionally  subject  themselves  to  observation.  The  ex- 
perienced psychopathist  will  also  find  little  difficulty  in  apportion- 
ing a  vast  number  of  the  other  cases  according  to  their  predomi- 
nant character,  under  one  or  other  of  these  headings. 

"  Insanity,  therefore,  may  be  defined  as,  A  condition  of  the  mind  in 
which  a  false  action  of  conception  or  judgment,  a  defective  power  of  the 
will,  or  cm  uncontrollable  violence  of  the  emotions  and.  instincts,  have 
separately  or  conjointly  been  produced  by  diseased — Bucknill  on  Crimi- 
nal Lunacy,  pp.  27,  28. — P.] 

Moral  Insanity.— -In  addition  to  that  form  of  insanity  in  which  the 
mind  is  affected,  known  as  intellectual  insanity,  Dr.  Pritchard  and 
other  medico-legal  writers  have  described  a  state  which  they  call 
moral  insanity  [Mania  simj  d,  ii r in),  which  is  manifested  simply  by  ;i 
perverted  or  disordered  state  of  the  feelings,  passions,  and  emotions, 
irrespective  of  any  apparent  intellectual  aberration.  There  are  no 
hallucinations  or  illusions,  and  there  is  no  evidence  of  delusion,  but 
simply  a  perversion  of  the  moral  sentiments.  Thus  it  is  alleged 
that  this  form  of  insanity  may  appear  in  the  shape  of  a  causeless 
sn.-picion,  jealousy,  or  hatred  of  others,  especially  of  those  to  whom 
the  affected  person  ought  to  be  attached;  and  it  may  also  manifesl 
itself  under  the  form  of  a  wild,  reckless,  and  cruel  disposition  to- 
wards mankind  in  general.     It  does  not  seem  probable,  however, 


632  MORAL    INSANITY. 

that  moral  insanity,  as  thus  denned,  ever  exists  or  can  exist  in  any 
person  without  greater  or  less  disturbance  of  the  intellectual  faculties. 
The  mental  powers  are  rarely  disordered  without  the  moral  feelings 
partaking  of  the  disorder;  and,  conversely,  it  is  not  to  be  expected 
that  the  moral  feelings  should  become  to  any  extent  perverted  with- 
out the  intellect  being  affected,  for  perversion  of  moral  feeling  is 
generally  observed  to  be  one  of  the  early  symptoms  of  disordered 
reason.  [See  Bucknill  on  Criminal  Lunacy,  Appendix,  note  E. — P.] 
The  intellectual  disturbance  may  be  sometimes  difficult  of  detection; 
but  in  every  case  of  true  insanity  it  is  more  or  less  present,  and  it 
would  be  a  highly  dangeous  practice  to  pronounce  a  person  insane, 
when  some  evidence  of  its  existence  was  not  forthcoming.  The  law 
does  not  recognize  moral  insanity  as  an  independent  state ;  hence, 
however  perverted  the  affections,  moral  feelings,  or  sentiments  may 
be,  a  medical  jurist  must  always  look  for  some  indications  of  dis- 
turbed reason.  Medically  speaking,  they  are,  according  to  Dr. 
Pritchard,  two  forms  of  insanity,  moral  and  intellectual;  but  in  law 
there  is  only  one — that  which  affects  the  mind.  Moral  insanity  is 
not  admitted  as  a  bar  to  responsibility  for  civil  or  criminal  acts,  ex- 
cept in  so  far  as  it  may  be  accompanied  by  intellectual  disturbance. 
[But  see  the  case  of  Reg.  v.  Crochroft  (Leeds  Autumn  Assizes,  1865), 
cited  post,  in  chapter  63.  It  is  admitted  in  Pennsylvania.  See  i 
of  Com.  v.  Master,  4  Barr,  266.  Com.  v.  Shurlock,  14  Leg.  Int.  33.  lb. 
v.  Smith,  15  Leg.  Int.  33.  lb.  v.  Freath,  6  Am.  Law  Register,  p. 
400.  See  also  Lewis's  Crim.  Law,  404.  In  most  of  the  States,  how- 
ever, the  law  is  as  stated  in  the  text,  and  the  test  still  is  the  know- 
ledge of  right  and  wrong.  See  Farrar  v.  State,  2  Ohio  St.  R.  54. 
State  v.  Spencer,  1  Zabrieski,  196  (New  Jersey).  Fisher  v.  /'■  ople,  23  111. 
283.  Loeffner  v.  State,  10  Ohio  (X.  S.)  598.— P.]  Dr.  Mayo  denies 
its  existence,  and  contends  that  no  abnormal  state  of  mind  should 
confer  irresponsibility  unless  it  involves  intellectual  as  well  as  moral 
perversion.  ("Medical  Testimony,"  p.  69.)  The  late  Sir  B.  Brodie 
also  considered  that  there  are  no  reasonable  grounds  for  admitting  this 
to  be  an  independent  form  of  insanity.  There  has  been,  as  he  sug- 
gests, much  mystification  on  the  subject.  The  term  has  been  applied 
to  cases  in  which  the  name  of  insanity  ought  not  to  have  been  ap- 
plied at  all,  i.  e.,  to  "moral  depravity/'  and  also  to  cases  in  which 
delusions  have  really  existed,  and  which  might  therefore  have  been 
more  properly  classed  with  cases  of  ordinary  mental  aberration. 
("Psychological  Inquiries,"  p.  99.)  Of  one  fact  we  may  be  well  as- 
sured :  if  in  these  cases  of  alleged  moral  insanity  there  is  no  indication 
of  a  perversion  of  intellect,  medical  evidence  is  not  required  to  deter- 
mine the  fact  or  the  degree  of  responsibility  in  reference  to  these 
persons.  Those  who  administer  the  law,  and  any  man  endowed 
with  plain  common  sense,  will  be  as  well  qualified  as  a  medical  ex- 
pert, to  decide  the  question  of  criminal  responsibility.  Further, 
until  medical  men  can  produce  a  clear  and  well-defined  distinction 
between  moral  depravity  and  moral  insanity,  such  a  doctrine,  em- 
ployed as  it  has  been  for  the  exculpation  of  persons  charged  with 
crime,  should  be  rejected  as  inadmissible. 


UNSOUNDNESS    OF    MIND.  633 

Legal  Definitions. — The  law  of  England  recognizes  two  states  of 
mental  disorder  or  alienation:  1.  Dementia  naturalis,  corresponding 
to  idiocy;  and  2.  Dementia  adventitia,  or  accidentalis,  signifying  gene- 
ra) insanity  as  it  occurs  in  persons  who  have  once  enjoyed  reasoning 
power.  To  this  state  the  terra  lunacy  is  also  applied,  from  an  influ- 
ence formerly  supposed  to  be  exercised  on  the  mind  by  the  moon. 
Lunacy  is  a  term  generally  applied  to  those  disordered  states  of  mind 
which  are  known  to  medical  men  under  the  names  of  mania,  mono- 
mania, and  dementia;  and  which  are  frequently,  although  not  ne- 
cessarily, accompanied  by  lucid  intervals.  The  main  character  of 
insanity,  in  a  legal  view,  is  considered  to  be  the  existence  of  delusion — 
i.  e.,  that  a  person  should  believe  something  to  exist  which  does  not 
exist,  and  that  he  should  act  upon  this  belief.  Many  persons  may 
labor  under  harmless  delusions,  and  still  be  fitted  for  their  social 
duties;  but  should  these  delusions  be  such  as  to  lead  them  to  injure 
themselves  or  others  in  person  or  property,  then  the  case  is  con- 
sidered to  require  legal  interference. 

Beside  the  terms  Idiocy  and  Lunacy,  we  find  another  frequently 
employed  in  legal  proceedings,  namely,  u  unsoundness  of  mind" — (non 
compos  mentis) — of  the  exact  meaning  of  which  it  is  impossible  to 
give  a  consistent  definition.  From  various  legal  decisions,  it  would 
appear  that  the  test  for  unsoundness  of  mind  in  law  has  no  immediate 
reference  to  the  existence  of  delusion  in  the  mind  of  a  person,  so 
much  as  to  proof  of  incapacity  from  some  morbid  condition  of  intel- 
lect to  manage  his  affairs  with  ordinary  care  and  propriety.  (Amos.) 
Neither  condition  will  suffice  to  establish  unsoundness  without  the 
other :  for  the  intellect  may  be  in  a  morbid  state,  and  yet  there  may 
be  no  legal  incompetency;  or  the  incompetency  alone  may  exist  and 
depend  on  bodily  infirmity  or  want  of  education — conditions  which 
must  not  be  confounded  with  mental  disorder.  Thus,  then,  a  person 
may  be  of  unsound  mind,  i.  e.,  legally  incompetent  to  the  control  of 
his  property,  and  yet  not  come  up  to  the  strict  legal  standard  of 
lunacy  or  idiocy. 

Some  medical  practitioners  have  attempted  to  draw  a  distinction 
between  insanity  and  unsoundness  of  mind.  A  case  occurred  in  1839, 
in  which  a  medical  man  hesitated  to  sign  a  certificate  for  the  con- 
finement of  an  alleged  lunatic,  because  in  it  the  words  "  unsound 
mind"  were  used.  He  said  he  would  not  have  hesitated  to  sign  it 
had  the  term  "  insane"  been  employed.  The  difference,  if  any  exist, 
is  purely  arbitrary,  and  depends  on  the  fact  that  "  unsound  mind"  is 
a  legal  and  not  a  medical  phrase,  referring  to  an  incapacity  to  manage 
affairs,  which  insanity,  in  its  most  enlarged  sense,  does  not  always 
imply.  The  law,  however,  appears  to  admit  some  sort  of  distinction : 
for,  according  to  Chitty,  it  is  a  criminal  and  an  indictable  act  mali- 
ciously to  publish  that  any  person  is  afflicted  with  insanity,  since  it 
imputes  to  him  a  malady  generally  inducing  mankind  to  shun  his 
society;  although  it  is  not  libellous  to  say  that  a  man  is  not  of  sound 
mind,  because  no  one  is  of  perfectly  sound  mind  but  the  Deity! 
("  Med.  Jur."  vol.  1,  p.  351.)  In  reference  to  the  signing  of  ccrlili- 
cafes  of  insanity,  it  is,  however,  an  error  to  suppose  that  the  use  oi 


634  SYMPTOMS    OF    INSANITY. 

one  term  can  involve  a  practitioner  in  any  greater  share  of  respon- 
sibility than  the  use  of  the  other. 

Symptoms  of  Incipient  Insanity. — -The  symptoms  by  which  insanity 
is  indicated  at  an  early  stage  are  liable  to  great  variation,  according 
to  the  sex,  age,  and  social  position  of  the  person.  In  reference  to 
suicide,  the  execution  of  wills,  or  the  perpetration  of  crime,  we  often 
find  after  the  death  of  the  person,  or  at  the  trial  which  follows  the 
crime,  that  the  most  trivial  and  irrelevant  circumstances  are  brought 
forward  as  indications  of  insanity.  This  subject  has  been  ably 
treated  by  Dr.  Forbes  Winslow  ("Obscure  Diseases  of  the  Brain."' 
p.  88),  and  to  his  work  I  must  refer  the  reader  for  much  useful  in- 
formation. The  facts  are  there  gathered  chiefly  from  the  accounts 
furnished  to  him  by  those  who  have  recovered.  There  is  great 
irritability  at  the  most  trifling  circumstances ;  impatience  of  contra- 
diction, loquacity,  great  difficulty  in  directing  attention  to,  and 
steadily  occupying  the  mind  with  any  train  of  thought,  neglect  of 
usual  employment,  sleeplessness,  depression  of  spirits  without  rea- 
sonable cause,  a  disposition  to  seclusion,  doubts  about  personal 
identity,  followed  by  hallucinations  and  illusions.  A  lady,  who  was 
gradually  affected,  remained  insane  for  nearly  eleven  months;  she 
informed  Dr.  Winslow  that  during  the  whole  of  that  time  she  fancied 
she  was  in  hell  and  tormented  by  evil  spirits ;  she  thought  every 
person  near  her  was  the  devil.  Sometimes  a  patient  fancies  he  is 
continually  watched  by  spies,  that  policemen  are  looking  after  him, 
and  that  conspiracies  and  plots  among  his  relatives  or  friends  are 
going  on  secretly  against  him  ;  he  believes  that  his  food  is  drugged 
or  poison,  and  will  refuse  to  eat.  Great  anxiety  on  any  subject  fol- 
lowed by  headache  may  be  the  forerunners  of  an  attack ;  there  is 
generally  an  entire  loss  of  interest  in  the  usual  occupations,  a  silent 
manner,  and  a  great  desire  for  solitude.  In  one  instance,  fits  of  im- 
moderate laughter  at  the  most  trivial  occurrences  preceded  the 
attack.  Sooner  or  later  these  symptoms  are  attended  by  perverted 
taste  or  smell ;  by  illusions  of  hearing  or  sight ;  voices  are  heard, 
and  objects  are  seen,  which  at  first  perplex  and  then  confuse  the 
patient ;  they  continue  until  he  feels  overpowered  mentally  and 
bodily;  and  he  then  falls  into  delusions  regarding  himself,  his  friends 
who  are  about  him,  his  profession  or  occupation,  and  his  worldly 
circumstances. 

Hallucinations  and  Illusions. — These  are  the  most  striking  symp- 
toms which  are  met  with  in  a  confirmed  state  of  insanity.  Halluci- 
nations are  those  sensations  which  are  supposed  by  the  patient  to  be 
produced  by  external  impressions,  although  no  material  objects  act 
upon  his  senses  at  the  time;  illusions,  on  the  other  hand,  are  sensa- 
tions produced  by  a  false  perception  of  objects.  A  man  has  visions 
of  all  kinds,  including  the  forms  of  the  dead  and  the  living,  floating 
before  him,  when  he  is  gazing  upon  vacancy.  He  fancies  he  hears 
voices  speaking  or  mysteriously  whispering  to  him,  while  there  is 
profound  silence ;  these  are  hallucinations.  Another  may  erro- 
neously imagine  that  the  taste  or  smell  of  his  ordinary  food  is  earthy, 
metallic   or  poisonous;  when   the  perversion  is  in  his  own  sen-   3; 


HALLUCINATIONS    AND    ILLUSIONS.  635 

these  are  illusions.  Both  conditions  depend  upon  a  disordered 
state  of  the  mind.  Instances  of  hallucination  are  furnished  by  the 
act  of  dreaming ;  while  illusions  occur  often  during  the  act  of  sud- 
denly waking  from  sleep;  giving  rise  occasionally  to  serious  ques- 
tions involving  criminal  responsibility.  The  state  of  insanity  is  in 
other  points  of  view  analogous  to  dreaming.  There  is  equally  a 
want  of  power  in  the  two  states  to  change  or  control  the  current  of 
thought  passing  through  the  mind.  Things  which  are  impossible 
and  inconsistent,  are  believed  to  have  an  actual  existence.  A  voice 
heard  during  the  act  of  dreaming  sometimes  becomes  an  illusion 
connected  with  a  current  of  thought  then  passing  through  the  mind ; 
it  is  the  same  in  a  case  of  confirmed  insanity,  with  this  difference  in 
the  latter,  that  some  power  of  will  or  some  exercise  of  reason  may 
still  exist. 

Illusions  are  sometimes  met  with  in  the  sane,  but  when  arising 
from  external  objects,  the  false  perception  is  soon  corrected  by  a 
reference  to  the  other  senses ;  and  herein  consists  the  main  difference 
between  sanity  and  insanity ;  namely,  delusion,  or  a  misleading  of 
the  mind.  When  the  hallucination  or  illusion  is  believed  to  have  a 
positive  existence,  and  this  belief  is  not  removed  either  by  reflection 
or  an  appeal  to  the  other  senses,  the  person  is  insane ;  but  when  the 
false  sensation  is  immediately  detected  by  the  judgment,  and  is  not 
acted  on  as  if  it  were  real,  then  the  person  is  sane.  Delusion,  there- 
fore, properly  refers  to  the  judgment,  and  illusion  to  the  senses.  The 
meaning  of  these  terms  is  often  confounded;  but  while  delusion  is 
always  connected  with  insanity,  illusion  is  not  necessarily  indicative 
of  mental  disorder.  Hallucinations  and  illusions  are  the  main  fea- 
tures of  those  forms  of  insanity  which  are  known  as  mania  and 
monomania.  They  are  rarely  met  with  in  cases  of  idiocy  and  imbe- 
cility, sometimes  in  dementia,  but  they  are  most  common  in  parox- 
ysms of  mania.  Acts  of  murder  may  generally  be  traced  to  their 
existence,  for  the  person  laboring  "under  mania  or  monomania  is  un- 
able during  a  paroxysm  to  divest  his  mind  of  the  belief  that  what 
he  sees  has  a  positive  existence  before  him.  He  feels  impelled  to 
suicide  by  the  hallucination  of  voices  calling  to  him,  and  to  murder 
by  the  illusion  that  he  is  not  destroying  a  wife,  child,  or  friend,  but 
an  evil  spirit  substituted  for  them.  The  acts  of  the  insane  are  gen- 
erally connected  with  their  delusions,  although  it  is  not  easy  to  trace 
the  connection  except  by  their  own  admissions.  When  the  acts  are 
unusual  and  strange,  it  is  most  probable  that  they  depend  on  hallu- 
cination, illusion,  or  both. 

Lu&id  Intervals. — By  a  lucid  interval,  we  are  to  understand  in  a 
legal  sense,  a  temporary  cessation  of  the  insanity,  or  a  perfect  resto- 
ration to  reason.  This  stale  differs  entirely  from  a  remission,  in 
which  there  is  a  mere  abatement  of  the  symptoms.  It  has  been  said 
that  a  lucid  interval  is  only  a  more  perfect  remission,  and  that  al- 
though the  lunatic  may  act  rationally  and  talk  coherently,  yet  his 
brain  is  in  an  excitable  state,  and  lie  labors  under  a  greater  disposi- 
tion toafresh  attack  of  insanity  than  one  whose  mind  has  never  been 
affected.     Of  this  there  can  be  no  doubt,  but  the  same  reasoning 


636  LUCID    INTERVALS. 

would  tend  to  show  that  insanity  is  never  cured  ;  for  the  predispo- 
sition to  an  attack  is  undoubtedly  greater  in  a  recovered  lunatic  than 
in  one  who  is  and  has  always  been  perfectly  sane.  Even  admitting 
the  correctness  of  this  reasoning,  it  cannot  be  denied  that  lunatics 
do  occasionally  recover  for  a  longer  or  shorter  period,  to  such  a  de- 
gree as  to  render  them  perfectly  conscious  of  and  legally  responsible 
for  their  actions  like  other  persons.  The  law  intends  no  more  than 
this  by  a  lucid  interval ;  it  does  not  require  proof  that  the  cure  is  so 
complete  that  even  the  predisposition  to  the  disease  is  entirely  ex- 
tirpated. Such  proof,  if  it  could  even  be  procured,  would  be  totally 
irrelevant.  If  a  man  acts  rationally  and  talks  coherentlyT  we  can 
have  no  better  proof  of  a  restoration  to  reason.  If  no  delusion  af- 
fecting his  conduct  remained  in  his  mind,  we  need  not  concern  our- 
selves about  the  degree  of  latent  predisposition  to  a  fresh  attack 
which  may  still  exist.  Lucid  intervals  sometimes  appear  suddenly 
in  the  insane ;  the  person  feels  as  if  awakened  from  a  dream,  and 
there  is  often  a  perfect  consciousness  of  the  absurdity  of  the  delusion 
under  which  he  was  previously  laboring.  The  duration  of  the  inter- 
val is  uncertain ;  it  may  last  for  a  few  minutes  only,  or  may  be 
protracted  for  days,  weeks,  months,  and  even  years.  In  a  medico- 
legal view,  its  alleged  existence  must  be  always  looked  upon  with 
suspicion  and  doubt  when  the  interval  is  very  short. 

Lucid  intervals  are  most  frequently  seen  in  cases  of  mania  and 
monomania;  they  occasionally  exist  in  dementia  when  this  state  is 
not  chronic,  but  has  succeeded  a  fit  of  intermittent  or  periodical 
mania.  They  are  never  met  with  in  cases  of  idiocy  and  imbecility. 
It  is  sometimes  a  matter  of  great  importance  to  be  able  to  show 
whether  or  not  there  exists  or  has  existed  a  lucid  interval,  since,  in 
this  state,  the  acts  of  a  person  are  deemed  valid  in  law.  The  mind 
should  be  tested,  as  in  determining  whether  the  patient  is  laboring 
under  insanity  or  not.  He  should  be  able  to  describe  his  feeliugs, 
and  talk  of  the  subject  of  his  delusion,  without  betraying  any  signs 
of  unnecessary  vehemence  or  excitement.  It  may  happen  that  the 
person  who  is  the  subject  of  a  Commission  of  Inquiry  is  at  the  time 
of  examination  under  a  lucid  interval,  in  which  case  there  may  be 
some  difficulty  in  forming  an  opinion  of  the  existence  of  insanity. 
It  has  been  said  that  a  person  in  a  lucid  interval  is  considered  by 
law  to  be  responsible  for  his  acts,  whether  these  are  of  a  civil  or 
criminal  nature.  In  regard  to  criminal  offences  committed  during  a 
lucid  interval,  it  is  the  opinion  of  some  medical  jurists  that  no  per- 
son should  be  convicted  under  such  circumstances,  because  there  is 
a  probability  that  he  might  at  the  time  have  been  under  the  influ- 
ence of  that  degree  of  cerebral  irritation  which  renders  a  man  in- 
sane. (Prichard.)  This  remark  applies  especially  to  those  instances 
in  which  the  lucid  interval  is  very  short.  Juries  now  seldom  con- 
vict, however  rationally  in  appearance  a  crime  may  have  been  per- 
petrated, if  it  can  be  clearly  proved  that  the  accused  was  really 
insane  within  a  short  period  of  the  time  of  its  perpetration. 


VARIETIES    OF    INSANITY.  637 


CHAPTER  LIX. 

Varieties  of  insanity. — mania. — abstinence  from  food. — de- 
lusions     REGARDING     POISON. — DELIRIUM    DISTINGUISHED    FROM 

MANIA. MONOMANIA. DEMENTIA.  —  IDIOCY. IMBECILITY. 

HEREDITARY   TRANSMISSION. — FEIGNED   INSANITY. — APPEARANCES 
AFTER  DEATH. — ECCENTRICITY. 

Variety  of  Insanity. — Medical  jurists  have  commonly  recognized 
four  distinct  forms  of  insanity :  Mania,  Monomania,  Dementia  and 
Idiocy  (Amentia).  This  division  was  proposed  by  Esquirol,  and  al- 
though of  a  purely  artificial  nature,  it  is  highly  convenient  for  the 
arrangement  and  classification  of  the  facts  connected  with  the  sub- 
ject. In  some  instances  there  is  great  difficulty  in  assigning  a  par- 
ticular case  to  either  of  these  divisions,  which  is  owing  to  the  cir- 
cumstance, that  these  states  of  disordered  mind,  if  we  except  idiocy, 
are  frequently  intermixed,  and  are  apt  to  pass  and  repass  into  each 
other.  On  other  occasions  a  case  may  represent  mixed  characters 
which  appertain  to  all  the  divisions.  Some  psychologists  Lave  pro- 
posed two  subdivisions,  namely,  Incoherency  and  Imbecility ;  but  the 
former  is  merely  a  mixed  state  of  mania  and  dementia,  while  the 
latter  is  a  term  applied  to  those  cases  of  idiocy  wherein  the  mental 
faculties  are  susceptible  of  some  degree  of  cultivation  after  birth, 
without  reaching  the  normal  standard. 

Mania. — In  this  form  of  insanity  there  is  a  general  derangement 
or  perversion  of  the  mental  faculties,  accompanied  by  greater  or  less 
excitement,  sometimes  amounting  to  violent  fury.  (Pagan's  "Med. 
Jur.  of  Insanity,"  p.  59 :  Marc.  "  De  la  Folie,"  vol.  1,  p.  211.)  Ideas 
flow  through  the  mind  without  order  or  connection,  the  person  losing 
all  control  over  his  thoughts,  and  believing  and  acting  upon  them, 
however  absurd  and  inconsistent  they  may  be.  Rapidity  of  utter- 
ance and  incessant  agitation  accompany  this  state;  there  is  also 
great  irritability,  so  that  not  the  least  contradiction  can  be  borne.. 
Mania  may  take  place  suddenly,  as  after  a  violent  moral  shock,  but 
in  general  it  comes  on  slowly.  It  may  be  chronic  or  acute,  recurrent, 
or  continued.  There  are  very  few  cases  which  do  not  present  re- 
missions, more  or  less  complete;  and  in  sonic  instances  after  a  vio- 
lent attack,  the  reason  appears  to  be  perfectly  restored,  forming 
then  what  is  termed  a  lucid  interval,  the  clear  distinction  of  which, 
in  a  legal  point  of  view,  is  of  material  importance.  In  recurrent 
mania  the  attack  comes  on  without  any  obvious  cause.  It  may  last 
for  a  week,  a  month,  or  even  longer.  There  is  usually  a  stage  of 
excitement  followed  by  depression  before  recovery.  Persons  labor- 
ing under  mania,  especially  when  it  is  associated,  as  it  frequently  is, 


638  INSANITY.      CHARACTERS    OF    MONOMANIA. 

with  paralysis,  arc  comparatively  insensible  to  severe  injuries.  They 
will  bear  exposure  to  cold  without  complaining,  and  even  conceal 
the  existence  of  a  fracture  or  other  injury  which  would  cause  great 
pain  to  a  sane  person.  They  will  also  sustain  the  privation  of  food 
for  a  great  length  of  time  without  any  apparent  injury  to  health. 
In  some  instances,  owing  to  a  suspicion  that  the  food  is  poisoned, 
they  refuse  to  take  any;  it  is  then  necessary  to  feed  them  with  a 
stomach-pump.  (Winslow's  "  Obscure  Diseases  of  the  Brain,"  p. 
71.)  This  delusion  respecting  the  poisoning  of  food  is  very  com- 
mon in  the  early  stages  of  mania.  The  patient  will  fancy  that  he 
himself,  or  some  favorite  animal  is  undergoing  a  process  of  slow 
poisoning  by  a  secret  enemy.  In  the  greater  number  of  cases  of 
mania  there  is  excitement  coming  on  in  paroxysms  without  any 
obvious  cause,  and  leading  the  person  to  acts  of  violence  either 
towards  himself  or  others. 

It  is  necessar}^  that  a  medical  jurist  should  be  able  to  distinguish 
mania  from  delirium  depending  on  bodily  disease.  Delirium  closely 
resembles  the  acute  form  of  mania — so  closely  that  mistakes  have 
occurred,  and  persons  laboring  under  it  have  been  improperly 
ordered  into  confinement  as  maniacs.  The  following  are  perhaps  the 
best  differences  :  A  disordered  state  of  the  mind  is  the  first  symptom 
remarked  in  mania;  while  delirium  is  a  result  of  bodily  disease,  and 
there  is  greater  febrile  excitement  in  it  than  in  mania.  Delirium 
being  a  mere  symptom  attendant  on  the  disease  which  produces  it, 
exists  so  long  as  that  disease  and  no  longer;  while  mania  depending 
on  widely  different  causes,  is  persistent.  Delirium  disappears  sud- 
denly, leaving  the  mind  clear ;  while  mania  commonly  experiences 
only  remissions.  (See  Pagan's  "  Med.  Jur.  of  Insanity,"'  p.  69.)  In 
delirium  there  is  generally  acuteness  of  the  senses.  Inflammation 
of  the  brain  or  its  membranes  (phrenitis)  is  distinguished  from  acute 
mania  by  the  mode  of  its  attack,  the  presence  of  severe  pain  in  the 
head,  and  excessive  sensibility  with  intolerance  of  light  and  sound. 

Monomania. — This  name  is  applied  to  that  condition  in  which  the 
mental  alienation  is  only  partial;  in  other  words,  it  is  nothing  more 
than  partial  insanity.  In  mania  the  mind  is  disordered  on  all  kinds 
of  subjects  ;  in  monomania  the  disorder  is  confined  chiefly  either  to 
one  subject  or  to  one  class  of  subjects.  Monomaniacs  are  infected 
with  false  ideas  on  certain  points,  of  which  they  cannot  divest  them- 
selves, and  out  of  which  they  cannot  be  reasoned;  they  start  from 
false  principles,  but  setting  this  aside,  their  inferences  and  deductions 
from  these  principles  often  possess  logical  accuracy.  In  every  sub- 
ject not  connected  with  their  special  delusion,  they  are  like  the  rest 
of  the  world  ;  they  talk  and  reason  as  justly  upon  facts  as  before  the 
access  of  their  malady,  but  their  general  deportment,  habits,  and 
character  are  changed.  Thus,  a  miser  may  become  a  spendthrift, 
and  a  hard-working  and  industrious  mechanic  may  pass  his  time  in 
idleness  ;  a  man  of  moral  habits  will  become  immoral  in  conversa- 
tion and  conduct,  and  an  abstemious  man  may  become  a  drunkard. 

The  monomania  may  be  so  slight  that  the  person  will  have  the 
power  of  so  controlling  his  thoughts  and  actions,  as  to  appear  like 


MONOMANIA    AND    ECCENTRICITY.  639 

one  who  is  sane  provided  the  subject  of  his  delusion  is  not  referred 
to.  There  is  no  doubt  that  those  who  are  affected  with  monomania 
in  an  early  stage,  are  frequently  able  to  direct  their  minds  with  reason 
and  propriety  to  the  performance  of  their  social  duties,  so  long  as 
these  do  not  involve  any  of  the  subjects  of  their  delusions.  Their 
power  of  controlling  their  thoughts  and  feelings,  as  well  as  of  con- 
cealing their  delusions,  implies  a  certain  consciousness  of  their  con- 
dition not  usually  met  with  in  mania ;  and  it  also  appears  to  imply  the 
existence  of  such  control  over  their  conduct,  as  to  render  them  equally 
responsible  with  sane  persons  for  many  of  their  acts.  In  a  case  of 
confirmed  monomania,  however,  it  is  not  to  be  supposed  that  a  man 
is  insane  upon  one  point  only,  and  sane  upon  all  other  subjects.  The 
only  admissible  view  of  this  disorder  is  that  which  was  taken  by 
Lord  Lyndhurst,  in  one  of  his  judgments.  In  monomania  the  mind 
is  unsound ;  not  unsound  in  one  point  only,  and  sound  in  all  other 
respects,  but  this  unsoundness  manifests  itself  principally  with 
reference  to  some  particular  object  or  person.  (Prichard.)  There  is 
no  doubt  that  all  the  mental  faculties  are  more  or  less  affected,  but 
the  affection  is  more  strikingly  manifested  in  some  than  in  others. 

The  delusion  of  a  monomaniac  will  be  generally  uppermost  in  his 
mind:  his  will  is  powerless  to  dismiss  it,  just  as  in  mania  the  will  is 
powerless  to  stop  the  constant  and  rapid  succession  of  different  and 
perhaps  heterogeneous  ideas  which  present  themselves  to  the  mind 
in  this  form  of  insanity.  In  the  first  stage  of  monomania  the  judg- 
ment may  be  strong  and  the  mind  apparently  sound  upon  every  point 
except  the  particular  subject  of  delusion,  and  even  in  some  instances, 
there  may  be  such  a  control  over  this  delusion,  that  it  would  be 
difficult  to  discover  whether  or  not  there  was  any  just  ground  for 
imputing  mental  unsoundness  ;  but  in  a  more  advanced  form  of  dis- 
ease, the  delusion  whatever  it  may  be,  whether  relating  to  wealth, 
ambition,  religion  or  politics,  so  overpowers  the  patient  that  he  loses 
self-control.  His  character  is  changed,  and  his  habits  are  such  as  to 
render  him  unfit  for  social  intercourse ;  he  becomes  incoherent ;  his 
ideas  are  perverted  on  all  subjects,  and  he  gradually  lapses  into 
mania  or  dementia.  The  last  condition  happens  when  the  monomania 
is  of  long-standing.  Monomania  may  be  remittent  or  intermittent, 
and  it  is  sometimes  accompanied  with  lucid  intervals.  Its  progress 
is  rapid,  and  its  termination  often  unexpected ;  in  some  instances  the 
disease  ceases  suddenly  without  any  previous  warning,  owing  to  the 
effects  of  a  strong  moral  shock  or  impression. 

Monomania,  in  its  early  stage,  is  liable  to  be  confounded  with 
eccentricity :  but  there  is  this  difference  between  them.  In  mono- 
mania there  is  obviously  a  change  of  character — the  person  is  dif- 
ferent from  what  he  was :  in  eccentricity  such  a  difference  is  not 
remarked  :  he  is,  and  always  has  been,  singular  in  his  ideas  and 
actions — there  is  no  observable  change  of  character.  An  eccentric 
man  may  be  convinced  that  what  he  is  doing  is  absurd  and  con- 
trary to  the  general  rules  of  society,  but  he  professes  to  set  these 
rules  at  defiance:  a  true  monomaniac  cannot  be  convinced  of  his 


610  DEMENTIA. 

error,  and  lie  thinks  that  his  acts  are  consistent  with  reason  and  the 
general  conduct  of  mankind.  In  eccentricity  there  is  the  will  to  do 
or  not  to  do  :  in  real  monomania  the  controlling  power  of  the  will 
appears  to  be  lost.  Eccentric  habits  suddenly  acquired  are,  how- 
ever, presumptive  insanity.  It  will  be  seen  hereafter  that  the  dis- 
tinction of  these  states  is  of  considerable  importance  in  relation  to 
the  testamentary  capacity  of  persons. 

Monomania  frequently  assumes  one  of  two  forms :  either  the 
thoughts  are  lively  and  gay,  or  they  are  oppressed  with  gloomy 
melancholy.  In  the  first  state,  the  persons  will  fancy  themselves 
to  be  kings  and  queens,  and  overflowing  with  wealth,  which  they 
are  prepared  to  distribute  with  regal  profusion ;  in  the  second  state, 
we  find  silence,  seclusion,  and  the  most  heart-rending  sorrow.  Tbe 
latter  condition,  by  no  means  uncommon  as  a  form  of  monomania, 
is  called  melancholia  (mania  with  depression),  or  lypemania  (xvrtjj,  sor- 
rovS).  Those  who  are  affected  with  it  suppose  they  have  committed 
some  unpardonable  sin,  and  pass  their  hours  in  silence  and  in  the 
most  gloomy  forebodings  of  temporal  and  eternal  punishment.  They 
do  not  sleep,  and  will  sometimes  neither  eat,  speak,  nor  move;  force 
must  be  used  to  make  them  take  food  and  exercise.  In  some  in- 
stances no  persuasion  can  conquer  their  silence;  one  patient  thus 
affected  was  not  heard  to  utter  a  word  during  four  years.  If  spoken 
to,  they  shed  tears  and  violently  repulse  the  person  who  addresses 
them.  Melancholia  frequently  leads  to  an  act  of  suicide  or  murder 
and  persons  affected  with  it  require  very  close  watching.  In  the 
lighter  forms  of  the  disease  there  is  no  sign  of  mental  aberration 
and  the  patient  will  go  through  his  usual  routine  of  duty,  but  al- 
ways with  the  same  desponding  air — so  that  his  occupation  seems 
scarcely  to  distract  his  thoughts  from  the  delusion  for  a  single  in- 
stant. In  other  cases  the  delusion  is  so  well  concealed  that  no  sus- 
picion exists,  until  an  act  of  suicide  leads  to  inquiry,  and  some  evi- 
dence of  strangeness  of  conduct  is  then  for  the  first  time  forthcoming. 
There  is  either  an  entire  absence  of  motive  for  the  act,  or  the  mo- 
tive is  based  on  a  delusion. 

Dementia. — This  is  a  state  which,  although  sometimes  confounded 
with  mania,  is  very  different  in  its  characters.  Dementia,  when 
confirmed,  consists  in  a  total  absence  of  all  reasoning  power,  and 
an  incapacity  to  perceive  the  true  relations  of  things  ;  the  language 
is  incoherent,  and  the  actions  are  inconsistent:  the  patient  speaks 
without  being  conscious  of  the  meaning  of  what  he  is  saying ;  mem- 
ory is  lost,  and  sometimes  the  same  word  or  phrase  is  repeated  for 
many  hours  together ;  words  are  no  longer  connected  in  meaning, 
as  they  are  in  mania  and  monomania.  This  state  is  often  called 
fatuity ;  it  is  a  not  unfrequent  consequence  of  mania  or  monomania. 

Dementia  varies  in  degree.  The  disordered  mind  of  aged  persons 
is  one  form  of  dementia;  here  we  find  memory  and' some  mental 
power,  although  the  memory  is  restricted  to  objects  long  since  past, 
and  the  exertions  of  the  mind  are  only  momentary.  Some  persons 
in  dementia  are  quiet,  others  are  in  constant  motion  as  if  in  search 
of  something.     There  is  generally  a  strong  disposition  manifested 


IDIOCY    AND    IMBECILITY.  641 

to  collect  all  kinds  of  useless  articles,  which  are  hoarded  up  as  if 
they  were  of  great  value.  In  some  instances  this  disease  comes  on 
gradually — the  faculties  both  normal  and  intellectual,  decay  one  by 
one ;  while  in  other  instances,  although  much  more  rarely,  demen- 
tia may  occur  suddenly  from  a  violent  shock  or  impression  on  the 
mind.  Dementia  may  be  acute  or  chronic,  remittent  or  intermittent. 
The  countenance  of  the  patient  is  generally  pale,  vacant,  and  with- 
out expression,  the  look  vague  and  uncertain,  and  tears  are  abund- 
antly shed  from  the  slightest  causes. 

The  following  may  be  taken  as  the  most  striking  differences  be- 
tween mania  and  dementia.  In  mania  there  is  an  incoherence  of 
ideas,  but  depending  on  too  great  rapidity  of  thought  and  excite- 
ment of  the  intellectual  powers ;  in  dementia  there  is  a  want  of 
ideas,  and  the  incoherence  depends  on  the  loss  of  the  power  of  con- 
necting them,  owing  to  defect  of  memory ;  volition  is  lost  and  the 
brain  seems  in  a  state  of  collapse.  (Esquirol,  "Maladies  Mentales," 
vol.  2,  pp.  224  and  282.)  In  fact,  in  dementia  there  is  a  more  or  less 
complete  abolition  of  the  moral,  intellectual,  and  voluntary  powers ; 
in  mania,  and  also  in  monomania  they  are  in  a  state  of  perversion. 
Dementia  is  often  a  consequence  of  these  states,  and  sometimes  alter- 
nates with  them. 

Idiocy.  Imbecility. — Idiocy  is  the  dementia  naturalis  of  lawyers. 
The  term  idiot  is  applied  to  one  who  from  original  defect  has  never 
had  mental  power.  Idiocy  differs  from  the  other  states  of  insanity 
in  the  fact  that  it  is  marked  by  congenital  deficiency  of  the  mental 
faculties.  There  is  not  here  a  perversion  or  a  loss  of  what  has  once  been 
acquired,  but  a  state  in  which,  from  defective  structure  of  the  brain, 
the  individual  has  never  been  able  to  acquire  any  degree  of  intel- 
lectual power  to  fit  him  for  his  social  position.  It  commences  with 
life  and  continues  through  it,  although  idiots  are  said  rarely  to  live 
beyond  the  age  of  thirty.  (Esquirol,  "Maladies  Mentales,"  vol.  2, 
p.  284.)  The  deficiency  of  intellect  is  marked  by  a  peculiar  physi- 
ognomy, an  absence  of  all  expression,  and  a  vague  and  unmeaning 
look ;  there  is  no  power  of  speech,  or  only  the  utterance  of  a  cry  or 
sound ;  there  is  no  will,  but  the  actions  of  these  beings  appear  to 
depend  upon  impulse,  a  power  of  imitation,  or  mere  animal  instinct ; 
they  recognize  no  one,  they  remember  no  one,  and  the  mind  seems 
to  be  a  blank.  Such  is  the  picture  of  what  may  be  termed  a  com- 
plete idiot.  In  Switzerland  this  state  of  idiocy  is  often  accompanied 
with  great  bodily  deformity,  and  enlargement  of  the  thyroid  gland, 
both  in  males  and  females;  it  is  there  termed  cretinism.  Cretins 
resemble  monsters  more  than  human  beings.  A  confirmed  idiot  may 
in  almost  all  cases  be  recognized  by  the  expression  of  countenance 
and  the  form  of  the  skull. 

idiocy  is  not  always  so  complete  as  this  description  implies.  There 
is  a  state  scarcely  separable  from  idiocy  in  which  the  mind  is  capable 
of  receiving  some  ideas,  and  of  profiting  to  a  certain  extent  by  in- 
struction. Owing,  however,  either  to  original  defect,  or  to  a  defect 
proceeding  from  arrested  development  of  the  brain  as  a  result  of 
disease  or  other  causes  operating  after  birth,  the  minds  of  such  per- 
41 


042  INSANITY.      IMBECILITY. 

sons  are  not  capable  of  being  brought  to  a  healthy  standard  of  intel- 
lect, like  that  of  an  ordinary  person  of  similar  age  and  social  posi- 
tion. This  state  is  called  imbecility  ;  it  is  nothing  more  than  idiocy 
in  a  minor  degree.  In  common  language,  persons  laboring  under  it 
are  often  called  idiots,  but  for  the  sake  of  precision  in  medical  lan- 
guage they  are  more  correctly  described  as  imbeciles.  (Esquirol, 
op.  cit.  vol.  2,  p.  289.)  In  imbecility  the  physical  organization  dif- 
fers but  little  from  the  ordinary  standard ;  the  moral  and  intellectual 
faculties  are  susceptible  of  cultivation,  but  to  a  less  degree  than  in  a 
perfect  man,  and  even  this  capacity  does  not  exist  beyond  a  certain 
point.  Imbeciles  never  attain  a  normal  standard  of  intellect,  and 
when  placed  in  the  same  circumstances  as  other  men  they  never 
make  a  similar  use  of  their  intellectual  powers.  They  can  form  no 
abstract  ideas,  and  sometimes  their  capacity  to  receive  instruction  is 
limited  only  to  a  certain  subject — as  for  instance  arithmetic.  Their 
memory  and  judgment  are  limited,  although  sometimes  the  former 
is  remarkably  strong.  They  express  themselves  in  a  hesitating  man- 
ner, and  differently  from  other  men;  they  require  time  to  perceive 
the  relations  of  objects  which  are  immediately  perceived  by  sane 
persons.  The  degree  to  which  imbecility  exists  is  well  indicated  by 
the  power  of  speech.  In  idiots  there  is  no  speech,  or  only  an  utter- 
ance of  single  words ;  in  the  better  class  of  imbeciles  the  speech  is 
often  easy  and  unaffected,  while  there  is  every  grade  between  these 
two  extremes.  Some  have  arranged  imbeciles  in  classes,  according 
to  their  capacity  to  receive  instruction;  others  according  to  their 
power  of  speech;  but  such  divisions  are  practically  without  value: 
each  case  must  be  judged  by  itself.  The  precise  boundary  between 
idiocy  and  imbecility  cannot  be  defined.  The  major  degrees  of  im- 
becility approach  so  closely  to  those  of  idiocy,  that  there  is  no  dis- 
tinction between  them,  and  in  a  practical  view  no  distinction  is  re- 
quired. Idiocy  has  been  here  described  as  that  condition  in  which 
the  congenital  defect  is  not  susceptible  of  being  removed  by  any 
kind  of  instruction ;  but  many  medico-legal  writers  apply  the  term 
idiot  to  one  who  does  manifest  capacity  to  receive  instruction,  although 
in  a  low  degree.  The  difference  is  immaterial  so  long  as  the  mean- 
ing of  the  word  is  understood. 

How  are  the  minor  degrees  of  imbecility  to  be  distinguished  from 
sanity  ?  This  is  a  question  by  no  means  easy  to  answer,  for  the 
reason  that  sane  persons  differ  remarkably  in  their  mental  power  to 
.receive  instruction,  to  retain  what  they  have  been  taught,  and  to 
allow  them  to  make  a  practical  use  of  it  in  the  world  for  their  own 
benefit.  How  many  persons  pass  through  life  and  advance  in  the 
world  who  are  yet  undoubtedly  weak-minded,  and  who  have  the 
reputation  among  all  who  know  them  of  being  so!  The  truth  is, 
the  lowest  degrees  of  intelligence  legally  constituting  sound  mind, 
are  not  separable  from  the  minor  forms  of  imbecility,  so  far  as  the 
moral  and  intellectual  faculties  are  concerned.  By  running  this  dis- 
tinction too  closely,  one  half  of  the  world  might  easily  reason  itself 
into  the  right  of  confining  the  other  half  as  insane. 

Idiocy  and  imbecilitv  must  not  be   confounded  with  mania  and 


IMBECILITY.  643 

monomania.  In  idiots  and  imbeciles  ideas  are  wanting,  and  tlie 
power  of  thought  is  absent  or  defective  ;  in  maniacs  and  monoma- 
niacs the  ideas  flow  freely,  but  they  are  perverted,  and  the  power  of 
thought  is  irregular  and  uncontrolled.  In  idiocy  and  imbecility  we 
do  not  meet  with  the  hallucinations  and  illusions  which  constitute 
the  main  features  of  mania  and  monomania.  Idiocy  is  much  more 
likely  to  be  confounded  with  dementia,  and  indeed,  when  dementia 
is  confirmed  and  complete  (fatuity),  there  is  no  appreciable  differ- 
ence, for  in  neither  state  is  there  any  evidence  of  the  exercise  of 
mental  power.  In  idiocy  no  ideas  have  ever  been  formed ;  in  imbe- 
cility they  have  been  partially  formed,  but  arrested ;  in  dementia 
they  have  been  more  or  less  completely  formed,  but  have  subse- 
quently become  entirely  obliterated.  It  is  important  to  remember 
that  in  idiocy  and  imbecility  there  is  no  gradual  loss  or  sudden  im- 
pairment of  the  mental  faculties,  as  is  generally  observed  in  dementia ; 
the  person  is  what  he  always  has  been ;  mentally  weak  and  unsuscep- 
tible of  any  degree  of  improvement  by  instruction. 

From  these  remarks  it  will  be  perceived  that  imbecility  is  a  state 
existing  from  birth  or  from  childhood — for  it  is  possible  that  it  may 
supervene  from  disease  after  birth,  in  a  child  in  whom  there  was  no 
reason  to  suspect  its  existence — but  it  is  more  common  to  find  the 
deficiency  congenital.  Still,  the  term  is  often  applied  to  that  weak- 
ness of  the  mental  powers  which  takes  place  in  the  aged  at  the  close 
of  life,  even  when  the  mind  has  been  well  developed  in  maturity. 
Thus  we  speak  of  the  imbecility  of  age :  this  is  truly  nothing  more 
than  a  state  of  senile  dementia,  and  to  apply  to  it  the  term  "  imbeci- 
lity'1 tends  to  create  confusion. 

Such  then  are  the  four  forms  under  which  insanity  or  mental 
aberration  may  present  itself  to  our  notice,  and  although  there  are 
occasionally  mixed  states,  as  of  mania  and  dementia  (incoherency), 
yet  it  is  an  important  feature  in  the  distinction  of  mental  disorders, 
to  observe  that  in  real  insanity  the  characters  presented  to  us  in  any 
given  case  do  not  vary  materially  from  those  which  have  been  de- 
scribed as  peculiar  to  each  of  these  states.  This  medical  classifica- 
tion, it  must  be  remembered,  is  made  for  the  sake  of  convenience, 
because  by  it  a  practitioner  may  be  led  to  form  a  safe  diagnosis  of 
the  real  state  of  mind  of  a  person.  It  is  not  recognized  in  any  of 
the  law-proceedings  connected  with  the  insane :  for  in  these  the  term 
unsoundness  of  mind — comprehending  lunacy,  idiocy,  imbecility,  and 
all  forms  of  mental  weakness — is  almost  exclusively  employed.  In 
adopting  this  arrangement,  a  medical  jurist  must  take  care  not  to 
fall  into  an  error  which  has  been  sometimes  committed — i.  e.  of  pro- 
nouncing a  person  to  be  of  sound  mind,  because  his  case  could  not 
be  easily  placed  in  any  one  of  these  four  great  divisions  of  insanity. 
This  would  be  as  serious  an  error  as  that  formerly  committed  by  some 
law-authorities — namely,  of  giving  restricted  and  incorrect  defini- 
tions of  lunacy,  idiocy,  and  imbecility,  and  then  contending  that 
whoever  was  not  a  lunatic,  idiot,  or  imbecile  according  to  the.se  arbi- 
trary legal  definitions,  must  be  a  person  of  sound  mind. 


644  HEREDITARY    TRANSMISSION. 

Hereditary  Transmission. — The  hereditary  transmission  of  insanity 
has  sometimes  presented  itself  as  a  medico-legal  question  in  relation 
to  the  criminal  responsibility  of  the  insane.  According  to  Chitty. 
it  is  an  established  rule  of  law,  "that  proof  that  other  members  of 
the  same  family  have  decidedly  been  insane  is  not  admissible  either 
in  civil  or  criminal  cases."  ("Med.  Jur."  vol.  1,  p.  352.)  But  recent 
decisions  have  shown  that  this  statement  is  not  correct.  In  Reg.  v. 
Ross  Touchet  (1844),  in  which  the  accused  was  tried  for  shooting  a 
man,  and  acquitted  on  the  ground  of  insanity.  Maule,  J.,  held  that 
evidence  that  the  grandfather  had  been  insane  might  be  adduced, 
after  it  had  been  proved  by  medical  testimony  that  such  a  disease  is 
often  hereditary  in  a  family.  It  was  also  admitted  in  Oxford's  case — 
the  prisoner  having  been  tried  for  shooting  at  the  Queen  ("Law 
Times,"  Oct.  26,  1844),  and  since  that  date  it  has  been  admitted  in  a 
number  of  cases  in  which  insanity  was  urged  as  a  defence  on  a  charge 
of  murder.  [It  was  also  admitted  in  Pennsylvania,  in  the  case  of 
Smith  v.  Kramer1  (1  Am.  Law.  Reg.  p.  353),  upon  the  question  of  a 

1  [Chief  Justice  Gibson,  in  admitting  the  evidence  in  this  case,  thus  expressed  him- 
self: "I  admit  the  deposition  without  hesitation,  notwithstanding  the  dicta  of  Mr. 
Shelford  ('Treat,  on  Lunacy,'  59),  and  Mr.  Chitty  ('Med.  Juris.'  355),  that  it  is  an 
established  rule  of  law  not  to  admit  proof  of  insanity  in  other  members  of  the  family 
in  civil  or  criminal  cases.  Established  ?  When,  where,  and  by  whom  ?  Certainly 
not  by  the  House  of  Lords  in  McAdam  v.  Walker  (1  Dow's  Par.  Ca.  148),  the  only 
case  cited  for  it,  for  the  question  there  was  avowedly  dodged.  That  high  court  would 
not  shock  common  sense  by  affirming  the  order  of  the  Scotch  Court  of  Sessions :  nor 
would  it  gratuitously  reverse  it,  where  the  decision  could  be  safely  put  on  another 
ground.  The  authority  of  a  judgment  appealed  from,  and  left  in  dubio,  cannot  be 
very  great."  *****  "Does  not  proof  of  hereditary  madness  bear  directly  on  the 
condition  of  the  mind  which  is  the  subject  of  investigation  ? 

"  What  if  the  point  had  been  ruled  by  the  Chancellor  and  law  judges  in  the  House 
of  Lords  ?  Profoundly  learned  in  the  maxims  of  the  law,  they  were  profoundly  igno- 
rant of  the  lights  of  physiology  ;  yet,  free  from  the  presumptuousness  of  which  igno- 
rance is  the  foster-father,  they  refused  to  rush  on  the  decision  of  a  question  to  which 
they  felt  themselves  incompetent."  *****  "When  it  is  admitted  by  Mr.  Chitty 
and  Mr.  Shelford  themselves,  that  insanity  is  a  descendible  quality,  they  give  up  the 
argument.  There  can  be  nothing  unreasonable  in  referring  wild,  furious,  and  unnatu- 
ral actions,  not  otherwise  accouuted  for,  to  the  aberrations  of  a  mind,  the  reflex  of 
that  of  a  crazy  father.  Mr.  Taylor,  a  distinguished  lecturer  on  Medical  Jurisprudence 
in  Guy's  Hospital,  London,  says  that  'in  making  a  diagnosis  of  a  case  of  insanity, 
the  first?  question  put  is  commonly  in  reference  to  the  present  or  past  existence  of  the 
disorder  in  other  members  of  the  family.  There  can  be  no  doubt,  from  the  concur- 
rent testimony  of  many  writers  on  insanity,  that  a  disposition  to  the  disease  is  fre- 
quently transmitted  from  parent  to  child,  through  many  generations.  M.  Esquirol 
has  remarked  that  this  hereditary  taint  is  the  most  common  of  all  the  causes  to 
which  insanity  can  be  referred.'  (Taylor  on  Med.  Juris.  502.)"  *****  "The 
knowledge  attained  by  men  of  a  subject  with  which  they  have  grappled  all  their 
lives,  ought  surely  to  prevail  against  knowledge  gleaned  from  the  handbooks  of  a  pro- 
fession to  which  the  gleaners  did  not  belong.  Strange  that  a  source  of  information, 
open  to  every  one  else,  should  be  closed  to  those  who  are  to  pass  on  the  fact !  Every 
man  has  observed  that  there  are  families,  through  which  insanity  has  been  handed 
down  for  generations."         *         *         * 

"An  objection  to  an  inquisition  which  does  not  disclose  the  specific  nature  of  the 
ancestor's  infirmity  might  stand  in  a  different  light,  but  testimony  which  brings  the 
fact  of  madness  home  to  him  ought  to  be  received  like  evidence  of  family  likeness, 
which,  though  less  reliable,  was  allowed  to  be  corroborative  proof  of  paternity  in  the 
Douglas  Peerage  case  in  1767,  and  again  in  the  Townsend  Peerage  case  in  1843." 
*****  "In  prosecutions  for  bastardy,  the  practice  in  the  Quarter  Sessions  was.  in 
my  day,  not  exactly  to  give  the  child  in  evidence,  but  to  put  it  before  the  jury,  some- 
times by  the  prosecutor,  and  sometimes  by  the  putative  father.     But  ancestral  irregu- 


DETECTION    OF    FEIGNED    INSANITY.  645 

testator's  sanity.  So  in  Massachusetts,  Baxter  Y.Abbott  (7  Gray,  71). 
In  Delaware,  in  a  trial  for  murder,  the  evidence  was  admitted,  and  it 
was  said  "  that  reputation  in  the  family  of  such  cases  (of  insanity)  may 
be  proved  on  the  principle  of  births,  deaths,  genealogies,  &c."  {Stale 
v.  Windsor,  5  Harrington,  512.)  In  State  v.  Christmas  (6  Jones,  Law 
North  Carolina,  471),  it  was  held  that  where  hereditary  insanity  is 
offered  as  an  excuse  for  crime,  it  must  appear  that  the  kind  of  insanity 
proposed  to  be  proven,  as  existing  in  the  prisoner,  is  no  temporary 
malady ;  but  that  it  is  notorious,  and  of  the  same  species  as  that  with 
which  other  members  of  the  family  have  been  afflicted. — P.]  This 
kind  of  evidence  has,  however,  been  frequently  rejected,  and  it  is  not 
admitted  in  the  law  of  Scotland.  {Gibson'' s  case,  Edinburgh,  Decem- 
ber, 1844.) 

Feigned  Insanity. — Insanity  is  frequently  feigned  by  persons  ac- 
cused of  criminal  offences  in  order  to  procure  an  acquittal  or  dis- 
charge. In  the  first  place,  when  feigning  is  suspected,  it  will  be 
proper  to  inquire  whether  the  person  has  any  motive  for  pretending 
to  be  insane.  No  sane  person  feigns  without  a  motive.  It  is  neces- 
sary to  remember  that  insanity  is  never  assumed  until  after  the  com- 
mission of  a  crime  and  the  actual  detection  of  the  criminal.  No 
one  feigns  insanity  merely  to  avoid  suspicion.  In  general,  as  in 
most  cases  of  imposture,  the  part  is  overacted — the  person  does  either 
too  much  or  too  little,  and  he  betrays  himself  by  inconsistencies  of 
conduct  and  language  which  are  never  met  with  in  cases  of  real  in- 
sanity. There  is  commonly  some  probable  cause  to  which  insanity 
may  be  traced,  but  when  the  malady  is  feigned  there  is  no  apparent 
cause :  in  this  case  the  appearance  of  the  assumed  insanity  is  always 
sudden — in  the  real  malady,  the  progress  of  an  attack  is  generally 
gradual ;  and  when  the  attack  is  really  sudden,  then  it  will  be  found 
to  be  due  to  some  great  moral  shock  or  other  very  obvious  cause. 
We  should  observe  whether  for  some  time  previously  there  has 
been  any  marked  change  of  character  in  the  person,  or  whether  his 
conduct,  Avhen  he  had  no  interest  to  feign,  presented  any  of  the  usual 
indications  of  a  disordered  mind.  Some  difficulty  may  arise  when 
fits  of  eccentricity  or  strangeness  of  character  are  deposed  to  by 
witnesses ;  but  these  statements  may  be  inconsistent  with  each  other, 
and  the  previous  acts  of  the  person  may  bear  no  resemblance  what- 
ever to  those  performed  by  him  in  the  recently  assumed  condition. 
A  difficulty  of  this  kind  rarely  presents  itself,  since  in  an  impostor 
no  act  indicative  of  insanity  can  be  adduced  for  any  antecedent  pe- 
riod of  his  life :  it  is  only  after  the  perpetration  of  a  crime  and  its 
detection,  that  any  action  simulating  the  habits  of  the  insane  will 
be  met  with.  In  real  insanity  the  person  will  not  admit  that  he  is 
insane ;  in  the  feigned  state  all  his  attempts  are  directed  to  make  you 
believe  that  he  is  mad  ;  and  an  impostor  may  be  induced  to  perform 

larity  in  the  action  of  the  brain  is  more  frequently  transmitted  than  any  resemblance 
in  form  or  feature  ;  and  it  is  difficult  to  imagine  an  objection  to  evidence  of  it  for 
purposes  of  corroboration." — P.] 


6±6  INSANITY.      APPEAEANCES    AFTER    DEATH. 

any  act,  if  it  be  casually  observed  to  another  in  his  hearing,  that 
the  performance  of  such  an  act  will  furnish,  strong  evidence  of  his 
insanity. 

Mania  is  perhaps  more  frequently  assumed  than  any  other  form, 
because  the  vulgar  notion  of  insanity  is,  that  it  is  made  up  of  vio- 
lent action,  and  vociferous  and  incoherent  language:  but  mania 
rarely  comes  on  suddenly,  or  without  some  obvious  cause.  A 
maniacal  patient  is  also  equally  furious  day  and  night,  while  an  im- 
postor is  obliged  to  rest  after  his  violent  exertions.  Dr.  Burrows 
recommends  that  close  attention  should  be  paid  to  the  expression  of 
the  eye.  The  mobility  of  the  features  may  be  as  rapid  as  the  imagi- 
nation is  vivid  ;  but  when  every  feature  may  vary,  or  be  kept  under 
control  and  be  steady,  the  eye  will  still  indicate  the  erring  thought — 
its  expression  cannot  be  easily  assumed.  There  is  about  the  eyes 
in  mania  a  restlessness  which  cannot  fail  to  attract  attention ;  the 
patient  sleeps  but  little,  and  the  sleep  is  disturbed — an  impostor 
sleeps  as  soundly  as  a  healthy  person.  The  violence  of  a  maniac 
continues  whether  he  is  alone  or  not,  while  the  impostor  acts  his 
part  only  when  he  thinks  he  is  observed  ;  hence  the  imposition  may 
be  detected  by  watching  him  when  he  is  not  aware  that  an  eye  is 
directed  upon  him. 

Appearances  after  Death. — In  some  cases  a  medical  practitioner  may 
be  required  to  state  whether  certain  appearances  found  in  the  brain 
of  a  deceased  person  do  or  do  not  indicate  the  past  existence  of  in- 
sanity or  imbecility.  Such  a  question  is  only  likely  to  arise  in 
chronic  cases,  in  which  the  past  existence  of  insanity  from  oral  tes- 
timony may  be  disputed.  (Case  of  Sink,  Prerog.  Court,  1852.)  The 
appearances  commonly  met  with  on  an  inspection  of  the  head  are — 
thickening  of  the  bones  of  the  skull,  close  adhesions  of  the  dura  mater 
(the  lining-membrane),  with  great  congestion  of  the  pia  mater,  and 
opacity  and  thickening  of  the  arachnoid  or  inner  membrane  of  the 
brain.  There  is  a  general  fulness  of  the  bloodvessels  of  the  brain 
with  remains  of  old  cysts,  hardened  deposits,  or  even  abscesses  in 
various  parts  of  the  cerebral  substance.  Inferences  from  the  existence 
of  these  appearances  in  the  brain  must,  however,  be  drawn  with 
caution,  because  it  cannot  be  said  that  they  necessarily  indicate  in- 
sanity; nevertheless,  such  chronic  changes  must  be  considered  as 
producing  greater  or  less  derangement  of  the  mental  functions  ;  but 
the  actual  degree  to  which  the  impairment  has  existed  ought  properly 
to  be  determined  by  evidence  of  the  conduct  and  actions  of  the 
deceased  during  life.  In  a  communication  made  by  Dr.  Webster  to 
the  Medico-Chirurgical  Society  in  April,  1855,  there  is  a  statistical 
summary  of  the  appearances  met  with  in  the  examination  of  the  bodies 
of  290  insane  patients.  In  226  cases  the  pia  mater  was  infiltrated  : 
in  207  effusion  had  taken  place  in  the  ventricles;  in  18-1  fulness  of 
the  bloodvessels  in  the  brain  or  membranes  was  observed ;  in  117  the 
arachnoid  membrane  was  thickened  and  opaque;  in  61  the  color  of 
the  brain  appeared  changed  from  its  natural  hue ;  in  51  the  bloody 
points  (puncta  omenta)  were  large  and  numerous  upon  the  cut 
surface  of  the  medullary  substance;  while  in  40  instances  blood  was 


APPLICATION    OF    RESTRAINT.  647 

effused,  sometimes  to  a  considerable  extent,  within  the  cranium. 
This  effusion  had  evidently  been  the  immediate  cause  of  death  in 
most  of  the  patients.  From  these  data  it  appears  that — first,  infiltra- 
tion of  the  pia  mater ;  secondly,  effusion  of  fluid  in  the  ventricles ;  and 
thirdly,  fulness  of  the  cranial  vessels,  are  the  principal  as  also  the 
most  frequent  diseased  alterations  of  structure  observed  in  patients 
who  die  whilst  suffering  under  symptoms  of  mental  disorder. 

As  neither  the  symptoms  nor  the  duration  of  the  insanity  is  given, 
it  is  difficult  to  apply  these  results  to  special  instances.  In  the  case 
of  Roberts  v.  Kerslake  (Warwick  Aut.  Assizes,  1854),  the  main  ques- 
tion was  whether  certain  appearances  in  the  brain  and  its  membranes 
did  or  did  not  indicate  disease  of  long-standing  as  well  as  insanity  at 
the  particular  date  at  which  a  will  was  made.  Dr.  Conolly  and  I 
considered  that  the  appearances  were  not  inconsistent  with  the  sup- 
position that  the  testator  was  sane  at  the  time  of  making  his  will. 
("  Journal  of  Psychological  Med."  Oct.  1854,  p.  573.) 


CHAPTER    LX. 

Medico-legal  questions  in  relation  to  the  insane. — appli- 
cation   OF    RESTRAINT. ILLEGAL    IMPOSITION    OF    RESTRAINT. — 

VIOLENCE    OF    TEMPER. — CERTIFICATES   OF    INSANITY. — RULES    FOR 
THE    DISCHARGE    OF    LUNATICS. 

Among  the  questions  Avhich  may  come  before  a  medical  jurist  in 
relation  to  the  subject  of  insanity  are  the  following:  A  practitioner 
may  be  required  to  say  whether  a  person  affected  with  the  malady 
should  or  should  not  be  confined  in  a  lunatic  asylum — whether  he 
should  be  deprived  of  his  civil  rights  by  interdiction,  or  whether  he 
is  so  completely  cured  of  his  malady  as  to  justify  his  liberation  from 
confinement.  Then  again  medical  evidence  may  go  far  to  determine 
whether  a  will  or  deed  executed  by  an  alleged  lunatic  should  be  set 
aside ;  whether  a  marriage-contract  or  debt  should  be  annulled ;  and 
lastly,  whether  a  criminal  act  was  committed  by  a  person  while 
laboring  under  insanity — a  question  involving  either  the  life  or, 
according  to  circumstances,  the  perpetual  imprisonment  of  a  person 
accused  of  crime. 

Application  of  Restraint. — By  restraint  in  a  legal  sense  we  are  to 
understand  the  placing  of  attendants  to  watch  or  control  the  actions 
of  an  alleged  lunatic,  or  his  forcible  removal  from  friends  or  relatives 
with  or  without  the  confinement  of  his  person  by  physical  force.  What 
are  the  circumstances  which  will  justify  a  practitioner  in  applying 
restraint  to  the  insane  ?  The  law  has  given  great  power  in  this  respect 
to  members  of  the  medical  profession,  but,  owing  to  certain  abuses, 
the  power  has  been  of  late  years  much  restricted  by  various  Acts  of 
the  Legislature.     Must  medico-le<j;al  writers  auree  that  we  are  not 


6±S  MEDICAL    RESPONSIBILITY. 

justified  in  ordering  restraint  except  when,  from  symptoms  witnessed 
by  ourselves,  we  have  reason  to  apprehend  that  the  lunatic  will  injure 
l  is  person  or  property  or  the  person  or  property  of  others.  It  is  then  not 
sufficient  to  seek  merely  for  evidence  of  the  existence  of  some 
delusion,  but  to  determine  how  far  that  delusion,  if  present,  affects 
the  conduct  of  the  person.  Unless  the  delusion  be  such  as  to  render 
it  probable  that  the  patient's  oavu  interests  or  those  of  others  may  be 
damaged  by  his  insane  conduct,  careful  superintendence  will  answer 
all  the  purposes  of  jthe  closest  restraint.  (For  some  remarks  on  this 
subject,  see  "  Med.  Gaz."  vol.  44,  p.  1061.)  The  act  of  resorting  to 
restraint  on  all  occasions  has  been  justified  on  the  principle  that  it 
may  tend  to  the  cure  of  a  patient  by  removing  his  delusion.  In  this 
point  of  view  the  subject  has  reference  to  medical  practice  and  not 
to  legal  medicine.  It  may  be  urged  with  more  plausibility,  that  by 
withholding  restraint  in  incipient  cases,  mischief  may  be  done  by  the 
lunatic  to  himself  or  others,  and  that  then  it  will  be  too  late  to 
interfere ;  but  even  here  careful  superintendence  may  render  close 
confinement  unnecessary. 

The  legal  rule  for  interference  with  the  liberty  of  a  person,  which 
restraint  always  implies,  may  be  inferred  from  the  following  state- 
ment by  Mr.  J.  F.  Stephen :  "  There  is  a  normal  state  in  which  all 
human  creatures  act  on  the  same  principles,  and  the  general  mean- 
ing of  sanity  is,  that  the  person  conducts  himself  in  this  normal 
manner;  that  he  is  acquainted  with  the  circumstances  by  which  he 
is  surrounded ;  that  he  has  objects  in  view  in  his  actions,  and  that 
he  regulates  his  conduct  with  reference  to  them  and  to  the  general 
considerations  which  affect  matters  of  that  class."  ("General  View 
of  the  Criminal  Law  of  England,"  pp.  87  et  seq.)  It  cannot  be  too 
strongly  impressed  on  the  mind  of  a  medical  man  that,  before  he 
employs  the  powers  conferred  upon  him  by  law  to  confine  a  person 
who  is  said  to  be  mad,  he  should  have  well  in  his  mind  what  lawyers 
imply  by  the  term  "  madness,"  in  a  practical  sense.  As  defined  by 
Mr.  Stephen,  it  means  conduct  of  a  certain  character — not,  as  it  is 
usually  interpreted  by  medical  men,  a  certain  disease  of  the  brain 
the  existence  of  Avhich  is  speculative,  but  one  of  the  effects  of  which, 
if  present,  is  to  produce  such  conduct.  In  examining  an  alleged 
lunatic,  with  a  view  of  determining  whether  he  should  or  should 
not  be  placed  in  confinement,  his  conduct  must  therefore  be  com- 
pared with  that  of  other  men  in  a  normal  state:  and  here,  in  order 
to  constitute  sane  behavior,  we  must  look  for  a  generic  and  not  for 
a  specific  resemblance.  Any  degree  of  ignorance,  vice,  or  folly  is 
perfectly  consistent  with  sane  conduct  in  a  legal  sense.  The  power 
of  restraint  is  not  intended  to  be  applied  to  such  cases  as  these ;  they 
are  properly  under  certain  circumstances  amenable  to  the  criminal 
law.  An  ignorant,  vicious,  or  foolish  man  may  do  a  great  amount 
of  mischief,  but  he  has  a  liberty  of  choice  and  freedom  of  action ; 
and  if  from  folly  or  depravity  he  selects  a  bad  course,  he  is  not 
therefore  insane,  but  is  as  much  responsible  for  his  actions  as  a  sane 
man  who  prefers  a  good  course.  Such  a  man  should  not  be  treated 
as  a  lunatic  or  confined  in  an  asylum  under  a  medical  certificate.   It 


RULES    RESPECTING    APPLICATION"    OF    RESTRAINT.      649 

may  be  sometimes  difficult  to  define  the  line  which  separates  acts  of 
depravity  from  those  of  insanity :  but  medical  men  have  not  been 
in  many  cases  sufficiently  cautious  in  endeavoring  to  make  a  dis- 
tinction. Lawyers  look  closely  to  conduct  as  a  ground  of  interfer- 
ence with  personal  liberty  :  the  conduct  must  be  such  as  to  be  incon- 
sistent with  the  usual  behavior  of  a  normally  sane  person  placed 
under  similar  circumstances. 

In  examining  a  person  proposed  to  be  placed  under  restraint,  we 
must  take  care  not  to  confound  acts  depending  on  violence  of  temper 
with  those  which  proceed  from  unsoundness  of  mind.  A  man  may 
have  always  had  a  violent  temper,  subject  to  occasional  fits  of  aggra- 
vation ;  but  this  condition  must  not  be  mistaken  for  mental  disease. 
In  order  to  determine  whether  the  acts  of  a  person  be  due  to  violent 
temper  or  insanity,  it  will  be  proper  to  ascertain  what  may  have 
been  his  natural  habits.  The  great  feature  of  insanity  is  change  of 
character — a  man  who  is  really  insane  is  different  from  what  he  has 
previously  been ;  but  it  may  be  proved  of  a  violent-tempered  man 
that  he  has  always  been  the  same.  The  greatest  abuses  of  the  re- 
straint system  have  been  chiefly  observed  in  respect  to  monomania, 
where  persons  have  been  forcibly  imprisoned  and  confined  in  their 
persons,  because  they  entertained  some  absurd  delusions,  over  which, 
however,  they  had  so  great  a  power  of  control  as  to  render  it  some- 
what difficult  even  for  a  shrewd  and  experienced  examiner  to  detect 
them.  "When  at  last,  after  many  hours'  cross-examination,  the  ex- 
istence of  a  delusion  has  been  made  apparent,  the  result  has  been 
looked  upon  as  furnishing  matter  for  triumph  and  exultation ;  but, 
as  Dr.  Conolly  justly  remarks,  one  point  in  these  cases  appears  to 
have  been  wholly  lost  sight  of,  namely — What  possible  injury  could 
have  resulted  to  the  patient  or  his  friends  from  the  existence  of  a 
delusion  over  which  he  had  such  complete  control  and  mastery  as  to 
render  it  a  most  laborious  task  to  obtain  any  evidence  whatever  of 
its  existence?  ("Indications  of  Insanity.")  It  may  be  freely  ad- 
mitted that  where  delusion  does  exist,  there  is  reason  to  suppose  that 
the  mind  must  be  more  or  less  disordered  in  all  its  faculties;  but 
such  patients  require  only  close  watching,  not  a  rigorous  imprison- 
ment in  an  asylum.  The  greatest  danger  is  to  be  apprehended  in  all 
those  cases  where  there  is  the  least  power  of  self-control.  The  forci- 
ble removal  of  a  person  from  his  home  to  a  lunatic  asylum,  unless 
the  circumstances  are  of  such  a  nature  as  to  render  immediate  inter- 
ference necessary  on  the  ground  of  admitted  or  proved  insanity,  is 
unjustifiable  in  law,  and  may  involve  those  concerned  in  the  removal 
in  a  serious  responsibility.  In  cases  of  incipient  insanity  interfer- 
ence would  not  be  legally  justifiable,  and  a  practitioner  placing 
restraint  on  a  person  so  situated  might  find  himself  defendant  in  an 
action  for  damages. 

In  Hill  v.  Philp  the  judges  decided  that  a  medical  man,  when 
called  upon  to  give  a  certificate  for  the  confinement  of  a  person, 
may  act  upon  the  directions  of  a  wife,  but  that  the  directions  must 
be  considered  as  only  guiding  his  judgment,  and  not  as  absolutely 
dictating  to  him  and  justifying  his  proceedings;    that  he  is  still 


650  CERTIFICATES    OF    INSANITY. 

bound  to  exercise  his  own  professional  knowledge  and  discretion 
so  far  as  to  refrain  from  doing  anything  or  adopting  any  course 
which  might  be  injurious  to  the  patient.  A  medical  man  is,  there- 
fore, ultimately  responsible  for  his  treatment  of  a  lunatic  :  no  person 
can  give  him  authority  to  do  that  which  is  not  in  accordance  with 
general  practice  or  the  necessity  of  the  case.  (For  a  report  of  this 
case,  and  some  judicious  remarks  upon  the  decision,  see  the  "  Legal 
Examiner,"  May  29,  1852,  pp.  307,  318.)  In  Scott  v.  Wakem  (Guild- 
ford Summer  Assizes,  1862),  the  defendant,  a  medical  practitioner, 
was  sued  for  damages  in  placing  under  restraint,  and  without  neces- 
sity or  authority,  a  man  laboring  under  delirium  tremens.  In  this 
case  the  wife  denied  that  she  had  given  any  authority  for  interfer- 
ence, and  on  this  point  her  evidence  conflicted  with  that  of  the  de- 
fendant, the  medical  man  whom  she  had  consulted.  Fortunately 
the  facts  were  adverse  to  her  statement ;  but  in  future  cases  of  this 
kind,  it  would  be  desirable  for  a  medical  man  to  have  a  written  au- 
thority for  such  proceedings,  bearing  in  mind  that  he  does  not  ex- 
ceed what  is  necessary,  proper,  or  usual  for  the  treatment  of  the 
person;  and  on  this  he  must  always  exercise  his  own  judgment, 
irrespective  of  the  opinions  or  suggestions  of  others.  Medical  men, 
even  when  acting  most  conscientiously  in  discharge  of  their  duties, 
cannot  hope  to  escape  harassing  and  vexatious  actions  when  they 
are  called  upon  to  deal  with  cases  of  delirium  tremens.  The  pecu- 
liarity of  this  disorder  is  that  with  the  cause,  it  may  soon  disappear, 
and  thus  medical  evidence  may  be  easily  procured  to  show  that  a 
person,  at  a  short  period  before  or  after  the  imposition  of  restraint, 
was  in  a  sane  state  of  mind  and  not  in  a  condition  to  justify  any  in- 
terference with  his  personal  liberty. 

In  order  to  provide  for  the  protection  of  lunatics  and  for  the  pre- 
vention of  undue  violence  or  frequency  in  the  application  of  restraint, 
the  law  compels  the  keepers  of  asylums  to  enter  in  a  book  a  report 
of  each  case  or  of  each  occasion  on  which  any  mechanical  restraint 
is  resorted  to.  An  omission  to  make  this  entry  is  a  misdemeanor : 
and  at  the  Maidstone  Lent  Assizes,  1851,  two  medical  men  were 
convicted  and  fined  for  placing  patients  under  restraint  without  hav- 
ing made  the  proper  entries  required  by  law.  (Bey.  v.  Mdddock: 
see  also  ';  Med.  Gaz."  vol.  17,  p.  006  :  and  a  paper  on  the  "  Use  and 
Abuse  of  Kestraint,"  in  the  "  Journ.  Psychol.  Med.''  1819,  p.  210.) 

Certificates  of  Insanity. — It  will  here  be  necessary  to  state  the  cir- 
cumstances which  require  the  attention  of  a  practitioner  when  he  is 
called  upon  to  sign  a  certificate  of  insanity,  whereby  a  person  may 
be  placed  in  confinement  in  an  asylum.  The  Acts  which  specially 
refer  to  this  subject  are  the  16th  k  17th  Victoria,  c.  96  and  97. 
These  Acts,  which  came  into'  operation  on  the  1st  of  November 
1853,  are  a  consolidation  of  the  statutes  on  the  regulation  of  the 
care  and  treatment  of  lunatics.  Their  provisions  are  very  stringent, 
both  with  respect  to  medical  men  who  sign  certificates,  and  those 
who  keep  asylums  for  the  reception  of  lunatics.  According  to  s.  71, 
c.  97,  no  person  (not  a  pauper)  can  be  received  into  or  detained  in 


CERTIFICATES    OF    INSANITY.  651 

any  asylum,  without  an  order  from  some  person  (generally  the  near- 
est relative)  and  two  medical  certificates,  which  must  be  signed  by 
two  physicians,  surgeons,  or  apothecaries  not  in  partnership  or  an  as- 
sistant to  the  other,  and  each  of  whom  shall  separately  from  the  other 
have  personally  examined  the  person  to  whom  it  relates  not  more 
than  seven  clear  days  previously  to  the  reception  of  such  person  into 
such  asylum.  These  certificates  need  not  be  filled  up,  signed,  and 
dated  on  the  day  of  examination;  but  the  examination  of  the  patient 
must  be  made  in  every  case  within  seven  clear  days  before  admission. 
The  following  is  the  form  of  a  medical  certificate  in  the  case  of 
private  patients : — 

I,  the  undersigned,  being  a  (duly  registered)  physician  or  surgeon 
or  apothecary  [here  set  forth  the  qualification],  and  being  in  actual 
practice  as  such,  hereby  certify  that  I,  on  the         day  of  ,  at 

[here  insert  the  street  and  number  of  the  house  {if  any),  or  other  like  par- 
ticulars'], in  the  county  of  &c,  separately  from  any  other  medi- 
cal practitioner,  personally  examined  A.  B.,  the  person  named  in  the 
accompanying  statement  or  order,  and  that  the  said  A.  B.  is  a  luna- 
tic [or  an  idiot,  or  a  person  of  unsound  mind],  and  a  proper  person 
to  be  taken  charge  of  and  detained  under  care  and  treatment,  and 
that  I  have  formed  this  opinion  upon  the  following  grounds,  viz: — 

1.  Facts  indicating  insanity  observed  by  myself  [here  state  the 
M-ts]. 

2.  Other  facts  (if  any)  indicating  insanity,  communicated  to  me 
by  others  [here  state  the  information,  and  from  whom]. 

(Signed)  Name. 

Place  of  abode. 
Dated  this         day  of  ,  One  thousand  eight  hundred  and 

Under  s.  10,  c.  96,  no  person  can  be  received  into  any  registered 
hospital  or  licensed  house,  or  as  a  single  patient,  under  any  certifi- 
cate which  purports  to  be  founded  only  upon  facts  communicated 
by  others.  A  medical  certificate  may  be  amended  if  incorrect  or 
defective.  No  medical  man  can  receive  as  a  boarder  in  his  house 
any  insane  person,  whether  for  medical  treatment  or  otherwise,  un- 
less he  has  previously  obtained  a  license  from  the  Commissioners 
of  Lunacy,  and  one  certificate  duly  signed  by  two  other  medical 
men.  In  January,  1861,  a  medical  practitioner  was  convicted  of  mis- 
demeanor for  thus  receiving  illegally  a  lunatic  patient,  (it"/,  v. 
Kelley,  C.  C.  0.  Jan.  29,  1861.)  This  was  a  clear  breach  of  the  regu- 
lations. The  defence  was  that  ho  was  ignorant  of  the  law,  but  this 
was  no  answer  to  the  charge.  ("Med.  Times  and  Gaz."  Jan.  28, 
1861,  ]>.  105;  and  "Lancet,'''  Feb.  9,  1861,  p.  151.) 

Dr.  Millar,  who  has  had  considerable  experience  as  the  superin- 
tendent of  a  large  lunatic  asylum,  states  that,  as  a  rule,  very  few  of 
tlir  certificates  which  are  brought  with  private  patients  are  correctly 
filled  up,  notwithstanding  the  plainness  of  the  instructions.  The 
omission  of  particulars  apparently  of  no  importance  has  often  caused 
them  to  be  rejected  as  illegal;  and  it  will  therefore  be  useful  to  point 


652  CERTIFICATES    OF    INSANITY. 

out  the  chief  errors  which,  according  to  this  gentleman,  are  com- 
mitted by  medical  men.  1st.  A  neglect  in  stating  the  qualification 
which  empowers  the  medical  practitioner  to  practise.  It  is  not  un- 
usual for  the  blank  space  to  be  filled  up  with  the  words  "  physician," 
'•surgeon,"  or  "apothecary,"  instead  of  inserting  the  qualification 
which  enables  him  to  practise  in  any  of  these  capacities.  2dly. 
Omitting  the  address  of  the  house  at  which  the  examination  was 
made.  If  there  should  be  no  number  to  the  house,  it  will  be  suffi- 
cient to  state,  "  At  the  dwelling-house  of ,  in street,  vil- 
lage, &c."  3dly.  Omitting  the  address  and  occupation  of  the  person 
examined.  In  nine  cases  out  of  ten,  according  to  Dr.  Millar,  an 
omission  of  one  of  these  three  simple  and  obvious  particulars,  oc- 
curs— a  degree  of  carelessness  not  creditable  to  the  profession. 
Medical  men  no  doubt  err  from  regarding  them  as  having  no  bearing 
whatever  on  the  sanity  or  insanity  of  a  patient.  (See  Millar's  "  Hints 
on  Insanity,"  p.  78.) 

By  s.  13,  c.  96,  a  medical  practitioner  who  gives  a  false  certificate, 
or  any  person  not  being  a  registered  physician,  surgeon,  or  apothe- 
cary in  actual  practice,  who  gives  a  certificate  as  such,  is  declared 
to  be  guilty  of  a  misdemeanor.  For  any  act  done  by  a  registered 
medical  practitioner  contrary  to  any  of  the  provisions  of  the  Act 
(although  not  declared  to  be  a  misdemeanor),  he  is  subjected  for  each 
proved  offence  to  a  penalty  of  twenty  pounds.  By  s.  36  the  words 
"physician,"  "surgeon,"  or  " apothecary"  shall  respectively  mean 
one  duly  "  licensed  or  registered  to  practise  as  such  by  or  as  a  mem- 
ber of  some  College,  University,  Company,  or  Institution,  legally 
constituted  and  qualified  to  grant  such  authority  or  license  in  some 
part  of  the  United  Kingdom,  or  one  who  was  in  practice  as  an  apo- 
thecary in  England  or  Wales  on  or  before  the  1st  day  of  August. 
1815,  and  being  in  actual  practice  as  such  physician,  surgeon,  or 
apothecary."  (16  &  17  Vict.  cap.  96,  s.  36.)  Thus  the  certificates  of 
Irish  medical  practitioners  are  valid  for  the  confinement  of  lunatics 
in  England,  and  conversely  those  of  English  practitioners  are  valid 
for  asvlums  in  Ireland.  A  special  Act  has  been  passed  for  Scotland 
(20  &  21  Vict.  c.  71):  and  by  sections  31  and  35  the  rules  regarding 
certificates  are  similar  to  those  of  the  English  statute. 

A  medical  practitioner  must  not  be  too  ready  to  lend  himself  to 
the  signing  of  certificates  for  the  .confinement  of  persons  avIio  may 
be  laboring  under  harmless  delusions.  In  violent  mania,  or  in  mono- 
mania with  a  homicidal  or  a  suicidal  propensity,  there  can  be  no 
doubt  of  the  propriety  of  applying  some  degree  of  restraint,  for 
here  the  necessity  is  imminent.  If  a  remarkable  change  has  sud- 
denly taken  place  in  the  character  of  a  person,  if  he  has  become 
irritable,  outrageous,  or  threatened  personal  violence  to  any  one,  or 
if  he  has  recklessly  endangered  the  interests  of  himself  and  family, 
he  is  undoubtedly  a  fit  subject  for  restraint.  (^See  Pagan,  p.  7">.) 
The  more  he  approaches  to  this  condition,  the  less  difficulty  we  shall 
have  in  coming  to  a  decision,  and  in  a  really  doubtful  instance  there 
will  be  no  impropriety  in  employing  restraint;  since,  although  the 
person   is  thereby  deprived   of  liberty,  it  is  better  that  this  should 


CERTIFICATES    OF    INSANITY.  653 

happen  than  that  he  or  his  friends  should  incur  the  risk  of  suffering 
severely  by  his  insane  conduct. 

The  74th  section  of  cap.  97  provides  that  in  cases  of  emergency  a 
person  (not  a  pauper)  may,  under  special  circumstances  (these  beino- 
stated  i]i  the  order),  be  received  into  a  house  or  hospital  upon  a  cer- 
tificate signed  by  one  medical  practitioner  only,  provided  that  within 
three  days  two  other  such  certificates  are  signed  by  two  other  medical 
practitioners  not  being  connected  with  such  house  or  hospital,  upon 
a  like  examination.  The  detaining  of  a  person  upon  one  medical 
certificate  only  beyond  the  period  of  three  days,  without  such  further 
certificates,  is  a  misdemeanor  in  the  keeper  of  the  house  or  hospital. 
By  s.  67,  c.  97,  the  certificate  of  one  medical  practitioner  only,  signed 
according  to  the  above  rules,  will  suffice  for  a  pauper  lunatic,  pro- 
vided the  person  has  been  previously  examined  by  a  justice,  clergy- 
man, and  overseer  or  relieving  officer.  By  s.  12,  c.  96,  no  medical 
practitioner  who  is  interested  in  or  attends  a  licensed  house  or  hos- 
pital, or  whose  father,  brother,  son,  partner,  or  assistant  is  wholly 
or  partly  the  proprietor  of,  or  a  regular  professional  attendant  in, 
sruch  house  or  hospital,  shall  sign  any  certificate  for  the  reception  of 
a  patient  into  it.  It  is  obvious  from  the  terms  of  the  Act  that  one 
person  cannot  sign  a  certificate  as  a  substitute  for  another,  and  yet 
there  have  been  several  instances  of  its  violation  under  these  cir- 
cumstances. In  December,  1855,  a  medical  assistant  was  committed 
for  trial  because  he  had  signed  the  name  of  the  surgeon  with  whom 
he  was  living  to  a  certificate  of  insanity  for  the  confinement  of  a 
pauper  lunatic.  There  was  no  doubt  about  the  insanity  of  the  per- 
son, and  the  plea  urged  in  defence  was  that  the  surgeon  whose  name 
was  thus  forged  was  in  ill-health,  and  had  given  the  assistant  an 
authority  to  sign  papers  for  him.  This,  however,  was  no  justification 
of  a  violation  of  the  terms  of  the  Act :  the  words  of  the  certificate 
are  so  explicit  on  this  point  that  no  reasonable  person  can  have  anv 
doubt  about  their  meaning. 

[The  principal  hospitals  for  the  insane  of  the  United  States  have 
printed  forms  and  obligations,  which  are  furnished  to  the  friends  of 
patients  to  be  filled  up  and  signed  according  to  the  law  of  the  State 
and  the  rules  of  the  hospital.  The  form  of  the  medical  certificate 
generally  requires  the  patient  to  have  been  seen  and  examined  by 
the  physician  signing,  on  the  day  on  which  the  certificate  is  dated. 
In  all  cases  the  certificate  is  expected  to  apply  only  to  the  actual 
condition  of  the  patient  at  the  time  of  signing,  and  to  be  used  with- 
out delay  in  order  to  be  available. 

The  medical  certificate  must  always  be  accompanied  by  a  formal 
application  for  admission  of  the  patient,  signed  by  a  responsible 
guardian,  near  relative  or  friend.  These  papers  have  also  annexed 
to  them,  a  series  of  questions  relating  to  the  past  history  and  exist- 
ing condition  of  the  patient,  the  peculiar  symptoms  of  the  case,  and 
the  probable  cause  of  the  attack ;  which  questions  are  to  be  answered 
by  the  friends  and  relatives,  and  the  attending  physician. 

Some  hospitals  require  the  signatures  of  two  "physicians  to  the 
medical  certificate,  neither  of  them,  of  course,  being  connected  with 


654  SPECIFICATION"    OF    FACTS. 

the  hospitals  applied  to.  The  State  Lunatic  Hospital  of  New  Jersey 
requires  the  medical  certificate  to  be  formally  deposed  to  by  two 
physicians  before  a  magistrate. 

Patients  sometimes  obtain  their  discharge  on  a  writ  of  habeas 
corpus,  but  are  generally  removed  by  friends  or  discharged,  when 
sufficiently  recovered,  at  the  discretion  of  the  superintendent.  AVe 
are  not  aware  of  any  legal  restriction  in  this  country  on  the  libera- 
tion of  insane  patients,  except  in  cases  of  homicidal  or  otherwise 
dangerous  lunatics,  who  have  been  confined  by  order  of  a  magistrate 
or  of  a  court  of  law.  Such  patients  can  only  be  released  by  an 
authority  similar  to  that  which  first  committed  them.  There  are 
patients  of  this  class  now  in  durance  at  the  Eastern  State  Peniten- 
tiary of  Pennsylvania,  and  in  the  different  State  Asylums. — H.] 

As  ignorance  of  the  law  is  not  allowed  to  be  an  excuse  for  its 
violation,  so  a  medical  man,  unless  acquainted  with  all  the  particu- 
lars above  mentioned,  may  easily  subject  himself  to  a  prosecution 
or  a  civil  action ;  and  he  is  not  likely  to  be  spared  the  disgrace  and 
mortification  attendant  upon  either,  should  it  happen  that  the  case 
is  of  a  doubtful  nature.  The  law  expressly  requires  from  each 
medical  man  a  separate  visit,  a  separate  personal  examination  of  the 
alleged  lunatic,  and  a  separate  medical  certificate,  setting  forth  the 
special  fact  or  facts  (whether  observed  by  himself  or  derived  from 
the  information  of  others)  upon  which  his  opinion  is  based.  L>r. 
Conolly  has  shown  that  there  are  objections  to  the  severity  of  the 
restrictions  regarding  the  certificates.  ("Journal  of  Medical  Sci- 
ence,1' April,  1861,  p.  127),  but  some  recent  cases  have  proved  that 
they  are  not  even  strong  enough  to  prevent  sane  persons  from  being 
wrongfully  sent  as  lunatics  to  asylums. 

Specification  of  Facts. — It  will  be  observed  that  every  medical 
practitioner  signing  a  certificate  of  insanity  is  required  to  specify 
the  facts  upon  which  his  opinion  is  formed,  and  whether  such  facts  are 
derived  from  Jus  own  observation  or  from  the  information  of  any 
other  person.  Medical  practitioners  have  had  some  difficulty  in 
performing  this  duty,  i.  e.  in  assigning  the  fact  or  facts  upon  which 
their  judgment  of  the  insanity  of  a  person  is  based.  ("Med.  Gaz.," 
vol.  36,  p.  1131;  and  vol.  37,  p.  485.)  What  will  constitute  the  de- 
scription of  a  fact  to  render  a  certificate  valid  ?  This  important 
question  was  raised  and  decided  in  the  case  of  Shuttleworth  (Queen's 
Bench,  Nov.  17,  1817).  An  application  was  made  for  the  discharge 
of  a  lunatic  on  the  ground  that  the  medical  certificates  did  not  set 
forth  the  facts  from  which  the  opinion  of  those  who  signed  them 
was  derived.  In  one  it  was  stated  that  the  lunatic  labored  under  a 
variety  of  delusions,  and  that  she  was  dirty  and  indecent  in  the  extreme; 
in  the  other  the  certifier  stated  that  he  had  formed  his  opinion  from 
the  conversation  which  he  had  that  day  had  with  her.  It  was  con- 
tended that  the  statement  in  the  first  certificate  was  not  so  much  a 
fact  as  a  conclusion  drawn  from  other  facts,  which  ought  to  have 
been  mentioned  in  the  certificate  itself.  Lord  Denman,  in  giving 
the  judgment  of  the  court,  held  that  the  certificates  were  valid — 
that  it  was  not  necessary  to  have  all  the  delusions  of  an  insane  per- 


PROOFS    OF    INSANITY.  655 

son  stated  in  the  certificate.  The  statement  that  the  lunatic  was 
dirty  and  indecent  in  the  extreme  was  prima  facie  sufficient  to  justify 
the  imputation  of  insanity,  even  if  the  certificate  did  not  state  that 
the  patient  labored  under  a  variety  of  delusions:  the  allegation  that 
the  opinion  respecting  insanity  was  founded  upon  a  conversation 
with  the  alleged  lunatic  was  also  sufficient  to  render  the  certificate 
valid.  ("Med.  Gaz.,"  vol.  38,  p.  932;  also  "Law  Times,"  Nov.  21, 
1846,  p.  145.)  Hence  it  follows  that  a  general  statement  of  the  cir- 
cumstances which  have  led  to  the  belief  in  the  insanity  of  a  person, 
will  be  a  sufficient  compliance  with  the  requirements  of  the  statute 
to  render  a  certificate  valid,  provided  the  examination  has  been  made 
bond  fide  and  with  due  care  and  attention. 

Dr.  Millar  has  shown  how  little  the  words  "Facts  indicating  insa- 
nity observed  by  myself,"  are  appreciated  or  even  understood  by 
many  medical  men,  who  are  legally  empowered  as  registered  mem- 
bers of  the  profession  to  sign  these  certificates.  The  facts  are  fre- 
quently stated  in  a  loose  and  careless  manner,  showing  a  complete 
misapprehension  of  their  meaning.  What  is  really  required  by  the 
law  is  a  statement  of  facts  observed  or  witnessed  by  the  medical 
man  himself,  which  would  carry  conviction  to  the  mind  of  any  non- 
professional man  reading  it,  that  the  person  to  whom  it  referred  was 
of  unsound  mind.  A  medical  man  should  in  all  cases  avoid  giving 
as  a  fact  indicating  insanity,  any  delusion  which  might  in  reality 
have  some  foundation  in  truth.  With  respect  to  the  second  require- 
ment of  the  statute — namely,  "  Other  facts  (if  any)  indicating  insanity 
communicated  by  others" — it  may  be  observed  that,  although  these 
do  not  supersede  the  facts  observed  by  the  medical  man  himself,  they 
are  of  great  importance  in  throwing  light  upon  the  propensities  or 
habits  of  the  patient,  and  thus  serve  as  a  guide  for  treatment.  (Op. 
cit.,  p.  79.)  A  medical  man  must  take  care  to  draw  a  clear  distinc- 
tion between  the  facts  observed  by  himself  and  the  facts  communi- 
cated to  him  by  others,  and  avoid  such  vague  expressions  as  that  he 
"thinks"  and  "believes,"  &c. 

As  every  medical  certificate,  although  accepted  by  the  Commis 
sioners  of  Lunacy,  may  become  at  a  future  time  a  subject  of  close 
and  hostile  criticism  in  court,  a  medical  practitioner  should  be  fully 
prepared  to  justify  the  use  of  the  terms  which  he  has  employed,  it 
is  therefore  desirable  that  he  should  studiously  avoid  any  misstate- 
ment or  exaggeration  of  the  symptoms.  One  of  the  facts  cited  as 
indicative  of  insanity  in  an  old  lady  was,  that  she  kept  a  cockatoo ! 
In  the  case  of  Uavies,  the  tea-dealer,  Lord  Brougham,  then  a  counsel 
at  the  bar  retained  to  oppose  the  commission  against  the  alleged 
lunatic,  elicited  from  one  of  the  witnesses,  as  a  fact  upon  which  he 
relied  to  indicate  insanity — that  when  asked  the  question,  Mr.  Davies 
did  not  know  how  much  change  he  had  in  his  pocket !  Another 
relied  upon  the  fact  as  indicative  of  weak  mind,  that  the  alleged 
lunatic  had  said  he  preferred  seeing  the  people  come  from  Epsom 
races  rather  than  the  racing  on  the  course!  Vague  and  trivial  facts 
which  do  not  indicate  insanity,  naturally  tend  to  produce  a  feeling 
in  the  minds  of  the  jury  the  very  reverse  of  that  for  which  they  are 


656  MEDICAL    RESPONSIBILITY. 

brought  forward.  Tims  in  this  case,  although  there  could  be  no 
doubt,  from  what  subsequently  occurred,  that  Mr.  Davies  was  a 
lunatic  and  a  fit  and  proper  person  to  be  placed  under  restraint,  yet 
the  eloquence  of  Lord  Brougham,  and  the  result  of  a  skilful  cross- 
examination  in  bringing  into  prominence  the  weakness  of  the  facts 
on  which  the  witnesses  relied  to  establish  insanity,  had  such  an 
influence  with  the  jury  that  they  returned  a  verdict  in  favor  of  the 
lunatic,  and  for  a  time  he  was  considered  as  the  unhappy  victim  of 
an  unjust  persecution  on  the  part  of  his  mother  and  other  relatives. 
In  a  case  referred  to  by  Dr.  Bucknill,  one  of  the  medical  men  certi- 
fying to  the  insanity  of  a  gentleman,  who  was  at  that  time  undoubt- 
edly insane,  had  stated  as  facts  observed  I"/  himself,  that  "his  (the 
patient's)  habits  were  intemperate,  and  that  he  had  squandered  his 
property  in  mining  speculations."  But  on  cross-examination  in  the 
Queen's  Bench,  he  was  obliged  to  confess  that  the  only  act  of  intem- 
perance he  had  actually  observed  was  the  patient's  drinking  one 
glass  of  beer,  and  that  the  squandering  of  property  was  the  loss  of 
what  was  to  him  a  mere  trifle  in  a  mining  speculation,  which  even- 
tually turned  out  to  be  a  very  good  one.  (Millar's  "Hints  on  Insa- 
nity," 1861,  p.  187.)  Counsel  properly  hold  a  medical  practitioner 
strictly  to  the  common  and  accepted  meaning  of  the  words  which 
he  uses. 

No  professional  man  is  compelled  to  take  upon  himself  the  respon- 
sible duty  of  signing  certificates  of  insanity ;  but  if  he  does  under- 
take it,  he  must  perform  it  with  reasonable  care  and  ordinary  skill. 
If  he  certifies  that  a  person  is  laboring  under  delusions,  he  must 
take  care  that  he  understands  the  meaning  of  the  term  and  what  are 
the  delusions ;  and  admitting  that  he  is  correct  in  believing  from  his 
own  observation  that  they  exist  in  the  mind  of  the  patient,  it  must  1  >e 
remembered  that,  in  order  to  justify  restraint  or  imprisonment  in 
an  asylum,  the  law  looks  always  to  the  influence  of  these  delusions 
upon  conduct. 

In  reference  to  the  important  question  of  medical  responsibility, 
the  following  observations  were  made  by  the  learned  judge  in  the 
case  of  Hall  v.  Semple  (Q.  B.  Dec.  1862):  "  The  true  ground  of  com- 
plaint is  the  negligence  of  the  defendant  and  the  want  of  due  care  in 
the  discharge  of  the  duty  thrown  upon  him :  and  I  think  that  if  a 
person  assumes  the  duty  of  a  medical  man  under  this  statute,  and 
signs  a  certificate  of  insanity  which  is  untrue,  Avithout  making  the 
proper  examination  or  inquiries  which  the  circumstances  of  the  case 
would  require  from  a  medical  man  using  proper  care  and  skill  in 
such  a  matter — if  he  states  that  which  is  untrue,  and  damage  ensues 
to  the  party  thereby,  he  is  liable  to  an  action,  and  it  is  to  that  I  de- 
sire to  direct  your  particular  attention.  In  point  of  law,  if  a  medical 
man  assumes  under  this  statute  the  duty  of  signing  a  certifi< 
wit  liout  making  due  and  proper  examination  which  a  medical  man 
under  such  circumstances  ought  to  make,  not  in  the  exercise  of  the 
extremest  possible  care,  but  in  the  exercise  of  ordinary  care,  so 
that  he  is  guilty  of  culpable  negligence  ami  damage  ensue,  then  an 
action  will  lie  against  him,  although  there  may  have  been  no  impro- 


DISCHARGE    OF    LUNATICS.  657 

per  motive,  and  the  certificate  may  not  be  false  to  his  knowledge." 
In  this  case  the  jury  found  a  verdict  for  the  plaintiff — that  the  certi- 
ficate was  untrue  in  effect,  and  that  it  had  been  signed  without  proper 
examination  and  inquiries,  and  without  probable  cause. 

Discharge  of  Lunatics. — In  forming  an  opinion  relative  to  the 
propriety  of  discharging  a  person  who  has  once  been  confined  as  a 
lunatic  in  an  asylum,  it  is  proper  to  examine  the  particulars  of  his 
case  with  the  same  caution  as  if  the  object  were  to  confine  him  for 
the  first  time.  The  question  of  liberation  is  commonly  restricted, 
like  that  of  restraint,  to  cases  of  mania  and  monomania.  It  may  so 
happen  that  the  person  has  a  lucid  interval  at  the  time  of  examina- 
tion, in  which  case  it  will  be  necessary  to  make  more  than  one  visit. 
One  who  has  been  guilty  of  a  heinous  crime  like  murder  should 
never,  on  any  pretence,  be  discharged.  There  are  often  long  lucid 
intervals  in  homicidal  mania,  and  it  is  impossible  to  be  certain  that 
the  disease  is  entirely  removed.  If  the  person  has  manifested  the 
least  disposition  to  suicide,  we  should  be  extremely  cautious  in  libe- 
rating him ;  for  suicidal  mania  is  often  artfully  concealed  under  a 
cheerful  exterior.  We  cannot  always  test  the  propriety  of  granting 
liberation  by  the  lightness  of  the  offence  for  which  a  criminal  luna- 
tic has  been  confined.  The  circumstances  under  which  the  most 
trifling  offence  has  been  committed  may  show  that  the  mind  is 
wholly  unsettled  with  regard  to  moral  responsibility ;  and  such 
lunatics  can  never  be  trusted,  even  when  there  is  a  great  improve- 
ment in  their  language  and  deportment. 

The  16th  and  17th  of  Victoria,  c.  97,  has  placed  certain  restrictions 
on  the  power  of  liberating  lunatics.  Under  ss.  83  and  81,  the  person 
originally  signing  the  order  which  is  required  in  addition  to  the 
medical  certificates,  may  write  an  order  for  the  discharge  or  removal ; 
but  under  s.  84  this  order  is  of  no  effect,  if  a  medical  practitioner 
certify  that  in  his  opinion  such  patient  is  dangerous  and  unfit  to  be 
at  large,  together  with  the  grounds  on  which  his  opinion  is  founded, 
unless  the  commissioners  or  visitor  shall,  after  the  production  of 
such  certificate  give  their  consent  in  writing  for  the  removal  or  dis- 
charge of  such  patient.  Under  other  clauses,  additional  powers  of 
discharge  are  given  to  the  commissioners  and  visitors,  subject  to  such 
restrictions  as  to  leave  the  control  for  the  most  part  in  the  hands  of 
professional  men.  These  powers  of  discharge  do  not,  however,  apply 
either  to  criminal  lunatics  or  to  those  found  insane  under  a  commis- 
sion issued  by  the  Lord  Chancellor. 


42 


658  COMMISSIONS    OF    LUNACY. 


CHAPTEE   LXI. 

Interdiction.  —  commissions  of  lunacy.  —  examination  of  al- 
leged LUNATICS. — MEDICAL  AND  LEGAL  TESTS  OF  COMPETENCY. — 
CONFLICT  OF  EVIDENCE  AND  OPINION. 

Interdiction.- — By  interdiction  we  are  to  understand  the  depriving 
of  a  person  laboring  under  mental  disorder  of  his  civil  rights ;  in 
other  words,  preventing  him  from  exercising  any  control  or  manage- 
ment over  his  affairs.  It  may  be  with  or  without  restraint,  for  one 
condition  does  not  necessarily  imply  the  other,  although  there  is  a 
popular  idea  to  the  contrary.  In  Re  Smith  (June,  1862)  an  order  for 
a  jury  was  issued  to  try  the  question  of  sanity  or  insanity,  and  in 
affirming  the  order,  Lord  Justice  Knight  Bruce  made  the  following- 
statement:  "It  is  desirable  to  remove  the  idea,  but  too  generally 
entertained  by  persons  (common  persons)  in  different  stations  of  life, 
that  the  finding  by  a  jury  that  a  person  is  of  unsound  mind  necessa- 
rily involves  an  interference  witli  his  personal  freedom  :  it  does  not. 
The  court  places  no  further  restraint  upon  a  lunatic  than  is  necessary 
for  his  protection,  and  I  would  refer  to  the  fact  that  there  are  several 
lunatics  living  under  the  protection  of  the  court  who  reside  in  their 
own  houses  with  large  establishments." 

When  a  person,  from  mental  incompetency,  is  liable  to  be  imposed 
upon  by  others,  or  is  guilty  of  foolish  and  extravagant  acts,  whereby 
his  property  is  damaged,  a  Commission  is  commonly  granted  by  the 
Court  of  Chancery,  in  order  to  determine  whether  he  be  "compos"  or 
unon  compos  mentis."  This  writ  is  well  known  under  the  name  of 
"  de  lunatico  inquirendo."  Before  it  can  be  issued  it  is  necessary,  among 
other  matters,  that  there  should  be  affidavits  made  by  two  or  three 
physicians  or  surgeons,  certifying  to  the  insanity  of  the  party.  It 
has  been  already  explained  that  the  object  of  the  Commission  is  to 
determine  whether  the  incapacity  to  manage  affairs  is  owing  to  some 
mental  defect  or  disorder,  and  not  merely  to  want  of  education  or 
bodily  infirmity — otherwise  all  wealthy  minors  and  infirm  persons 
might  be  improperly  deprived  of  the  control  of  their  property. 
Formerly  Commissions  were  not  issued  unless  it  was  evident  that 
lunac}^  or  idiocy  existed — for  weakness  of  mind  or  imbecilit}*  was 
not  considered  sufficient  to  justify  legal  interference.  This  is  no  longer 
the  case,  "unsoundness  of  mind  with  incompetency"  being  all  that 
the  law  requires  to  be  established.  Thus,  then,  whether  the  case  be 
one  of  mania,  monomania,  or  dementia  is  not  now  the  question,  but 
whether  the  party  be  compos  or  non  compos  mutt  is:  if  the  latter, 
whether  it  be  to  a  degree  to  prevent  him  from 'controlling  his  pro- 
perty with  careful  and  provident  management.  There  was  a  strange 
contradiction  in  our  system  of  jurisprudence  some  years  ago.     A 


COMMISSIONS    OF    LUNACY.  (359 

person  who  had  a  delusion  on  a  particular  subject,  although  not  af- 
fecting his  social  duties,  was  deemed  a  fit  subject  for  a  Commission, 
and  deprived  of  his  civil  rights  merely  because  his  mental  disorder 
would  fall  under  the  definition  of  lunacy.  On  the  other  hand,  one 
who  had  no  delusion,  but  great  mental  weakness,  such  as  to  inca- 
pacitate him  from  properly  managing  his  affairs,  was  not  deemed  a 
fit  subject  for  a  Commission;  since  weakness  of  mind  and  insanity 
were  considered  to  be  two  entirely  different  states — the  latter  alone 
requiring  interference,  although  the  injurious  results  were  the  same 
in  both  cases. 

It  is  unfortunate  that  these  Commissions  have  been  usually  con- 
ducted on  so  expensive  a  scale  as  to  render  them  applicable  onlv  to 
the  wealthy  classes  of  society  :  and  even  here  the  expenses  attending 
such  a  simple  inquiry  as  that  for  which  the  Commission  is  issued, 
have  been  often  of  the  most  ruinous  kind,  and  the  results  by  no  means 
satisfactory.  The  Lord  Chancellor  has  it  now  in  his  power  to  direct 
an  inquiry  to  be  made  before  one  or  two  commissioners,  in  which  case 
a  jury  is  dispensed  with.  Evidence  may  then  be  received,  and  the 
decision  left  with  the  commissioner  or  commissioners  so  appointed. 
The  costs  of  an  inquiry  by  this  regulation  are  greatly  reduced ;  but 
even  under  the  amended  law  no  Commission  of  Lunacy  can  be  had 
at  a  less  expense  than  .£60,  and  this  only  in  uncontested  cases.  This 
form  of  proceeding  is  now  adopted  in  the  greater  number  of  cases,  so 
that  out  of  575  commissions  in  ten1  years  only  21  were  before  juries. 
The  Lunacy  Regulation  Acts  are  the  16th  &  17th  Vict.  c.  70  (1853), 
and  the  25th  &  26th  Vict.  c.  86  (August,  1862).  The  last-mentioned 
Act  has  greatly  improved  proceedings  in  lunacy,  and  has  removed 
much  of  the  injustice  which  formerly  prevailed.  In  order  to  shorten 
these  inquiries  and  lessen  the  expenses,  the  order  under  s.  3  is  to  be 
confined  to  the  question  whether  or  not  the  person  is  "  at  the  time 
of  unsound  mind  and  incapable  of  managing  himself  and  his  affairs." 
No  evidence  on  his  conduct  is  to  be  received  as  a  proof  of  insanity 
unless  it  refers  to  a  period  within  two  years  of  the  date  of  the  in- 
quiry. In  cases  of  contested  imbecility,  this  provision  might  ex- 
clude important  evidence,  but  there  is  a  discretionary  power  in  the 
judge  to  admit  it.  Section  4-  allows  of  the  case  being  tried  by  a  jury 
at  common  law.  The  alleged  lunatic  is  to  be  examined  before  the 
taking  of  the  evidence,  and  at  the  close  of  the  proceedings  before  the 
jury  consult  on  their  verdict.  Under  s.  12  power  is  given  to  the 
Chancellor  to  dispense  with  commissions  in  reference  to  persons  who 
have  but  small  property,  and  there  are  in  this  statute  other  strict 
rules  regarding  the  visiting  of  lunatics  confined  in  asylums. 

One  source  of  difficulty  on  these  occasions  is,  that  medical  wit- 
nesses are  allowed  to  be  separately  sought  out  and  summoned  by 
those  who  are  for  and  against  the  commission,  and  the  opinions 
given  by  them  often  exactly  neutralize  each  other.  Under  these 
circumstances  they  are  converted  into  partisans  in  the  cause  as  much 
as  if  they  were  counsel.  It  has  been  well  remarked,  that  a  man 
even  unknown  to  himself,  with  the  purest  intentions  and  the  most 
perfect  rectitude,  will  insensibly  lean  to  the  side  on  which  he  has 
been  consulted  or  employed.     (Pagan,  p.  301.)     The  public  are  apt 


680  MEDICAL    EVIDENCE. 

to  infer  from  such  conflicting  opinions  emanating  from  men  of  equal 
experience,  that  the  difference  cannot  depend  essentially  on  the  med- 
ical facts  of  a  case,  and  that  the  question  might  as  well  or  even  bet- 
ter be  determined  by  non-professional  persons.  See  the  case  of 
Mrs.  Gumming  ("Journal  of  Psychological  Medicine"  for  April 
1852),  in  which  the  conflict  of  medical  testimony  was  even  greater 
than  usual.  A  large  portion  of  this  lady's  property  was  spent  in 
determining  by  a  verdict  that  she  was  insane ;  and  there  was  an  in- 
tention that  the  remainder  should  be  expended  in  reversing  the  de- 
cision, when  the  unfortunate  lady  died! 

One  remedy  for  this  serious  evil  would  be,  that  medical  experts 
on  such  occasions  should  be  selected  and  appointed  by  the  Lord 
Chancellor,  to  examine  an  alleged  lunatic  and  give  evidence  on  his 
condition ;  they  should  be  in  all  cases  made  perfectly  independent 
of  both  parties.  At  present  they  rather  occupy  the  position  of  medi- 
cal counsel  than  medical  witnesses,  for  it  is  quite  clear  that  no  one 
would  be  summoned  whose  views  did  not  coincide  with  those  of  the 
party  summoning  him;  and  it  is  an  opinion  among  some  solicitors 
— for  which,  unfortunately,  there  is  apparent  reason — that  medical 
evidence  on  these  occasions  is  a  marketable  commodity,  and  may  be 
purchased  at  graduated  prices!  There  are  some  medical  men  who 
appear  to  think  that  on  these  occasions  they  are  justified  in  sinking 
the  witness  in  the  advocate,  and  that  they  are  bound  by  a  sort  of 
duty  to  make  the  best  of  the  case  for  the  person  who  retains  them: 
but  this  is  a  mistaken  view  of  their  position.  An  advocate  is  not 
bound  by  an  oath  to  state  "the  truth,  the  whole  truth,  and  nothing 
but  the  truth;"  but  a  scientific  witness  is  placed  under  this  sacred 
obligation,  and  it  is  a  duty  which  he  owes  to  his  profession  and  to 
society  that  he  should  lay  aside  all  personal  bias.  It  may  appear 
an  innocent  matter  to  suppress  some  facts  and  to  exaggerate  the  im- 
portance of  others,  in  order  to  induce  a  jury  to  pronounce  one  whose 
mental  soundness  is  in  question  to  be  perfectly  sane  and  competent : 
but  the  same  mercenary  zeal  which  would  thus  lead  to  the  civil  free- 
dom of  an  insane  person,  might  on  another  occasion  be  employed  in 
unjustly  depriving  a  sane  person  of  his  liberty.  The  confidence  of 
the  public  in  medical  opinions  in  reference  to  the  insane  has  been 
by  recent  events  already  much  shaken;  and  it  would  be  altogether 
destroyed,  and  such  opinions  entirely  dispensed  with,  if  it  were  once 
known  that  a  medical  man  on  these  occasions  accepted  a  retaining 
fee  not  to  speak  the  whole  truth  but,  rightly  or  wrongly,  to  give  his 
evidence  in  favor  of  the  party  who  consulted  him.  Whatever  may 
be  the  difficulties  of  the  case,  experienced  solicitors  know  that  if 
they  only  search  far  enough  they  will  generally  fall  upon  some  medi- 
cal men  who  will  adopt  their  views.  (The  reader  will  find  some  re- 
marks on  this  subject  in  the  "Medical  Gazette,"  vol.  5,  p.  719;  vol. 
11,  p.  710;  and  vol.  17,  p.  816). 

Examination  of  Alleged  Lunatics. — To  determine  whether  a  person 
is  or  is  not  a  fit  subject  for  interdiction  or  deprivation  of  civil  rights, 
it  is  necessary  to  bear  in  mind  that  it  is  not  enough  to  show  there  is 
delusion,  as  in  the  lighter  cases  of  monomania;  but  we  are  bound  to 
ascertain  how  far  the  delusion  affects  the  judgment  of  the  person,  so 


EXAMINATION    OF    LUNATICS.  661 

as  to  prevent  him,  like  other  men.  from  managing  his  affairs  with 
provident  care  and  propriety.  In  many  instances,  however,  some 
proof  of  delusion  only  is  sought  for:  and  if  this  be  procured,  it  is 
hastily  inferred  that  the  person  must  be  entirely  incompetent  to 
manage  his  property.  The  most  difficult  cases  are  those  which  in- 
volve questions  of  imbecility.     In  conducting  the  defence  of  the 

Windham  case  (Dec.  1861),  Sir  Hugh  Cairns  was  allowed  by  his 
medical  adviser  to  make  the  following  strange  statement:  "In  a  case 
of  insanity  accompanied  by  delusions,  the  mode  of  investigating  it 
so  as  to  arrive  at  the  truth  is  a  matter  of  great  difficulty  and  doubt: 
but  in  a  case  of  imbecility,  where  there  is  either  no  mind  at  all  or 
next  to  none,  the  task  of  coming  to  a  right  and  just  decision  is  com- 
paratively easy."  Such  a  statement  is  the  reverse  of  the  truth,  and 
must  have  been  made  under  some  hazy  notion  that  the  state  of  im- 
becility was  identical  with  that  of  idiocy.  One  of  his  own  witnesses 
(Dr.  Sutherland),  in  a  subsequent  stage  of  the  proceedings,  corrected 
this  error,  by  the  admission  in  cross-examination,  that  "drawing  the 
line  between  soundness  and  unsoundness  of  mind  in  cases  of  imbe- 
cility, is  one  of  the  most  difficult  questions  of  medical  science." 

In  conducting  the  examination  of  an  alleged  lunatic,  we  should 
compare  his  mind  as  it  is  with  what  it  is  proved  to  have  been;  and 
if  it  be  a  base  of  supposed  imbecility,  a  proper  regard  must  be  had 
to  age,  society,  education,  and  general  conduct.  "We  should  also 
consider  whether  the  person  has  been  treated  by  his  friends  and  re- 
lations as  a  lunatic  or  imbecile  prior  to  the  issuing  of  the  commis- 
sion. A  young  person  whose  education  has  been  much  neglected, 
and  who  has  never  been  intrusted  with  the  care  of  money,  cannot 
be  expected  to  have  much  knowledge  of  the  method  of  managing  a 
large  property.  Questions  are  sometimes  put  on  the  moral  respon- 
sibility of  man  and  the  attributes  of  God,  to  one  who,  perhaps,  never 
heard  of  ethics  or  metaphysics.  Again,  mathematical  and  arith- 
metical questions,  which  would"  embarrass  many  persons  who  are 
set  down  as  sane  and  competent,  are  sometimes  put  in  cases  of 
alleged  imbecility.  In  one  instance  a  physician  gave  evidence  on 
a  commission  that  he  found  the  alleged  imbecile  could  not  work 
the  first  proposition  in  Euclid,  but  this  person  admitted  that  he  had 
always  disliked  mathematics.  In  a  case  which  occurred  in  Scot- 
land, one  examiner  asked  the  alleged  imbecile,  who  said  he  had 
1,200Z.  in  the  Bank,  and  received  201.  for  interest — How  much  was 
that  per  cent.?  He  said  he  could  not  tell;  he  was  no  good  hand  at 
arithmetic.  The  counsel  who  appeared  against  the  brieve  or  com- 
mission afterwards  put  the  same  arithmetical  question  to  one  of  the 
medical  witnesses  who  had  deposed  to  the  imbecility  of  the  party; 
and  this  witness,  an  educated  man,  confessed  himself  quite  unable  to 
answer  it — a  practical  illustration  of  the  impropriety  of  pronounc- 
ing a  person  to  be  imbecile  or  incompetent  merely  because  he  is 
ignorant  of  that  which  he  has  never  been  taught!     (Case  of  David 

Toohw)  If  the  capacity  to  manage  affairs  rested  solely  upon  a 
knowledge  of  arithmetic,  many  now  go  free  who  ought  to  be  imme- 
diately placed  under  interdiction.  This  is  rather  a  commercial  test 
of  insanity:  but  it  will  be  found  that  it  has  been  applied  in  a  very 


6(32  TESTS    OF    CAPACITY. 

improper  manner  to  determine  the  capacity  of  young  and  ill-edu- 
cated women.  Unless  the  questions  are  confined  to  those  subjects 
which  the  person  has  had  either  the  opportunity  or  inclination  to 
learn,  a  medical  witness  will  always  incur  the  risk  of  confounding 
mere  ignorance  with  imbecility. 

One  of  the  best  tests  of  mental  capacity  will  be  found  in  deter- 
mining the  degree  to  which,  with  ordinary  opportunities,  a  person 
has  shown  himself  capable  of  being  instructed  ;  but  too  high  a 
standard  must  not  be  assumed  as  a  test  of  capacity.  The  mind  of 
an  alleged  imbecile  should  not  be  compared  with  the  most  perfect 
mind,  but  with  that  of  another  person  of  average  capacity,  of  the 
same  age  and  station  in  society,  and  who  has  enjoyed  like  opportu- 
nities of  instruction.  It  would  be  difficult  to  find  two  sane  persons 
who  were  exactly  equal  in  mental  power :  in  some,  one  faculty  is 
prominently  developed,  in  others  another.  All  that  we  have  to  look 
for  in  these  cases  of  alleged  unsoundness  is  an  average  degree  of 
intellectual  development  so  as  to  qualify  the  person  for  performing 
tlic  duties  of  his  station.  To  win  the  confidence  of  an  alleged  luna- 
tic for  the  purpose  of  examination,  we  should  not  treat  his  observa- 
tions or  delusions  with  levity,  but  rather  seriously  sympathize  with 
him  in  his  troubles  ;  we  should  listen  attentively  to  all  he  has  to  say, 
for  his  suspicions  will  be  excited  by  many  questions  being  put  to 
him.  If  we  cannot  agree  with  his  conclusions,  we  should  not  con- 
tradict him  abruptly,  but  endeavor  to  draw  him  out  by  asking  for 
some  corroborative  evidence  of  his  statements.  Dr.  Millar  has 
properly  advised  that,  before  visiting  the  patient,  we  should  make 
ourselves  thoroughly  acquainted  with  every  particular  connected 
with  his  history  and  condition,  and  treat  him  as  much  like  a  sane 
person  as  possible.  The  insane  are  exceedingly  suspicious,  and 
quick  to  detect  any  deceit  practised  on  them.  They  are  also  jealous 
of  the  intrusion  of  strangers,  and,  unless  great  tact  is  employed,  will 
look  upon  a  medical  man  as  an  enemy.  ("  Hints  on  Insanity,"  p. 
58.)  The  patient  should  be  informed  that  his  perceptions  are  merely 
the  result  of  natural  disease ;  it  is  useless  to  tell  him  that  he  is  under 
a  delusion  when  his  perceptions,  although  sometimes  exaggerated, 
are  too  real  to  be  doubted.     (Op.  cit.  p.  36.) 

The  conflicting  medical  evidence  given  on  Commissions  of  Lunacy 
is  in  great  part  to  be  ascribed  to  the  fact,  that  the  whole  of  the  mind 
of  the  person  is  not  fairly  examined.  One  physician  tests  one  fac- 
ulty, another,  another ;  each  has  his  own  theory  of  insanity,  and 
each  his  standard  of  competency.  The  witnesses  in  support  of  the 
commission  do  not  go  so  much  to  test  the  actual  state  of  mind  of 
the  person,  as  to  discover  what  they  deem  proofs  of  insanity :  those 
against  the  commission  take  an  opposite  course — they  look  only  for 
some  proofs  of  soundness.  It  cannot  therefore  happen  otherwise 
than  that  different  conclusions  should  be  drawn  under  such  different 
modes  of  investigation.  There  is  another  point  which  requires  at- 
tention in  these  cases.  Persons  laboring  under  a  slight  degree  of 
imbecility  are  very  soon  irritated;  they  are  easily  persuaded  that 
they  are  ill  used  and  persecuted;  and  when  they  happen  to  be  ques- 
tioned by  parties  who  are  represented  as  their  enemies,  they  lose 


CASES    OF    IMBECILITY.  663 

their  self-command,  and  are  no  longer  able  to  answer  questions, 
which  under  their  ordinary  state  of  mind  they  would  reply  to  with 
perfect  accuracy.     (Pagan,  op.  cit.  p.  302.) 

A  defective  memory  must  not  be  hastily  set  down  as  a  proof  of 
legal  unsoundness.  This  is  more  or  less  the  natural  result  of  age. 
A  man  may  not  have  a  good  memory,  and  yet  have  a  mind  sound 
enough  for  the  management  of  his  affairs.  A  defective  memory  in 
an  aged  person,  taken  alone,  proves  nothing.  (See  "  Ann.  d'Hyg." 
1836,  vol.  1,  p.  192.) 

A  medical  witness  must  not  allow  himself  to  be  embarrassed  by 
medical  or  legal  definitions  of  insanity.  The  malady  may  not  as- 
sume the  form  of  lunacy  or  idiocy,  in  a  strictly  legal  view — nor  of 
mania,  monomania,  dementia,  or  idiocy,  in  a  strictly  medical  view ; 
but  still  it  may  be  a  case  of  such  mental  disorder  as  to  create  an  inca- 
pacity/or managing  affairs.  This  is  the  point  to  which  a  medical 
examiner  has  to  direct  his  attention.  Cases  of  imbecility  present 
the  greatest  difficulty,  and  create  the  greatest  conflict  of  opinion 
among  medical  witnesses.  Imbecility  strictly  implies  a  weak  or 
feeble  mind,  and  the  term  is  properly  applied  to  one  who  has  an 
intellect  below  par  or  below  the  normal  average.  The  vagueness 
of  these  terms  shows  how  difficult  it  is  to  draw  a  clear  distinction 
between  legal  sanity  and  that  degree  of  mental  weakness  implied  by 
imbecility  which  would  justify  interdiction.  Insanity  in  the  common 
acceptation  of  the  term  cannot  be  proved  in  these  cases :  there  will 
be  no  evidence  of  delusion,  and  there  may  be  such  an  amount  of 
self-control  as  to  enable  a  person  to  maintain  a  conversation.  Mem- 
ory, judgment,  and  other  faculties,  although  weak,  are  still  present 
in  a  greater  or  less  degree ;  and  from  one  or  two  interviews  only, 
an  examiner  might  be  disposed  to  pronounce  the  person  of  sound 
mind  and  competent  to  manage  his  own  affairs.  There  is  a  wide 
field  for  argument  here ;  for  it  may  be  said  with  some  truth  in  a  de- 
fence, "that  the  doctors  cannot  put  their  fingers  on  a  single  point 
indicative  of  insanity."  In  short,  each  fact  specified  by  them  may 
be  frittered  away  by  the  remark  that  every  one  must  have  known 
some  person  who  had  either  a  bad  memory  or  a  weak  judgment ; 
who  squandered  money,  who  wasted  it  on  unworthy  objects,  who 
hoarded  it  and  refused  to  pay  just  debts,  or  who  lost  it  in  foolish 
speculations,  &c.  All  this  may  be  true,  and  yet  the  person  in  ques- 
tion may  be  legally  of  unsound  mind  and  properly  interdicted.  As 
Dr.  Pagan  justly  remarks,  there  is  a  facility  of  disposition  in  an 
imbecile  or  weak-minded  person,  which  lays  him  open  to  be  imposed 
upon  by  the  artful  and  designing :  and  our  conclusion  regarding  his 
competency  must  therefore  be  the  result  of  a  just  appreciation  of 
his  general  knowledge  of  affairs,  derived  from  an  examination  of  all 
his  faculties.  We  have  to  consider  how  far  his  imperfect  mind  would 
prevent  him  from  attending  to  his  own  interests,  not  in  a  manner 
which  would  insure  their  most  profitable  application,  but  in  such  a 
way  as  would  prevent  his  affairs  from  being  involved  in  ruin.  His 
knowledge  and  understanding  maybe  so  imperfect  that  his  property 
would  necessarily  go  to  waste  under  his  unassisted  control.  When 
it  is  proved  that  there  has  been  habitual  submission  to  the  dictation 


664  TESTS    OF    CAPACITY. 

of  others,  either  from  a  long  habit  of  being  controlled,  from  indif- 
ference, or  fear — when  a  man  has  allowed  himself  to  be  disobeyed 
or  neglected  by  his  servants,  and  to  be  openly  cheated  by  tradesmen 
—these  circumstances  furnish  evidence  of  weakness  of  mind,  and  a 
justification  of  the  opinion  that  there  should  be  interdiction.  (Op. 
cit.  p.  203.)  On  the  other  hand,  if  a  person  when  left  to  himself  has 
managed  his  affairs  with  reasonable  care  and  propriety,  and  has  acted 
independently  of  others,  there  can  be  no  stronger  proof  of  his  legal 
competency.  [See  the  very  able  opinion  of  Patton,  P.  J.,  in 
McELmjs  case,  6  W.  &  S.  451.— P.] 

The  testamentary  capacity  of  imbeciles  may  be  tried  by  the  same 
rules.  A  man  who  is  of  such  an  easy  disposition  as  to  be  impro- 
perly influenced  in  the  use  of  his  property  while  living,  may  be 
equally  influenced  by  fear  or  control  to  make  an  improper  disposi- 
tion of  it  by  his  will ;  but  in  this  case  the  terms  of  the  will,  if  drawn 
up  by  himself,  will  allow  a  fair  judgment  to  be  formed  of  the  men- 
tal soundness  of  the  testator.  There  is  on  these  occasions  a  method 
of  testing  the  state  of  mind  which  has  been  suggested  by  Dr.  Conolly 
— namely,  by  inducing  the  patient  to  express  his  thoughts  in  writing, 
as  in  a  letter  addressed  either  to  his  physician  or  to  some  confidential 
friend.  This  plan  would  probably  often  succeed  in  developing  the 
existence  of  a  latent  delusion,  when  an  examination  would  wholly 
fail ;  the  patient  would  not  be  led  to  suspect  that  he  was  being  sub- 
jected to  an  examination  for  a  hostile  purpose.  The  current  of  his 
thoughts  would  be  uninfluenced  by  the  suspicion,  that  the  act  of 
writing  was  to  test  the  state  of  his  mind ;  and  as  no  man  can  long 
write  in  a  connected  manner  who  does  not  think  collectedly,  so  we 
may  expect  to  find  ample  evidence  whether  a  delusion  really  exists 
in  his  mind  or  not.  There  are  cases  recorded  in  which  the  evidence 
of  delusion  has  been  derived  from  the  terms  of  a  will  or  deed  writ- 
ten or  dictated  by  the  lunatic  himself,  when  there  was  great  difficult  v 
in  obtaining  proof  by  an  oral  examination. 

In  idiocy  there  is  no  capacity  for  writing.  In  dementia,  as  there 
is  no  memory,  it  commonly  happens  that  the  same  word  is  written 
over  and  over  again.  No  person  in  a  state  of  dementia  can  write  a 
connected  sentence,  because  before  the  last  part  of  the  sentence  is 
completed  the  first  is  entirely  forgotten.  In  imbecility  we  may  meet 
with  every  variety  of  mental  defect,  but  the  state  of  the  mind  is 
pretty  well  shown  by  the  expression  of  the  thoughts  in  writing. 
This  method,  it  must  be  remembered,  cannot  show  whether  or  not 
a  person  is  capable  of  managing  his  affairs :  it  is  a  mere  index  of  a 
certain  state  of  the  mind,  and  must  be  coupled  with  general  habits 
and  conduct,  before  any  conclusion  is  drawn  from  it  relative  to  the 
propriety  of  interdiction.  It  will  often  serve  to  detect  the  existence 
of  a  delusion  when  other  means  fail.  Dr.  Forbes  Winslow  attaches 
some  importance  to  handwriting  as  foreshadowing  the  occurrence  of 
general  paralysis  with  softening  of  the  brain.  This,  however,  refers 
not  so  much  to  composition  or  style  as  correct  writing  and  spelling. 
(Op.  cit.  p.  464.)  The  reader  Avill  find  a  complete  essay  on  the  wri  I 
of  the  insane,  and  the  medico-legal  conclusions  to  which  they  lead, 
by  Dr.  Marce,  in  the  "Ann.  D'Hyg.  Publique,"  1864,  vol.  1,  p.  379. 


THE    WINDHAM    CASE.  665 

When  a  verdict  of  insanity  is  returned  under  a  commission,  it  must 
always  represent  the  party  to  be  of  unsound  mind,  and  by  reason  of 
that  unsoundness  to  be  incompetent  to  manage  his  affairs.  A  date 
must  be  fixed  at  which  the  insanity  first  appeared,  and  this  date 
should  always  be  anterior  to  the  issuing  of  the  commission.  If 
there  be  lucid  intervals,  the  space  of  time  occupied  by  these  should 
also  be  defined. 

Among  cases  well  calculated  to  show  the  conflict  of  medical  evi- 
dence is  that  of  the  late  Mr.  W.  F.  Windham  (December,  1861). 
Fifteen  of  the  relatives  of  this  gentleman  petitioned  for  an  inquiry 
into  his  state  of  mind  on  the  ground  that  he  labored  under  congenital 
deficiency  of  intellect,  and  this  view  was  supported  by  strong  medi- 
cal opinions ;  on  the  other  side  it  was  alleged  that  the  mental  condi- 
tion of  Mr.  Windham,  if  below  the  normal  standard,  was  merely  the 
result  of  a  neglected  education.  The  inquiry  lasted  thirty-three 
days,  during  which  140  witnesses  were  examined — namely,  fifty  on 
the  part  of  the  petitioners,  and  ninety  in  favor  of  Mr.  Windham,  at 
a  cost  of  about  30,000?.  There  was  no  proof  of  the  want  of  the 
opportunity  of  education,  but  strong  reason  to  believe  that  the 
alleged  imbecile  had  not  made  use,  like  other  boys  of  his  age,  of 
the  advantages  which  he  had  enjoyed.  He  had  been  sent  to  Eton, 
but  had  derived  little  benefit  from  his  connection  with  that  great 
public  school.  It  seems  to  have  been  admitted  that  as  a  boy  he  was 
wholly  unlike  other  boys,  and  when  he  attained  his  majority,  in 
August,  1861,  his  conduct  was  extravagant,  wild,  and  wholly  in- 
consistent with  his  social  position.  At  the  same  time  he  was  not 
entirely  deficient  in  business  matters ;  for  it  was  proved  that  his 
uncle,  one  of  the  petitioners,  had  shortly  before  negotiated  with 
him  for  the  sale  of  a  piece  of  land  of  the  value  of  1000?.,  thereby 
admitting  his  capacity  to  transact  business.  The  evidence  received 
on  this  occasion  was-allowed  to  extend  to  the  whole  of  his  life,  and 
it  may  be  observed  that  in  cases  of  alleged  imbecility  it  is  not  pos- 
sible, without  doing  injustice,  to  prevent  the  reception  of  evidence 
from  a  long  date. 

The  result  of  this  inquiry  was  that  the  jury,  by  a  majority  of 
fifteen  to  eight,  returned  the  following  verdict — "That  Mr.  Wind- 
ham is  of  sound  mind  and  capable  of  taking  care  of  himself  and  his 
affairs."  After  the  verdict  had  been  returned  pronouncing  him  sane 
and  competent,  he  was  guilty  of  many  extravagant  acts,  exhausted 
a  splendid  fortune  and  became  a  bankrupt ;  showing  that,  whatever 
legal  soundness  of  mind  he  might  possess  in  the  opinion  of  two- 
thirds  of  the  jury,  he  practically  did  not  evince  that  capacity  which 
they  declared  him  to  possess  of  taking  care  of  himself  or  his  affairs  ! 

A  large  section  of  the  public  joined  in  the  view  prominently  put 
forward  at  the  inquiry  by  his  counsel,  Sir  Hugh  Cairns,  that  this 
unfortunate  young  man  had  been  made  the  victim  of  a  charge  the 
most  cruel,  unjust,  and  unjustifiable  1  Insanity,  it  was  urged,  in  the 
ordinary  acceptation  of  tin'  word,  did  not  exist  in  his  case.  There 
were  no  illusions,  hallucinations,  or  delusions;  but  as  these  are 
never  met  with  in  the  form  of  unsoundness  imputed  to  Mr.  Wind- 
ham, namely  imbecility,  their  absence  proved  nothing  for  or  against 


CONFLICTING    MEDICAL    OPINIO:-"-. 

the  existence  of  imbecHity  or  weakness  of  mind.     But  whal  - 

there  for  imbecility  except  conduct  and  conversation  ?     There 
no  incohereney  of  language,  but  there       -  -         _  evidence  of  h:       - 
such  as  we  do  not  meet  with  among  men  of  really  reasonable  minds : 
but  opinions  were  divided  on  the  question,  whether  these  indie 
of  mind,  or  a  mixture  of  eccentricity  and  moral 
pravity  from  deficient  education.     A  maj<  he  jury  took  the 

latter  view ;  and  Lord  Chelmsford,  in  commenting  upon  this  verdict 
in  the  House  of  Lords  ('March.  1862    said  : — 'The  law  as  laid  d 

st  .'plied  to  -  -  short  of  insanity,  but  th  rast 
be  cases  of  unsoundness  of  mind ;  and  mere  extravagance  or  follies, 
which  indicated  imbecility,  would  :  1 1  sufficient  unless  the  imbe- 
cility amoun*  -  unsoundness  of  mind/'  The  legal  test  of  the 
existence  of  this  state  of  mind,  we  are  told  by  high  authority,  is 
luct."     A   lawyer  means  by  madness  :ain 

character,"  while  a  physician  means  by  it  "a  certain  dis  e  of 

the  effects  of  which  is  to  produce  -  \       ("Crirn. 

.  ^:ephen,  p.  87.)    The  whole  evidence  against 

Xindharn  bore  upon  •:,  and  from  the  verdict  we  learn 

what  sort  of  conduct         -       *  constitute  madness  in  a  nse. 

The  marrying  of  a  woman  of  disreputable  character — the  squandering 
.  her  of  14,000Z.  in  jewelry,  and  settling  upon  her,  without  any 
enable  groun  annum,  with  other  extrava^ 

lar  kind,  do  not  constitute  "conduct  of  a  certain  chara 
sufficient  to  render  a  man  non  compos  mentis  in  the  eye  of  the  law; 
but  if  these  ss  of  mind  and  a  competes 

manage  affairs,  what  are  the  acts  which  indicate  r  in- 

come ''a  the  other  hand,  we  are  told  that  the  physician 

is  to  the  sease;   out  a  physician  can  know 

nothing  about  the  exisl  -    of  the  brain  during  life  in 

any  imbecility,  except  in  so  far     3  its  <  fleets  m  mani- 

1  aet.     ~W"e  therefore  come  round  to  the  legal  tesl 
irtach  in  Mr.  Windham's      -         -        sidered  to  be  quite 
>.h  the  provident  management  of  a  large  estate  and  a 
lid  fortune.     That  the  legal  test  re  a  failure  in  afford  - 

fcection  from  wasteful:    -  -1  by  the  result — the 

of  the  whole  pro.  m  reckless  extra  vaga 

In  refe:  this  and  other  cases,  have  been  si 

condemned  for  not  agreeing  among  themselves  on  the  subject  of  in- 
sanity, and  it  has  been  suggested  that  persons  sense  and 
a  practical  knowledge  of  t        rorld  are  more  qualified  to  judge  of 

tdness  i lical  men.     In  the  Windham 

.  which  elicited  thes  sures,  1  listing 

•  men  with  a  ledge  of  the  differed  : 

each  other  even  more  than  the  — the  numbers  being  fifteen  in 

favor  of  a  verdict  of  sou..  d  eight  in  favor  of  unsound 

of  mind.     The  minority  :  _!yon  the  error  of  the 

of  the  majority,  that  they  specially  signified  their  dissent  from  it  to 
Lords  J.  ho  had  di]  *  lie  inquiry.     This  great 

-  therefore  simp!  led  arithn 

nunv         15  1  in  the  election  of  a    '        erofParliam 


COMMISSION'S    OF    LUNACY.  667 

The  chief  objections  to  the  evidence  of  medical  experts  on  these 
occasions  would  be  removed,  if  they  were  nominated  by  the  Lord 
Chancellor  or  the  Lords  Justices,  and  if  they  were  thus  made  as 
independent  as  special  jurors.  So  strong  was  the  public  feeling  in 
reference  to  medical  evidence  after  this  inquiry,  that  the  Lord  Chan- 
cellor actually  proposed  to  exclude  it  altogether,  in  commissions  of 
lunacy,  except  in  so  far  as  it  was  based  on  facts  within  the  personal 
knowledge  of  the  witnesses.  It  was  suggested  that  the  general 
scientific  conclusions  of  experts  should  not  be  received  as  evidence. 
This  proposition,  which  would  have  been  most  injurious  to  the  in- 
terests of  the  insane  as  well  as  the  sane,  did  not  meet  with  a  favor- 
able reception. 

A  Commission  of  Lunacy  may  be  superseded,  but  the  evidence 
must  then  be  as  strongly  in  favor  of  sanity  as  it  was  before  in  favor 
of  insanity.  The  onus  of  proof  is  then  thrown  on  the  person  who 
has  been  found  lunatic. 

[The  Constitution  of  Pennsylvania  vests  in  the  Supreme  Court 
and  the  several  courts  of  Common  Pleas,  the  care  of  the  persons  and 
estates  of  those  who  are  non  compos  mentis.  In  practice,  however, 
original  jurisdiction  in  these  cases  is  nearly,  if  not  exclusively,  con- 
fined to  the  courts  of  Common  Pleas. 

The  act  of  loth  June,  1836,  provides  the  manner  of  proceeding, 
in  cases  of  interdiction,  by  the  issuing  of  a  commission  in  the  nature 
of  a  writ  de  lunatico  inquirendo,  to  inquire  into  the  lunacy  or  habitual 
drunkenness  of  any  person  living  within  this  commonwealth  or  hav- 
ing real  or  personal  estate  therein.  The  commission  is  issued  upon 
the  application  in  writing,  accompanied  by  affidavits,  of  a  relation  by 
blood  or  marriage,  of  the  person  named,  or  of  a  person  interested  in 
his  estate:  or  (by  act  of  15th  April,  1351),  where  there  are  no  rela- 
tives, upon  the  application  of  any  disinterested  person  of  the  same 
township,  ward  or  borough,  in  which  the  alleged  lunatic  or  habitual 
drunkard  resides.  There  may  be  one  or  three  commissioners,  who  are 
to  "  diligently  inquire,  by  the  oaths  or  affidavits  of  six  good  and  lawful 
men  of  the  county,"  whether  the  party  is  a  lunatic,  &c,  how  long  he 
has  been  so,  whether  he  has  lucid  intervals,  what  property  he  owns, 
and  its  value,  &c.  &c;  and  "the  inquisition  so  to  be  made"  to  return 
to  the  court  at  a  time  specified  in  the  commission.  The  act  (§  67)  de- 
fines the  word  "lunatic"  as  meaning  "any  person  of  unsound  mind, 
whether  he  may  have  been  such  from  his  nativity,  as  idiots,  or  have 
become  such  from  any  cause  whatever."  By  §  63,  it  is  provided  that 
upon  petition  of  the  party  setting  forth  that  he  is  restored  to  a  sound 
state  of  mind,  the  court  shall  take  proof  of  the  facts,  and  if  satisfied 
of  the  truth  of  the  allegations  of  the  petition,  shall  suspend,  or  as 
the  court  shall  decide,  altogether  supersede  and  determine  the  com- 
mission, the  inquisition,  appointment  of  a  committee,  and  all  subse- 
quent proceedings. 

Though,  in  the  main,  governed  by  the  principles  applicable  to 
similar  proceedings  in  the  Court  of  Chancery,  the  provisions  of  this 
act  are  much  simpler  and  less  expensive. 


668  COMMISSIONS    OF    LUNACY. 

"Where  there  is  a  traverse  of  the  inquisition,  the  question  is  not 
simply  whether  unsoundness  of  mind  exists,  but  whether  it  exists 
to  such  an  extent  as  to  disqualify  the  traverser  from  conducting 
himself  with  personal  safety  to  himself  or  others,  or  from  managing 
and  disposing  of  his  own  affairs  and  discharging  his  relative  duties. 
McElroyh  case,  6  W.  &  S.  451.  The  great  object  of  the  proceedings 
under  a  commission  of  lunacy  is  to  afford  security  and  protection. 
The  fact  that,  as  yet,  the  lunatic  may  not  have  squandered  his  pro- 
perty is  no  security  that  he  may  not  do  it  hereafter.  The  act  is 
precautionary  in  its  design,  and  hence  a  disposition  of  mind  or  body, 
which  might  lead  to  the  wasting  of  an  estate  is  sufficient  to  justify 
the  enforcement  of  its  provisions.  lb.;  Sill  v.  McKnight,  1  W.  &  S. 
245;  Ludwick  v.  Commonwealth,  6  Harris,  175. 

The  same  act  (13th  June,  1836)  §£  58-62,  introduces  the  provi- 
sions of  39  and  40,  Geo.  3,  c.  94,  relative  to  the  subject  of  criminal 
proceedings  against  persons  who  were  lunatics  at  the  time  of  the 
commission  of  the  offence,  or  who  have  become  so  since.  These 
sections  have  been  re-enacted  by  the  new  criminal  code  of  31st  March, 
1860.  They  provide  that  when  a  jury  shall  acquit  any  person  charged 
with  crime  or  misdemeanor,  on  the  ground  of  insanity  at  the  time 
of  the  commission  of  the  offence,  or  when  he  shall  be  found  to  be  a 
lunatic  upon  arraignment,  such  jury  shall  find  specially  the  fact  of 
insanity  and  declare  in  their  verdict  that  this  was  the  ground  of 
acquittal.  The  court  may  then  order  him  to  be  kept  in  strict  cus- 
tody, so  long  as  he  shall  remain  of  unsound  mind,  or  he  may  be  de- 
livered to  his  friends  or  to  the  guardians  of  the  poor  upon  the  entry 
of  security  that  he  shall  be  restrained  by  seclusion  or  otherwise 
from  the  commission  of  any  offence.  When  the  prosecutor  fails  to 
appear,  and  the  prisoner  would  be  otherwise  discharged,  if  it  appear 
to  the  court  upon  affidavit  of  any  credible  person  that  the  defendant 
is  insane,  the  court  are  required  to  order  the  district  attorney  to  send 
a  written  allegation  of  such  insanity  to  the  grand  jury,  who  shall 
make  presentment  of  their  finding  to  the  court,  and  thereupon  a  jury 
shall  be  impanelled  to  try  the  insanity  of  such  person. 

Similar  statutory  provisions  exist  in  Massachusetts  and  in  Minne- 
sota, and  perhaps  in  other  States  of  the  Union.  See  Bonfanti  v. 
State,  2  Min.  123. 

The  criminal  courts  of  Pennsylvania  may  also  upon  petition  in- 
quire into  the  insanity  of,  and  commit  to  the  State  Lunatic  Asylum 
persons  unsafe  to  be  at  large,  and  those  who  are  suffering  unnecessary 
hardship  or  duress;  Act  of  14th  April,  1845.  This  application 
may  be  made  by  a  married  woman.  Shenango  v.  Wayne,  10  Casey, 
184.  See  also  Brightly's  Purdon's  Dig.  Tit,  "State  Lunatic  Asy- 
lum." Id.  Tit.  "  Lunatics  and  Habitual  Drunkards."  The  act  of 
1845  also  gives  the  officers  of  the  poor  authority  to  send  insane 
paupers  to  the  State  Asylum. 

These  acts  of  course  do  not  prevent  the  sending  of  persons  to 
asylums  by  their  friends,  without  the  intervention  of  the  courts.  All 
such  cases  may,  however,  be  brought  before  the  courts  upon  //< 
corpus.     See  Dr.  Hartshorne's  note,  ante,  p.  653.     See  also  the 
of  Hinchman  v.  Ritchie,  Bright.  K.  144. — P.] 


RESPONSIBILITY    IX    CIVIL    CASES.  669 


CHAPTEE   LXII. 

Civil  responsibility. — testamentary  capacity. — wills  made  by 

the   insane. — test   of  capacity.  —  evidence   of  delusion. 

eccentricity. 

Responsibility  in  Civil  Cases.  Insanity  as  an  Impediment  to  Mar- 
riage.— Insanity  is  deemed  in  law  to  be  a  civil  impediment  to  mar- 
riage, because  it  is  considered  that  there  cannot  be  that  rational 
consent  which  is  necessary  to  the  validity  of  a  contract.  The 
marriage  of  a  lunatic  is  therefore  called  a  nullity,  and  is  void  ab 
initio.  All  that  the  law  requires  is,  that  there  should  be  good  proof 
of  insanity  at  or  about  the  time  of  the  contract.  If  this  be  offered, 
and  it  be  alleged  that  the  contract  was  entered  into  during  a  lucid 
interval,  then  the  party  who  would  benefit  by  the  allegation  must 
prove  it.  The  suitableness  of  the  marriage,  as  well  as  the  conduct 
of  the  party  during  or  after  its  performance,  will  also  be  considered 
by  the  court.  In  Turner  v.  Myers,  a  lunatic  who  had  recovered  from 
his  lunacy  instituted  a  suit  to  set  aside  a  marriage  which  he  had 
contracted  while  in  that  state !  The  marriage  was  declared  void. 
("  Med.  Gaz.,"  vol.  viii.  p.  481.)  The  case  of  Baldry  v.  Ellis  (Norwich 
Summer  Ass.,  1851)  will  be  found  of  interest  in  relation  to  the 
matrimonial  engagements  of  alleged  lunatics. 

[But  though  marriage  with  an  idiot  or  lunatic  be  absolutely  void, 
and  no  sentence  of  avoidance  be  absolutely  necessary  [Browning  v. 
Peane,  2  Phillimore,  19,  69),  yet,  "as  well  for  the  sake  of  the  good 
order  of  society,  as  for  the  peace  of  mind  of  all  persons  concerned, 
it  is  expedient  that  the  nullity  of  the  marriage  should  be  ascertained 
and  declared  by  the  decree  of  a  court  of  competent  jurisdiction.  2 
Kent,  Com.  76.— P.] 

In  Bead  v.  Legard  (Court  of  Exchequer,  May  30,  1851),  a  ques- 
tion arose  whether  a  lunatic  was  responsible  for  necessaries  supplied 
to  the  wife.  The  articles  supplied  were  for  the  sole  use  of  the  wife, 
fhe  husband  being  a  confirmed  lunatic  and  the  inmate  of  an  asylum. 
The  court  held  that  the  fact  of  a  husband  being  from  the  visitation 
of  God  unable  to  manage  his  affairs,  did  not  absolve  him  from  the 
obligation  which  he  contracted  when  he  married,  to  provide  neces- 
saries for  the  support  of  his  wife.  He  was  then  of  sane  mind,  and 
although  he  had  subsequently  become  insane,  that  obligation  was 
not  revocable  under  the  circumstances.  (See  also  a  report  of  the 
case  of  Seaton  v.  Adcock,  "  Journ.  Psychol.  Med.",  1851,  p.  297.) 

The  validity  of  civil  contracts  entered  into  by  lunatics  will  de- 
pend mainly  on  the  circumstances  which  accompany  the  act.  If 
there  be  nothing  unreasonable  in  the  conduct  of  the  lunatic,  and  the 
party  with  whom  he  contracts  has  no  knowledge  or  suspicion  of  the 


670  RESPONSIBILITY    IN    CIVIL    CASES. 

insanity,  then  the  contract  will  be  binding  on  the  lunatic  and  his 
representatives.  It  was  so  held  in  Moncklon  v.  Cameraux  (Exchequer, 
June,  1848).  This  was  an  action  by  the  administrator  of  a  deceased 
person,- to  recover  from  the  defendant,  as  secretary  of  an  insurance 
office,  the  sum  paid  by  him  as  the  consideration  for  two  annuities, 
the  foundation  of  the  action  being,  that  at  the  time  of  the  arrange- 
ment in  question  the  deceased  was  not  in  a  sound  state  of  mind.  At 
the  trial  before  the  Chief  Baron  it  appeared  that  the  negotiation  had 
been  conducted  by  the  deceased  with  apparent  prudence,  sanity,  and 
judgment,  and  that  the  arrangement  entered  into  by  him  with  the 
office  was  just  such  as  any  ordinary  prudent  person  would  have  been 
expected  to  make  with  a  view  to  his  own  interest.  The  deceased, 
who  died  very  soon  after  the  business  had  been  arranged,  was,  both 
before  and  after,  in  an  unsound  state  of  mind.  Under  these  cir- 
cumstances, this  action  was  brought  by  his  representatives,  and  a 
verdict  recovered  by  them,  subject  to  the  opinion  of  the  court  on 
their  right  to  recover  as  on  the  entire  failure  of  consideration.  The 
Chief  Baron,  in  giving  judgment  in  favor  of  the  defendant,  said  it 
was  sufficient  for  the  purpose  of  this  case  to  lay  it  down  as  a  gen- 
eral rule,  that  when  a  person  of  apparently  sound  intellect  enters 
into  a  contract  such  as  any  other  ordinary  person  would  enter  into 
with  others  who  act  bond  fide,  and  the  parties  cannot  be  restored  to 
their  former  condition,  it  is  no  ground  for  setting  aside  the  contract, 
that  one  of  them  was  at  the  time  non  compos  mentis.  On  appeal  to 
the  Exchequer  Chamber  this  judgment  was  affirmed  in  May,  1849. 
(See  also  the  case  of  Staniland  v.  Willett,  Vice-Chancellor's  Court, 
Nov.  1818.)  In  the  case  of  Donat  v.  Haniquet  (Guildhall  Sittings, 
1854),  on  an  action  to  recover  a  sum  of  money,  in  which  the  defence 
was  that  the  defendant  was  of  unsound  mind  at  the  time  of  the  con- 
tract, Crompton,  J.,  held  that  unless  it  was  shown  that  the  plaintiff 
had  taken  advantage  of  defendant's  unsoundness  of  mind  he  would 
be  entitled  to  recover  the  amount  claimed. 

[In  the  case  of  Leach  v.  Marsh,  "American  Law  Reg."  Vol.  2  (N.  S.) 
p.  22,  the  Supreme  Court  of  Maine  decided  that  a  judgment  recov- 
ered on  default,  against  a  person  admitted  to  have  been  non  compos 
mentis  at  the  time  of  the  proceedings  in  the  case,  will  be  reversed 
on  a  writ  of  error  brought  by  his  administrators  after  his  decease. 
The  following  is  the  note  of  one  of  the  editors  (Hon.  I.  F.  Redfield) 
of  the  Register :  "  It  seems  well  settled  that  contracts  by  lunatics 
and  persons  of  unsound  mind,  as  a  general  rule,  are  not  binding. 
Lincoln  v.  Buckmaster,  32  Vt.  R.  652,  and  numerous  cases  there  cited. 
But  there  are  many  exceptions  to  this  rule. 

1.  Where  merchants,  apparently  sane,  have  purchased  goods  in 
the  ordinary  course  of  their  business,  and  have  disposed  of  them, 
in  whole  or  in  part,  so  that  the  goods  cannot  be  restored  to  the  seller, 
there  is  no  question  of  the  general  liability  upon  such  contracts, 
notwithstanding  it  should  appear  that  the  purchaser  was  in  fact  in- 
sane at  the  time  of  the  purchase.  Braes  v.  Lee,  10  Barr  56 ;  Molion 
v.  Cameraux,  2  Exch.  R.  502;  S.  C.  4  Id.  17.  And  the  same  rule 
extends  to  all  cases  where  the  seller  has  parted  with  his  property  in 
good  faith,  and  it  is  not  in  the  power  of  the  lunatic   to  restore   it. 


CIVIL    RESPONSIBILITY  OF    LUNATICS.  671 

Even  courts  of  equity  refuse  to  interpose  to  set  aside  the  contracts 
of  lunatics,  unless  the  parties  can  be  restored  to  their  former  condi- 
tion, or  the  sane  party  has  taken  some  unconscionable  advantage  in 
the  bargain.  Neil  v.  Morley,  9  Vesey  478.  The  parties  are  left  to 
their  legal  rights.  Sageron  v.  Leaky,  2  Atk.  R.  412.  The  same  rule 
extends  to  contracts  made  with  infants.  Farr  v.  Sumner,  12  Vt.  R. 
28  ;  Taft  v.  Pile,  14  Id.  405  ;  Weed  v.  Beebe,  21  Id.  495.  But  the 
recovery  in  both  cases  should  be  upon  the  quantum  meruit,  rather 
than  upon  the  contract. 

2.  Contracts  for  necessaries  for  the  lunatic  or  his  family  are  bind- 
ing to  the  same  extent,  and  much  upon  the  same  principles  as  similar 
contracts  by  infants.  Thompson  v.  Leach,  3  Mod.  R.  310;  Seaver  v. 
Phelps,  11  Pick.  R.  304,  306.  Some  of  the  American  cases  go  the 
length  of  holding,  that  no  recovery  can  be  had  against  a  lunatic, 
upon  a  contract  express  or  implied,  unless  for  necessaries.  Seaver 
v.  Phelps,  supra;  Fitzgerald  v.  Reed,  9  Sm.  and  Marshall;  Pearl  v. 
McDowell,  3  J.  J.  Marsh.  658 ;  2  Greenl.  Ev.  §  369 ;  Lincoln  v.  Buck- 
master,  supra. 

The  rule  in  regard  to  instituting  legal  proceedings  against  a  luna- 
tic is  much  the  same  as  that  which  obtains  in  the  case  of  infants ; 
and  there  would  seem  to  be  more  reason  for  a  strict  enforcement  of 
it  in  the  former  case  than  in  the  latter,  since  infants,  long  before 
they  get  out  of  their  nonage,  are  entirely  competent  to  select  coun- 
sel, and  conduct  the  defence  of  a  suit. 

This  subject  is  very  elaborately  discussed  by  Woodbury,  J.,  in 
Lang  v.  Whidden,  2  N.  H.  R.  435,  where  the  authorities,  prior  to  that, 
date  (1822),  will  be  found  very  extensively  quoted,  and  the  subject 
very  learnedly  discussed,  and  satisfactorily  disposed  of  by  the  court. 
It  is  here  said  the  guardian  must  be  notified,  in  all  cases,  or  the 
judgment  will  be  erroneous. 

The  same  rule  has  been  adopted  in  many  of  the  American  States. 
Aldridge  v.  Montgomery,  9  Ind.  R.  302;  Snowden  v.  Banbury,  11 
Penna.  St.  R.  522';  2  Barb.  Ch.  R.  387 ;  Wright's  Ap.  8  Barr.  57 ;  6 
B.  Mon.  R.  239.  But  if  one  who  is  a  lunatic  be  arrested  or  imprisoned 
in  a  civil  suit,  he  is  not  entitled  to  his  release  on  that  account.  A 
guardian  ad  litem  may  be  appointed,  and  the  suit  proceed.  Bush  v. 
Pettibone,  4  Comst.  R.  300;  Aldrich  v.   Williams,  12  Vt.  R.  413. 

There  seems  to  be  no  good  ground  to  question  the  decision  in  the 
principal  case.  The  same  rule  has  long  been  established  in  regard 
to  judgments  rendered  against  infants,  without  the  appointment  of 
guardians  ad  litem.  2  Saund.  R.  212,  N.  H. ;  Gastlemain  v.  Moody, 
4  B.  &  Ad.  90.  See  also  Mason  v.  Dennison,  15  "Wendell,  64 ;  Wead 
v.  Marsh,  14  Vt.  R.  77 ;    Crockett  v.  Drew,  5  Gray  399. 

In  the  case  of  Van  Brunt  v.  Taylor,  3  Philadelphia  R.  123,  it  was 
held  by  the  District  Court,  that  where  an  insane  partner  contracted 
loans,  the  firm  was  liable,  whether  the  money  was  misappropriated 
by  him  or  not. 

By  act  of  13th  June,  1836,  §  44,  no  person,  found  by  inquisition  to 
be  a  lunatic,  can,  in  Pennsylvania,  be  arrested  or  imprisoned  on 
mesne  or  final  process  in  any  civil  action,  so  long  as  he  shall  re- 
main of  unsound  mind. — P.] 


672  TEST    OF    CAPACITY. 

Testamentary  Capacity.  Wills  made  by  the  Insane. — Questions  in- 
volving the  testamentary  capacity  of  persons  are  of  very  frequent 
occurrence,  and  medical  evidence  is  commonly  required  for  their 
solution.  When  property  is  bequeathed  by  a  testator  out  of  the 
usual  order  of  succession,  it  may  be  alleged  by  the  relatives  that  he 
was  wholly  incompetent  to  understand  the  nature  of  the  deed — 
either  from  actual  insanity,  the  imbecility  of  age,  or  that  natural 
failing  of  the  mind  which  is  so  often  observed,  to  occur  from  disease 
or  on  the  approach  of  death.  Bodily  disease  or  incapacity  does  not 
affect  the  validity  of  a  will,  unless  the  mind  be  directly  or  indirectly 
disturbed  by  it.  Some  time  since  a  case  occurred,  in  France,  in  which 
a  will  was  contested  on  the  ground  that  the  testator  when  he  exe- 
cuted it,  was  laboring  under  hemiplegia.  The  opinion  of  Esquirol 
was  required,  and  he  said  that  hemiplegia  might  undoubtedly  affect 
the  brain — a  fact  clearly  indicated  by  the  sight,  hearing,  and  other 
senses  becoming  weakened ;  yet  this,  in  his  opinion,  did  not  neces- 
sarily indicate  an  impairment  of  the  intellectual  powers.  ("Ann. 
d'Hyg."  1832,  vol.  1,  p.  203.)  A  man's  mind,  under  these  circum- 
stances, may  not  be  so  strong  as  in  robust  health,  but  still  it  may 
retain  a  disposing  power.  In  Harwood  v.  Baker,  decided  by  the 
Privy  Council  in  1841,  a  will  was  pronounced  to  be  invalid  owing 
to  the  general  state  of  bodily  disease  in  which  the  testator  was  at 
the  time  of  making  it.  It  appears  that  he  was  laboring  under  ery- 
sipelas and  fever,  and  these  diseases  had  produced  a  degree  of  drowsi- 
ness and  stupor  which  rendered  him  incompetent  to  the  act.  In  the 
case  of  Day  (June,  1838),  epilepsy  was  alleged  to  have  affected  the 
mind ;  and  in  the  case  of  Blewett  (March,  1833),  paralysis  was  adduced 
as  a  ground  of  incompetency.  In  all  cases  of  this  kind,  the  law 
looks  exclusively  to  the  actual  effect  of  the  bodily  disease  upon  the 
mind;  and  this  is  commonly  a  question  to  be  determined  by  a  jury 
from  the  testimony  of  those  who  have  attended  the  deceased,  as  well 
as  from  the  evidence  of  medical  experts. 

Test  of  Capacity . — A  person  is  considered  to  be  of  a  sane  and  dis- 
posing mind  who  knows  the  nature  of  the  act  which  he  is  perform- 
ing, and  is  fully  aware  of  its  consequences.  From  some  decisions 
that  have  been  made,  it  would  appear  that  a  state  of  mind  for  which 
a  party  might  be  placed  under  interdiction  or  deprived  of  the  man- 
agement of  his  affairs,  would  not  render  him  incompetent  to  the 
making  of  a  will.  The  validity  of  the  will  of  a  lunatic  was  once 
allowed,  although  made  while  he  was  actually  confined  in  an  asylum, 
because  the  act  was  rational,  and  it  was  such  as  the  lunatic  had  an- 
nounced his  intention  of  making,  some  years  prior  to  the  attack  of 
insanity.  (Coghlan's  case;  see  Re  Garden,  "  Law  Times,"  July  6, 
1844,  p.  258;  also  the  case  of  Cartwright,  Mayo  on  "Medical  Testi- 
mony," p.  44.)  In  Nichols  and  Freeman  v.  Binns  (Probate  Court, 
Aug.  1858),  the  question  was  whether  the  will  of  a  Mr.  Parkinson, 
made  in  a  lunatic  asylum  near  Norwich,  was  executed  during  a  lucid 
interval.  The  jury  found  a  verdict  in  favor  of  the  will.  The  in- 
sanity of  a  person  when  not  already  found  insane  under  a  commission, 
must  not  in  these  cases  rest  upon  presumption  or  probability,  but 
be  established  by  positive  proof.    The  act  of  suicide  is  often  hastily 


DELUSION    IN    THE    DEED.      ECCENTRICITY    IN    WILLS.    673 

assumed  to  be  evidence  of  insanity ;  but  it  would  not  be  allowed  as 
a  proof  of  this  state,  even  when  a  testator  bad  destroyed  himself 
shortly  after  the  execution  of  his  will.  A  case  has  been  decided 
where  the  testator  committed  suicide  three  days  after  having  given 
instructions  for  his  will ;  but  the  act  was  not  admitted  as  a  proof  or 
even  as  a  presumption  of  insanity  at  the  time,  and  the  will  was  pro- 
nounced to  be  valid.  In  another  case,  Edwards  v.  Edwards  (Prerog. 
Court,  Feb.  1854),  it  was  proved  that  the  testator  had  committed 
suicide  three  days  after  the  execution  of  his  will,  and  there  was 
some  evidence  of  eccentric  habits  almost  amounting  to  insanity; 
but  the  will  was  pronounced  to  be  valid.  Suicide  is  not  deemed  in 
law  to  be  a  proof  of  the  existence  of  insanity. 

Delusion  in  the  Deed.  —  The  validity  of  deeds  executed  by  persons 
affected  with  monomania  is  often  a  subject  of  dispute.  The  practice 
of  the  law  indicates  that  the  mere  existence  of  a  delusion  in  the 
mind  of  a  person  does  not  necessarily  vitiate  a  deed,  unless  the  delu- 
sion form  the  groundwork  of  it,  or  unless  the  most  decisive  evidence 
be  given  that  at  the  time  of  executing  the  deed,  the  testator's  mind 
was  influenced  by  it.  Strong  evidence  is  often  derivable  from  the 
act  itself,  especially  when  a  testator  has  drawn  it  up  of  his  own 
accord.  In  the  case  of  Barton  (July,  1840)  the  Ecclesiastical  Court 
was  chiefly  guided  in  its  decision  by  the  nature  of  the  instrument. 
The  testator,  it  appeared,  labored  under  the  extraordinary  delusion 
that  he  could  dispose  of  his  own  property  to  himself,  and  make  him- 
self his  own  legatee  and  executor !  This  he  had  accordingly  done. 
The  instrument  was  pronounced  to  be  invalid.  But  a  will  may  be 
manifestly  unjust  to  the  surviving  relatives  of  a  testator,  and  it  may 
display  some  of  the  extraordinary  opinions  of  the  individual :  yet  it 
will  not  necessarily  be  void,  unless  the  testamentary  dispositions 
clearly  indicate  that  they  have  been  formed  under  the  influence  of 
a  delusion.  Some  injustice  may  possibly  be  done  by  the  rigorous 
adoption  of  this  principle,  since  delusion  may  certainly  enter  into  a 
man's  act,  whether  civil  or  criminal,  and  it  may  not  be  always  in 
our  power  to  discover  it ;  but,  after  all,  this  is  perhaps  the  most 
equitable  mode  of  construing  the  last  wishes  of  the  dead.  Accord- 
ing to  Sir  John  Nichol,  it  is  not  necessary  in  civil  suits  to  connect 
the  morbid  imagination  with  the  act  itself ;  if  the  mind  is  proved  to 
be  unsound  the  act  is  void.  In  Roberts  v.  Kerslakc  (Warwick  Aut. 
Assizes,  1851),  Lord  Wensleydale  held  that  to  vitiate  a  will,  if  it  be 
a  case  of  delirium,  the  act  must  be  traced  to  delirious  delusion,  but 
if  it  be  a  case  of  lunacy  it  need  not  be  traced  to  a  delusion. 

Eccentricity  in  Wills. — The  evidence  in  these  cases  sometimes 
amounts  to  proof  of  eccentricity  only  on  the  part  of  the  testator, 
or  in  the  deed  itself;  but  a  clear  distinction  must  be  here  drawn. 
The  will  of  an  eccentric  man  is  such  as  might  always  have  been  ex- 
pected from  him:  the  will  of  one  laboring  under  insanity  (delusion) 
is  different  from  that  which  he  would  have  made  in  an  unaffected 
state — the  instrument  is  wholly  different  from  what  it  would  once 
have  been.  It  has  been  justly  observed,  that  the  insane  are  eccen- 
tric in  their  ideas,  their  language,  or  their  conduct:  but  the  merely 
43 


674  ECCENTRICITY    IX    WILLS. 

eccentric  have  but  a  voluntary  resemblance  to  the  insane.  (Jamie- 
son's  Lectures,  "Med.  Gaz."  vol.  46,  p.  180.)  Wills  are  sometimes 
contested  more  on  the  ground  of  eccentricity  than  of  insane  delu- 
sion ;  but  if  eccentricity  only  be  proved,  a  court  will  not  interfere. 
In  the  case  of  Morgan  v.  Boys  (1838),  it  was  proved  that  the  testator, 
by  his  will,  had  left  a  large  fortune  to  his  housekeeper.  The  will 
was  disputed  on  the  ground  that  it  bore  intrinsic  evidence  of  the  de- 
ceased not  having  been  in  a  sane  state  of  mind  at  the  time  of  making 
it.  After  having  bequeathed  his  property  to  a  stranger,  the  testator 
directed  that  his  executors  should  "  cause  some  parts  of  his  bowels 
to  be  converted  into  fiddle-strings — that  others  should  be  sublimed 
into  smelling-salts,  and  that  the  remainder  of  his  body  should  be  vit- 
rified into  lenses  for  optical  purposes ! "  He  further  added,  in  a 
letter  attached  to  his  will — "  The  world  may  think  this  to  be  done 
in  a  spirit  of  singularity  or  whim ;  but  I  have  a  moral  aversion  to 
funeral  pomp,  and  I  wish  my  body  to  be  converted  into  purposes 
useful  to  mankind."  Sir  H.  Jenner,  in  giving  judgment,  held  that 
insanity  was  not  proved:  the  facts  merely  amounted  to  eccentricity, 
and  on  this  ground  he  pronounced  for  the  validity  of  the  will.  It 
was  proved  that  the  deceased  had  conducted  his  affairs  with  great 
shrewdness  and  ability;  that  he  not  only  did  not  labor  under  imbe- 
cility, but  that  he  had  been  always  treated  during  life  as  a  person 
of  indisputable  capacity  by  those  with  whom  he  had  to  deal.  The 
best  rule  to  guide  the  court,  the  Judge  remarked,  was  the  conduct 
of  persons  towards  the  deceased;  and  the  acts  of  his  relatives  evinced 
no  distrust  of  his  sanity  or  capacity  while  he  was  living.  The  de- 
ceased had  always  been  noted  for  his  eccentric  habits,  and  he  had 
actually  consulted  a  physician  upon  the  possibility  of  his  body  being 
devoted  to  chemical  experiments  after  death.  In  the  case  of  Mud- 
way  v.  Croft  (Prerog.  Court,  Aug.  1843),  a  will  contested  on  the 
ground  of  insanity  but  defended  on  the  plea  of  eccentricity,  Sir  H.  J. 
Fust  said — "It  is  the  prolonged  departure,  without  an  adequate  ex- 
ternal cause,  from  the  state  of  feeling  and  modes  of  thinking  usual 
to  the  individual  when  in  health,  that  is  the  true  feature  of  disorder 
of  the  mind." 

The  following  case  was  the  subject  of  litigation  in  Paris  in  1864. 
A  wealthy  Portuguese  gentleman  named  Mackado  died  in  1861, 
having  made  a  will  with  seventy-one  codicils  attached  to  it,  some 
of  them  containing  provisions  impossible  of  execution.  It  was  dis- 
puted on  the  ground  of  the  insanity  of  the  testator.  One  of  the 
codicils  was  to  this  effect:  "I  leave  for  the  Athenasum  of  Paris 
10,000  francs,  the  interest  of  which  at  5  per  cent,  will  be  500  francs. 
Half  of  this  interest  to  be  paid  to  a  Professor  of  Natural  History, 
who  shall  lecture  on  the  colors  and  patterns  of  dresses,  and  on  the 
characters  of  animals."  Again:  "My  funeral  shall  take  place  at  3 
P.  M.,  the  hour  at  which  the  rooks  of  the  Louvre  come  home  to  din- 
ner." The  testator  was  especially  fond  of  birds:  he  desired  that 
many  stuffed  specimens  should  be  placed  in  his  coffin;  that  his  ser- 
vant should  carry  to  the  ceremony  "one  of  my  favorite  birds  in  his 
cage;"  and  that  certain  birds  should  be  let  loose  on  the  day  of  his 
funeral.     The  testator  had  during  his  life  erected  his  own  tomb,  on 


WILLS    IN    SENILE    DEMENTIA.  675 

which,  were  engraved  a  sun,  a  bird,  an  ox,  and  a  dog,  an  egg  "  proper  " 
surmounting  them;  beneath  was  inscribed,  "  Here  reposes  the  author 
of  the  '  Theory  of  Likeness.' "  These  and  other  facts  of  a  similar 
kind  were  relied  upon  as  proofs  of  insanity,  but  it  was  decided  that 
the  deceased  was  only  vain,  not  insane,  and  therefore  he  had  a  right 
to  will  away  his  property  as  he  pleased.  It  was  proved  in  favor  of 
his  sanity,  that  in  spite  of  these  crotchets  he  had  while  living  man- 
aged his  affairs  with  all  the  caution  of  a  sane  person. 

Wills  in  Senile  Dementia. — "Wills  made  in  incipient  dementia  aris- 
ing from  extreme  age  (senile  imbecility)  are  sometimes  disputed, 
either  on  the  ground  of  mental  deficiency,  or  of  the  testator,  owing 
to  weakness  of  mind,  having  been  subjected  to  control  and  influence 
on  the  part  of  interested  persons.  If  a  medical  man  be  present  when 
a  will  is  executed,  he  may  easily  satisfy  himself  of  the  state  of  mind 
of  the  testator,  by  requiring  him  to  repeat  from  memory  the  mode 
in  which  he  has  disposed  of  the  bulk  of  his  property.  A  medical 
man  has  sometimes  placed  himself  in  a  serious  position  by  becom- 
ing a  witness  to  a  will  without  first  assuring  himself  of  the  actual 
mental  condition  of  the  person  making  it  (case  of  the  Duchess  of 
Manchester,  1854).  It  would  always  be  a  good  ground  of  justifica- 
tion, if,  at  the  request  of  the  witness,  the  testator  had  been  made  to 
repeat  substantially  the  leading  provisions  of  his  will  from  memory. 
If  a  dying  or  sick  person  cannot  do  this  without  prompting  or  sug- 
gestion, there  is  reason  to  believe  that  he  has  not  a  sane  and  dis- 
posing mind.  It  has  been  observed  on  some  occasions,  when  the 
mind  has  been  weakened  by  disease  or  infirmity  from  age,  that  it 
has  suddenly  cleared  up  before  death,  and  the  person  has  unexpect- 
edly shown  a  disposing  capacity.  ("Ann.  d'Hyg."  1831,  p.  8(30.) 
In  Durnell  v.  Corfield  (Prerog.  Court,  July,  184-1),  a  case  in  which  an 
old  man  of  weakened  capacity  had  made  a  will  in  favor  of  his  medi- 
cal attendant,  Dr.  Lushington  held  that  to  render  it  valid  there  must 
be  the  clearest  proof  not  only  of  the  factum  of  the  instrument,  but 
of  the  testator's  knowledge  of  its  contents.  [In  Greenfield' 's  Estate, 
2  Harris  (Penna.)  489,  where  the  decedent  during  her  lifetime  had  at 
the  age  of  eighty-six  or  eighty-seven,  executed  a  deed  to  persons 
who  were  to  hold  in  trust  for  her  for  life,  and  after  her  death,  to 
administer  the  property  in  the  manner  therein  set  forth,  it  was 
held,  that  a  provision  in  the  deed  in  favor  of  the  counsel  who 
drew  or  advised  it,  for  his  services  to  be  performed  as  trustee, 
with  the  further  provision  that  such  trustee  might  resign,  without 
forfeiting  his  compensation,  is  void,  at  least  unless  it  be  proved 
that  the  grantor  knew  of  the  particular  provisions,  and  without 
influence  from  those  interested,  assented  to  them.  If  a  doubt  exists 
in  this  respect,  the  provision  for  compensation  is  invalid ;  and  the 
provision  in  favor  of  the  other  trustees  who  acted  in  the  arrange- 
ment of  the  matter,  through  the  counsel,  or  in  connection  with  him, 
is  also  invalid.  The  trustees  may,  however,  be  decreed  compensa- 
tion by  the  proper  tribunal. — P.]  ("Law  Times,"  July  27,  1844.) 
In  West  v.  Sylvester  (Nov.  1864),  Sir  J.  Wilde,  in  pronouncing 
judgment  against  a  will  propounded  as  that  of  the  deceased,  an  aged 
lady,  said: — "At  the  time  she  executed  the  will  of  October,  1863, 


676  KESTKICTION    OF    MEDICAL    OPINIONS. 

although  for  many  purposes  she  might  be  said  to  be  in  her  right 
senses,  she  was  nevertheless  suffering  from  that  failure  and  decrepi- 
tude of  memory  which  prevented  her  from  having  present  to  her 
mind  the  proper  objects  of  her  bounty,  and  selecting  those  whom 
she  wished  to  partake  of  it." 

Wills  made  by  persons  whose  capacity  during  life  has  never  been 
doubted,  while  lying  at  the  point  of  death,  or,  as  it  is  termed,  in  ex- 
tremis, are  justly  regarded  with  suspicion,  and  may  be  set  aside 
according  to  the  medical  circumstances  proved.  Many  diseases, 
especially  those  which  affect  the  brain  or  nervous  system  directly 
or  indirectly,  are  likely  to  produce  a  dulness  or  confusion  of  intel- 
lect, under  which  a  proper  disposing  power  is  lost.  Delirium  some- 
times precedes  death,  in  which  case  a  will  executed  by  a  dying  per- 
son would  be  at  once  pronounced  invalid.  [By  a  statute  law  of 
Pennsylvania  (Act  of  26  April,  1855),  bequests  to  public  institutions 
are  invalid,  without  regard  to  the  testamentary  capacity  of  the  party 
making  the  bequest,  if  made  within  thirty  days  of  death  of  tes- 
tator.— H.] 

In  examining  the  capacity  of  a  person  under  these  circumstances, 
we  should  avoid  putting  leading  questions — namely,  those  which 
suggest  the  answers  "yes"  or  "no."  Thus,  a  dying  man  may  hear 
a  document  read  over,  and  affirm,  in  answer  to  such  a  question,  that 
it  is  in  accordance  with  his  wishes,  but  without  understanding  its 
purport.  This  is  not  satisfactory  evidence  of  his  having  a  disposing 
mind :  we  should  see  that  he  is  able  to  dictate  the  provisions  of  the 
document,  and  to  repeat  them  substantially  from  memory  when  re- 
quired. If  he  do  this  accurately,  there  can  be  no  doubt  of  his  pos- 
sessing complete  testamentary  capacity.  But  it  may  be  objected 
that  many  dying  men  cannot  be  supposed  capable  of  such  an  exer- 
tion of  memory :  the  answer  is  then  very  simple ;  it  is  better  that 
the  person  should  die  without  a  will,  and  his  property  be  distributed 
according  to  the  law  of  intestacy,  than  that,  through  any  failing  of 
the  mind,  he  should  unknowingly  cut  off  the  rights  of  those  who 
have  the  strongest  claims  upon  him. 

Restriction  of  Medical  Opinions. — In  an  important  case  {Bainbrigge 
v.  Bainbrigge,  Oxford  Summer  Ass.  1850),  tried  before  Lord  Camp- 
bell, in  which  the  testamentary  capacity  of  a  testator  was  disputed, 
it  was  held  that  a  medical  witness,  although  conversant  with  cases 
of  insanity,  cannot  be  asked  his  opinion  as  to  the  insanity  of  a  tes- 
tator founded  upon  the  evidence  given  at  the  trial  in  his  hearing. 
(4  Cox,  "Criminal  Cases,"  454:  see  also  on  this  subject  "Med.  Gaz." 
vol.  46,  p.  240.)  In  the  case  of  the  Duchess  of  Manchester,  however, 
the  opinions  of  Drs.  Sutherland,  Mayo,  and  Conolly,  on  the  compe- 
tency of  the  testatrix,  were  received  by  the  court,  although  based 
upon  the  evidence  given  at  the  trial. 

[In  general  every  man  is  presumed  to  be  sane  until  the  contrary 
is  proved;  and  hence  it  has  been  held,  that  the  burden  of  proving 
unsoundness  or  imbecility  of  mind  in  a  testator,  is  upon  the  party 
impeaching  the  validity  of  a  will  for  that  cause.     Especially,  it  is 


WILLS    OF    THE    INSANE.      ATTESTING    WITNESSES.      677 

said,  is  this  the  case  with  reference  to  wills  attested  by  subscrib- 
ing witnesses,  because  it  is  the  duty  of  the  latter  "to  be  satisfied  of 
the  testator's  sanity  before  they  subscribe  the  instrument"  (Werstler 
v.  Custer,  10  Wright  (Penna.)  502);  and  under  the  maxim  "  omnia 
prsesumuntur  rile  et  solenniter  acta  donee  probetur  in  contrarium,'1'1  it  is  to 
be  presumed  that  they  have  not  neglected  this  duty.  Such  is  the  rule 
in  Pennsylvania,  and  in  many  of  the  other  states  of  the  Union ; 
Werstler  v.  Custer,  supra ;  Grabillv.  Barr,  5  Ban*,  441 ;  Barber  v.  McFer- 
ran,  2  Casey,  214;  Bees  v.  Stille,  2  Wright,  138;  Jackson  v.  Vandeusen, 
5  Johns.  144 ;  Dean  v.  Dean,  1  Williams  (Yt.)  746 ;  Trumbull  v.  Gib- 
bons, 2  New  Jersey,  117 ;  Hawkins  v.  Grimes,  13  B.  Monroe  (Ky.) 
257 ;  Perkins  v.  Perkins,  39  New  Hamp.  163 ;  Stubbs  v.  Houston,  33 
Ala.  555  ;  McDaniel  v.  Crosby,  19  Ark.  533 ;  Chandler  v.  Ferris,  1 
Harrington  (Del.)  454. 

But  on  the  other  hand,  in  Harris  v.  Ingledew,  3  P.  Wms.  93,  Sir 
Joseph  Jekyll,  M.  R.  said,  "It  must  be  observed  that  the  proof  of  a 
will  is  attended  with  more  solemnity  than  that  of  a  deed :  the  former 
being  supposed  to  be  made  when  the  testator  is  in  extremis:  and 
therefore  in  equity,  it  is  necessary  to  prove  the  sanity,  which  is  all  pre- 
sumed in  the  case  of  the  latter."  See  also  Barry  v.  Butlin,  1  Curtis, 
637 ;  Sutton  v.  Sadler,  Com.  B.  10  Law  Rep.  N.  S.  703 ;  and  this  is 
said  to  be  more  particularly  the  rule  where  the  statute  relating  to 
wills  contains  the  provision  (which  indeed  it  generally  does)  that  the 
testator  must  be  of  "sound  mind."  Gilley  v.  Cilley,  34  Maine,  162; 
Comstock  v.  Hadlyne,  8  Conn.  261 ;  Crowning shield  v.  Orowningshield, 
2  Gray,  524 ;  Brooks  v.  Barrett,  7  Pick.  98,  99. 

The  subject  of  testamentary  capacity  is  very  fully  considered  in 
Jarman  on  Wills,  Perkins's  Ed.  vol.  1,  p.  51,  et  seq. ;  and  in  Wil- 
liams on  Executors,  vol.  1,  p.  11,  et  seq.  To  the  authorities  there 
cited,  mav  be  added  the  recent  cases  of  Vanpelt  v.  Vanpelt,  30  Barb. 
(N.  Y.)  134 ;  Dunham's  Ap.  27  Conn.  192 ;  Stubbs  v.  Houston,  33 
Ala.  555;  Bees  v.  Stille,  2  Wright,  138;  Aiman  v.  Stout,  6  ib.  114; 
Eckert  v.  Henry,  7  ib.  46 ;  Daniel  v.  Daniel,  3  ib.  191 ;  Werstler  v. 
Custer,  10  ib.  502.  In  the  case  of  Vanpelt  v.  Vanpelt,  it  was  held 
that  though  a  testator's  capacity  was  slender,  yet,  if  the  evidence  is 
sufficient  to  show  that  he  fully  understood,  and  intended  to  make  the 
disposition  which  he  has  made,  the  will  must  stand,  however  un- 
natural and  unjust  may  be  its  provisions.  And  in  Stubbs  v.  Houston, 
it  was  held,  that  though  a  condition  somewhat  short  of  a  total  depri- 
vation of  reason  will  destroy  testamentary  capacity,  yet  that  a  person 
not  competent  to  transact  the  ordinary  business  of  life,  may  make  a 
will.  The  existence  of  insane  delusions  was  held  in  Dunham's  Ap.  not 
to  incapacitate,  if  the  testator  has  mind  enough  to  know  and  appre- 
ciate his  relations  to  the  natural  objects  of  his  bounty,  and  the  cha- 
racter and  effect  of  the  dispositions  of  his  will.  In  Pennsylvania, 
mere  weakness  of  intellect,  however  great,  will  not  take  away  testa- 
mentary capacity,  provided  the  testator  at  the  time  of  executing  his 
will,  has  a  full  and  intelligent  consciousness  of  the  nature  and  effect 
of  the  act  he  is  engaged  in,  a  knowledge  of  the  property  he  pos- 
sesses, an  understanding  of  the  disposition  he  wishes  to  make,  and 
of  the  persons  and  objects  he  desires  to  participate  in  his  bounty. 


678        THE  PLEA  OK  DEFENCE  OF  INSANITY. 

It  is  not  necessary,  however,  that  he  should  collect  all  these  in  one 
review.     Daniels  v.  Daniels,  Rees  v.  Stille,  &c. 

It  is  the  duty  of  every  one  called  upon  to  attest  a  will,  to  first 
satisfy  himself  of  the  competency  of  the  testator.  If  he  has  doubts, 
he  should  refuse  to  sign  his  name.  Courts  nave  spoken  in  the  se- 
verest terms  of  persons  who  having  become  witnesses  to  wills,  have 
afterwards  come  forward  to  testify  as  to  the  insanity  of  the  testator. 
The  act  of  attestation  solemnly  testifies  the  testator's  competency ; 
so  that  the  person  who,  believing  that  this  does  not  exist,  neverthe- 
less signs  his  name  as  a  witness,  becomes  an  instrument  in  what  he 
himself  considers  a  fraud.  Should  such  witness  afterwards  attempt 
to  impeach  his  own  act,  and  to  prove  that  the  testator  did  not  know 
what  he  was  doing  when  he  made  what  purported  to  be  his  will, 
though  the  evidence  would  not  be  positively  inadmissible,  very  little 
credit  is  to  be  attached  to  it.  Bees  v.  Stille,  2  Wright,  1-40.  The 
older  cases  go  so  far  as  to  say  that  the  testimony  should  not  be  re- 
ceived at  all,  upon  the  maxim  of  the  civil  law,  nemo  allegans  suam 
turpitudinem  est  audiendus ;  and  in  Loive  v.  Jolliffe  (1  W.  Blackstone's 
Eep.  365),  where,  notwithstanding  the  testimony  of  the  subscribing 
witnesses  against  it,  the  will  was  supported,  Lord  Mansfield  sent 
for  those  witnesses  in  order  to  have  them  committed  for  perjury : 
but,  as  the  reporter  states,  they  very  prudently  "had  withdrawn 
themselves."  It  is  now  settled,  however,  that  the  question  is  one 
not  for  the  court  but  the  jury,  who  are  to  receive  the  evidence,  but 
with  the  most  scrupulous  jealousy  {Booth  v.  Bhmdell,  19  Ves. 
50-4) ;  bearing  in  mind,  as  declared  by  Woodward,  J.,  in  Wertsl&r  v. 
Custer,  10  Wright  (Penna.)  502,  that  "no  honest  man  will  subscribe 
as  a  witness  to  a  will  or  other  instrument,  executed  by  an  insane 
man,  an  imbecile,  or  an  idiot." — P.] 


CHAPTEE   LXIII. 

The  plea  or  defence  of  insanity. — circumstances  under  which 

it  is  admissible. homicidal  insanity. — moral  insanity. — 

symptoms. legal    tests. — medical    tests. — delusion. — tests 

of  irresponsibility. — medical  evidence. 

The  Plea  or  Defence  of  Insanity. — Eesponsibility  here  signifies  no- 
thing more  than  liability  to  punishment  for  crime,  and  a  criminal 
act  implies  the  existence  of  intention,  will,  and  malice.  (Stephen.) 
When  insanity  has  reached  a  certain  stage  or  degree,  an  act  may  be 
perpetrated  without  malice;  and  in  this  sense  the  person  is  con- 
sidered to  be  irresponsible  in  law.  This  is  a  question  of  fact,  to  be 
determined  by  a  jury  from  the  whole  evidence  set  before  them ; 
and  the  proof  rests  with  those  who  make  the  allegation  that  the  act 
in  question,  whether  murder  or  arson,  was  not  done  wilfully  and 
maliciously.     "  The  sanity  of  a  man's  conduct,"  observes  Mr.  Ste- 


THE    PLEA    OE    DEFENCE    OF    INSANITY.  679 

phen,  "involves  the  presence  of  intention  and  will  on  all  ordinary 
occasions ;  and  if  the  act  is  one  of  those  which  the  law  forbids,  it  is 
presumed  to  be  malicious  and  wicked."  ("Criminal  Law  of  Eng- 
land," p.  ,89.)  This  subject  is  of  considerable  importance  in  a 
medico-legal  view ;  for  should  a  plea  of  insanity  be  improperly  ad- 
mitted in  any  criminal  case,  then  punishment  is  made  to  fall  un- 
equally on  offenders ;  and  if,  on  the  other  hand,  it  be  improperly 
rejected,  punishment  is  administered  with  undue  severity.  The  rule 
of  law  is  that  no  man  is  responsible  like  a  sane  person  for  any  act 
committed  by  him  while  in  a  state  of  insanity.  The  plea  may  be 
raised  for  the  smallest  offence  up  to  the  highest  crime — murder ;  but 
it  is  rarely  made  a  defence  in  smaller  offences,  because  the  close 
confinement  to  which  an  accused  person,  if  found  insane,  would 
necessarily  be  subjected, -would  often  be  a  heavier  punishment  than 
that  which  the  law  actually  prescribes  for  the  offence  which  he  may 
have  committed.  In  a  case  of  felonious  assault,  it  was  urged  by 
counsel  in  defence  that  the  prisoner  was  insane ;  but  the  evidence 
on  this  point  was  not  by  any  means  conclusive — when  it  was  inti- 
mated by  the  court  that,  if  this  plea  were  admitted,  the  party  would 
probably  undergo  a  much  longer  imprisonment  than  if  on  conviction 
he  received  the  legal  punishment  for  the  offence !  (The  Queen  v. 
Reynolds,  Bodmin  Aut.  Ass.  1843.)  The  judge  is  reported  to  have 
said  that  there  was  no  proof  of  insanity.  If  the  prisoner  was  pro- 
nounced insane,  he  might  be  imprisoned  for  life,  and  therefore  he 
did  not  think  that  finding  would  benefit  him !  A  verdict  of  guilty 
was  returned,  and  the  man  was  sentenced  to  eighteen  months'  im- 
prisonment. This  case  shows  that  a  defence  of  this  kind  may  be 
sometimes  indiscreetly  put  forward.  Such  a  mode  of  dealing  with 
the  plea  of  insanity,  i.  e.  of  making  it  a  question  of  expediency  de- 
pendent on  the  amount  of  punishment  for  the  offence,  must  be  pro- 
nounced as  unsafe  and  indefensible.  Murder,  incendiarism,  and 
theft  are  the  crimes  for  which  the  plea  of  insanity  is  commonly 
raised ;  and  it  has  been  generally  confined  in  this  country  to  those 
cases  in  which  persons  have  been  charged  with  murder  or  attempts 
at  murder. 

Murder  may  be  perpetrated  by  one  who  is  obviously  laboring 
under  delirium  or  violent  mania,  or  by  an  idiot  or  imbecile.  Apart 
from  the  circumstances  connected  with  the  criminal  act,  there  may 
be  evidence  of  such  a  disordered  state  of  mind  in  the  person,  as  at 
once  to  exonerate  him  from  that  amount  of  responsibility  which  is 
exacted  from  one  who  is  sane.  The  appearance  of  the  accused,  or 
the  testimony  of  a  medical  man,  renders  it  unnecessary  to  go  into 
the  evidence,  and  a  verdict  is  returned  accordingly.  The  cases  of 
difficulty  are  those  in  which  insanity  presents  itself  in  a  doubtful 
aspect,  as  in  mania  or  imbecility.  The  mental  disorder  may  be  of  so 
Blight  a  nature  as  not  legally  to  justify  an  acquittal  for  murder.  In 
order  to  exculpate  a  person  it  must  be  proved  that  insanity  in  a 
certain  degree  existed  at  the  time  of  the  perpetration  of  the  act. 
"Whether  the  prisoner  is  or  is  not  insane  when  placed  on  his  trial  is 
immaterial  in  reference  to  the  question  of  responsibility.  In  the 
case  of  Murray  (tried  before  the  High  Court  of  Judiciary,  Edin- 


680  INSANITY.      RESPONSIBILITY 

burgh,  Nov.  1858),  it  was  proved  that  the  accused  recovered  his 
sanity  eight  hours  after  he  had  killed  the  deceased ;  but  he  was 
acquitted  on  the  ground  of  insanity  at  the  time  of  committing  the 
act. 

The  proved  existence  of  mental  disease  does  not  necessarily  ex- 
empt a  person  from  criminal  responsibility.  Many  a  man  whose 
mind  is  in  an  unsound  state  knows  perfectly  well  whether  he  is  doing 
wrong;  and  so  long  as  he  knows  that,  he  is  considered  to  be  subject 
to  the  criminal  law.  The  existence  of  a  morbid  delusion  cannot 
always  be  allowed  to  screen  a  criminal  from  the  consequences  of  his 
own  acts,  while  on  the  other  hand  there  are  instances  in  which  a 
plea  of  insanity  may  properly  be  allowed,  although  no  delusion  can 
be  proved.  Each  case  must  be  taken  with  all  its  surrounding  cir- 
cumstances, and  legal  theories  of  insanity  are  chiefly  valuable,  not 
as  rigorous  axioms  of  law,  but  as  cautions  to  be  observed  by  the 

JUI7- 

The  great  difference  of  opinion  which  exists  between  physicians 

and  jurists  in  reference  to  this  plea,  appears  to  me  to  consist  in  this  : 
Most  jurists  aver  that  no  degree  of  insanity  should  exempt  from 
punishment  for  crime,  unless  it  has  reached  that  point  that  the  -person 
is  utterly  unconscious  of  iht  difference  between  right  and  wrong  at  the 
time  of  committing  the  alleged  crime.  Physicians,  on  the  other 
hand,  affirm  that  this  is  not  a  proper  test  of  the  existence  of  that  de- 
gree of  insanity  which  should  exempt  a  man  from  punishment ;  that 
those  who  are  laboring  under  confirmed  insanity,  and  who  have  been 
properly  confined  in  asylums  for  years,  are  fully  conscious  of  the 
difference  between  right  and  wrong,  and  are  quite  able  to  appreciate 
the  illegality?'  as  well  as  the  consequences  of  their  acts.  Again,  those 
who  have  patiently  watched  the  insane  for  years,  agree  that  the  legal 
test  of  utter  unconsciousness  of  right  and  wrong  in  the  perform- 
ance of  acts  would  in  reality  apply  only  to  persons  who  were  suffer- 
ing from  delirium,  from  a  furious  paroxysm  of  mania,  or  from  con- 
firmed idiocy ;  and  that  if  the  rule  suggested — that  a  person,  in  order 
to  be  acquitted  on  the  ground  of  insanity,  should  be  first  proved  to 
be  as  unconscious  of  his  act  as  a  baby — were  strictly  carried  out, 
there  is  scarcely  an  inmate  of  an  asylum  who  happened  to  destroy 
a  keeper  or  attendant  who  might  not  be  executed  for  murder.  Such 
a  rule  amounts  to  a  reductio  ad  dbsurdum ;  it  would  abolish  all  dis- 
tinction between  the  sane  and  the  insane,  between  the  responsible 
and  the  irresponsible ;  and  it  would  consign  to  the  same  punishment 
the  confirmed  lunatic  and  the  sane  criminal.  This  species  of  baby- 
unconsciousness  of  action  exists  in  idiots  as  well  as  in  furious  maniacs, 
but  not  in  the  majority  of  lunatics ;  and  it  may  be  safely  asserted 
that,  if  this  criterion  be  the  true  one,  acquittals  on  the  ground  of 
insanity  have  involved  a  series  of  gross  mistakes  for  the  last  fifty 
years.  It  may  be  said  that  the  consciousness  of  the  insane  is  an  in- 
sane consciousness,  while  the  law  implies  the  consciousness  of  a 
sound  mind  ;  but  this  involves  apetitio  principii.  There  have  been 
numerous  cases  of  acquittal  in  which,  until  the  act  of  homicide  was 
committed,  there  was  no  imputation  either  against  the  sanity  or  the 
sane  consciousness  of  the  accused.     Having  pointed  out  these  incon- 


FOR    CRIMINAL    ACTS.  681 

sistencies,  it  is  only  proper  to  acknowledge  that  in  theory  the  Eng- 
lish law  would  punish  a  lunatic  just  as  it  would  punish  a  sane  man, 
provided  the  lunatic  "  had  that  degree  of  intellect  which  enabled 
him  to  know  and  distinguish  between  right  and  wrong,  or  what  was 
lawful  and  unlawful ;  if  he  knew  what  would  be  the  effects  of  his 
crime,  and  consciously  committed  it ;  and  further,  if  with  that  con- 
sciousness he  wilfully  and  intentionally  committed  it."  In  practice, 
however,  it  is  placed  beyond  doubt  that  some  who  ought  to  be  con- 
victed under  these  rules  are  acquitted  on  the  legal  fiction  that  they 
were  at  the  time  unconscious  (or  only  insanely  conscious)  of  the 
wrongfulness  of  their  acts.  Dr.  Wood  states,  that  of  thirty-three 
men  confined  as  lunatics  in  Bethlehem  who  had  actually  committed 
murder,  not  including  those  where  an  unsuccessful  attempt  was  made 
to  perpetrate  the  same  crime,  three  were  reported  sane ;  he  feels  quite 
satisfied  that  two  of  these  were  not  insane  at  the  time  they  committed 
the  murders,  and  of  the  fifteen  men  who  had  actually  committed 
murder,  five  were  reported  sane,  and  two  of  them  ought,  in  his  judg- 
ment, never  to  have  been  acquitted  on  the  ground  of  insanity.  ("  Plea 
of  Insanity,"  p.  50.)  According  to  Dr.  Hood,  in  the  six  years  from 
1852  to  1858,  120  persons  who  were  tried  for  murder,  or  attempt  at 
murder,  or  acts  of  personal  violence,  were  acquitted  on  the  ground 
of  insanity.  Of  that  number,  79  were  received  into  Bethlehem  Hos- 
pital, and  in  several  instances  they  exhibited  no  symptoms  of  insanity 
while  they  were  resident  in  the  asylum.  These  facts,  then,  are  suffi- 
cient to  show  that  the  rule  of  law  generally  adopted  does  not  err  on 
the  side  of  severity.  The  only  complaint  that  can  be  made  is,  that 
it  operates  with  uncertainty.  Of  late  years  some  learned  judges  have 
admitted  that  there  might  be  a  consciousness  that  the  act  was  wrong 
and  illegal,  and  yet  the  person  would  be  exempted  from  criminal  re- 
sponsibility, provided  it  was  proved  by  other  circumstances,  that  he 
labored  under  a  disease  of  the  mind  sufficient  to  prevent  him  from 
exercising  a  proper  control  over  his  actions. 

When  the  defence  of  insanity  is  set  up,  in  a  charge  of  murder,  in 
order  to  warrant  the  jury  in  acquitting  a  prisoner,  it  must  be  proved 
affirmatively  that  he  was  insane  in  a  certain  legal  sense,  at  the  time  of 
perpetrating  the  act;  if  this  be  left  in  doubt,  and  if  the  crime  charged 
in  the  indictment  be  proved,  it  is  their  duty  to  convict  him.  Beg. 
v.  Stokes,  8  Car.  and  Kir.  p.  185.)  It  is  necessary  to  impress  upon 
the  mind  of  the  medical  witness,  that  it  is  not  medical  but  legal 
insanity  which  has  to  be  proved  on  these  occasions  to  the  satisfac- 
tion of  a  jury.  As  no  two  medical  men  agree  about  what  is  mad- 
ness in  a  medical  sense,  and  as  some  "mad  doctors"  have  even  held 
that  all  great  criminals  are  necessarily  insane,  it  is  obvious  that  the 
power  to  absolve  from  responsibility  could  not  be  placed  in  the 
hands  of  the  profession  with  a  due  regard  to  the  protection  of  society, 
or  a  safe  administration  of  the  law.  The  facts  stated  by  Drs.  Hood 
and  Wood,  in  reference  to  the  admission  of  alleged  criminal  lunatics 
into  Bethlehem  (supra),  show  that  either  by  legal  or  medical  inge- 
nuity, or  both  combined,  sane  men  are  incarcerated  as  irresponsible 
lunatics ! 

Homicidal  Insanity. — Homicidal  mania  or  monomania  is  commonly 


632  HOMICIDAL    INSANITY. 

defined  to  be  a  state  of  partial  insanity,  accompanied  by  an  impulse 
to  the  perpetration  of  murder :  hence  it  is  sometimes  called  impul- 
sive or  paroxysmal  mania.  There  may  or  may  not  be  evidence  of 
intellectual  aberration,  but  the  main  feature  of  the  disorder  is  the 
existence  of  a  destructive  impulse  which,  like  a  delusion,  cannot  be 
controlled  by  the  patient.  This  impulse,  thus  dominating  over  all 
other  feelings,  leads  a  person  to  destroy  those  to  whom  he  is  most 
fondly  attached,  or  any  one  who  may  be  involved  in  his  delusion. 
Sometimes  the  impulse  is  long  felt,  but  concealed  and  restrained: 
there  may  be  merely  signs  of  depression  and  melancholy,  low  spirits, 
and  loss  of  appetite,  as  well  as  eccentric  or  wayward  habits,  but 
nothing  to  lead  to  a  suspicion  of  the  fearful  contention  which  may 
be  going  on  within  the  mind.  As  in  suicidal  mania,  many  of  those 
who  are  in  habits  of  daily  intercourse  with  the  patients  have  been 
first  astounded  by  the  act  of  murder,  and  then  only  for  the  first  time 
led  to  conjecture  that  certain  peculiarities  of  language  or  conduct, 
scarcely  noticed  at  the  time,  must  have  been  symptoms  of  insanity. 
Occasionally  the  act  of  murder  is  perpetrated  with  great  deliberation, 
and  apparently  with  all  the  marks  of  sanity.  These  cases  are  ren- 
dered difficult  by  the  fact  that  there  may  be  no  distinct  proof  of  the 
existence,  past  or  present,  of  any  disorder  of  the  mind,  so  that  the 
chief  evidence  of  mental  disorder  is  the  act  itself:  of  the  existence  of 
insanity,  in  the  common  or  legal  acceptation  of  the  term,  before  and 
after  the  perpetration  of  the  crime,  there  may  be  either  no  evidence 
whatever,  or  it  may  be  so  slight  as  not  to  amount  to  proof.  Such 
cases  are  regarded  and  described  by  some  medico- legal  writers  as 
instances  of  insanity  of  the  moral  feelings  only,  and  this  condition  has 
been  called  "  Moral  insanity"  (p.  639).  Its  existence,  as  a  state  inde- 
pendent of  a  simultaneous  disturbance  of  the  reason  or  intellect,  is 
denied  by  the  great  majority  of  lawyers,  as  well  as  by  some  eminent 
medical  authorities.  Whether  such  a  condition  exists  or  not  is  a 
simple  question  of  fact,  to  be  established  if  possible  by  clear  and 
conclusive  evidence.  Its  existence  in  the  case  of  a  person  charged 
with  murder  appears  to  have  rested  hitherto  on  a  mere  medical  dic- 
tum. Intelligible  reasons  have  not  been  assigned  by  those  witnesses 
who  have  sought  to  satisfy  a  court  of  law  that  this  has  as  distinct  an 
existence  as  intellectual  insanity;  in  general,  it  is  only  alleged  and 
not  proved  to  exist  in  a  given  case.  If  its  existence  were  satisfac- 
torily established,  it  would,  as  Mr.  Stephen  observes,  do  away  with 
one  of  the  essential  ingredients  of  crime — malice,  and  thus  justify  a 
jury  in  acquitting  a  person  charged  with  murder.  The  accused  on 
these  occasions  is  assumed  to  have  been  an  involuntary  agent.  As 
Mr.  Stephen  suggests,  it  might  be  a  good  defence  to  admit  that  a 
man  loaded  a  pistol  and  pointed  it  at  the  head  of  another,  but  that  it 
was  fired  by  a  sudden  involuntary  action  of  the  necessary  muscles, 
and  not  by  the  prisoner's  will.  The  only  difficulty  is  to  get  a  jury 
to  believe  it !  The  evidence  given  in  support  of  the  assertion  that 
a  man  is  morally  insane  is,  generally  speaking,  at  least  as  consistent 
with  the  theory  that  he  is  a  great  fool  and  a  great  rogue,  as  with 
the  theory  that  he  is  the  subject  of  a  special  disease  the  existence  of 
which  is  doubtful.    ("  Criminal  Law,"  p.  95.)     There  is  no  doubt  that 


SYMPTOMS.  683 

the  unrestricted  admission  of  such  a  theory  would  go  far  to  do  away 
with  all  punishment  for  crime,  for  it  would  render  it  utterly  impos- 
sible to  draw  a  line  between  (moral)  insanity  and  moral  depravity. 
What  is  crime  but  the  perversion  of  moral  feelings  ?  Moral  insanity 
in  a  person  of  sound  mind  is  a  contradiction  in  terms ;  whenever  the 
mind  is  sound,  a  man's  conscience  and  sense  of  right  and  wrong  will 
always  be  sufficient  to  enable  him  to  restrain  evil  desires  and  im- 
pulses. 

Symptoms. — Homicidal  mania  in  its  more  common  form,  may  make 
its  appearance  at  all  ages,  even  in  children  ;  it  is  occasionally  peri- 
odical, and  the  paroxysm  of  insanity  is  preceded  by  symptoms  of 
general  excitement.  The  patient  experiences  colicky  pains,  and  a 
sense  of  heat  in  the  abdomen  or  chest ;  headache,  restlessness,  and 
loss  of  appetite,  with  lowness  of  spirits ;  the  face  is  flushed  or  pale, 
the  pulse  hard  and  full,  and  the  whole  body  is  in  a  state  of  convul- 
sive trembling.  An  act  of  violence  is  committed  without  warning, 
and  the  patient  appears  as  if  relieved  from  some  oppressive  feeling. 
He  may  be  calm,  and  express  neither  regret,  remorse,  nor  fear ;  he 
may  coolly  contemplate  his  victim,  confess  the  deed,  and  at  once 
surrender  himself  to  justice.  In  some  rare  instances  he  may  con- 
ceal himself,  hide  the  weapon,  and,  like  a  sane  criminal,  endeavor  to 
obliterate  all  traces  of  the  crime — thus  showing  a  perfect  conscious- 
ness of  the  illegality  or  wrongfulness  of  the  act,  and  a  desire  to  evade 
discovery.  These  are,  however,  the  main  features  of  crime,  and  un- 
less there  is  independent  evidence  of  mental  disorder,  or  of  some 
bodily  disease  affecting  the  brain  and  destroying  the  power  of  self- 
control,  the  conclusion  must  be  that  the  person  is  sane  and  responsi- 
ble. The  great  problem  to  be  solved  on  these  occasions  is — What 
are  the  plain  practical  distinctions  between  defective  reasoning  power 
and  perverted  moral  sense  ?  The  latter  condition  alone  should  not 
exculpate  a  person  or  absolve  him  from  punishment — or  persons  un- 
deniably sane  who  have  committed  crimes,  should  be  equally  excul- 
pated and  absolved  from  punishment. 

The  symptoms  above  described  have  been  observed  to  be  more 
aggravated  in  proportion  as  the  homicidal  impulse  was  strong.  The 
propensity  to  kill  is  sometimes  a  fixed  idea,  and  the  patient  can  no 
more  banish  it  from  his  thoughts  than  a  person  afflicted  with  insanity 
can  divest  himself  of  the  delusive  ideas  which  occupy  the  mind. 
(Esquirol,  vol.  2,  p.  105.)  It  has  been  supposed  that  Esquirol  here 
implies  a  state  in  which  there  is  no  perversion  of  intellect.  The  facts 
which  he  mentions,  however,  clearly  prove  the  contrary ;  for  if  a 
patient  has  not  the  power  to  banish  from  his  thoughts  this  propensity 
to  kill,  he  has  passed  beyond  the  bounds  of  reason,  and  is  really  in- 
sane. The  admission  of  this  fact  proves  that  his  mind  must  be 
unsound.  Esquirol  says — before  the  perpetration  of  the  act  there 
may  be  no  sign  of  irrational  conversation  or  conduct ;  but  he  asks 
the  question:  because  there  is  no  proof  of  irrationality,  are  we  to 
assume  that  these  persons  possess  reason  ?  Is  it  possible  to  reconcile 
the  existence  of  a  rational  state,  of  mind  with  the  murder  of  those 
who  are  most  dear  to  them  ?  (Op.  cit.  vol.  2,  p.  102.)  In  Esquirol's 
view,  therefore,  it  may  be  taken  that  mere  perversion  of  feelimjs 


684  HOMICIDAL    INSANITY. 

(insanity),  irrespective  of  some  latent  aberration  of  intellect,  does  not 
exist,  and  moral  insanity  is  a  conventional  term  for  a  state  in  which 
the  proofs  of  mental  disturbance  are  not  so  clear  as  in  the  generality 
of  cases. 

An  erroneous  notion  prevails  in  the  public  mind,  that  a  homicidal 
lunatic  is  easily  to  be  distinguished  from  a  sane  criminal  by  some 
certain  and  invariable  symptoms  or  characters,  which  it  is  the  duty 
of  a  medical  witness  to  display  in  evidence,  and  of  a  medico-legal 
writer  to  describe.  But  a  perusal  of  the  evidence  given  at  a  few 
trials  will  surely  satisfy  those  who  hold  this  opinion,  that  each  case 
must  stand  by  itself.  It  is  easy  to  classify  homicidal  lunatics,  and 
say  that  in  one  instance  the  murderous  act  was  committed  from  a 
motive,  i.  e.,  revenge  or  jealousy;  in  a  second  from  no  motive,  but 
from  irresistible  impulse ;  in  a  third  from  illusion  or  delusive  motive, 
i.  e.,  mental  delusion;  in  a  fourth  from  perverted  moral  feeling,  with- 
out any  sign  of  intellectual  aberration.  This  classification  may 
comprise  all  the  varieties  of  homicidal  insanity,  but  it  does  not  help 
us  to  ascertain,  in  a  doubtful  case,  whether  an  act  was  or  was  not 
committed  under  an}?-  of  these  psychological  conditions.  It  enables 
us  to  classify  those  who  are  acquitted  on  the  ground  of  insanity,  but 
it  entirely  fails  in  giving  us  the  power  to  distinguish  a  sane  from  an 
insane  criminal,  or  a  responsible  from  an  irresponsible  agent.  Ac- 
cording to  M.  Esquirol,  whose  views,  more  or  less  modified,  are 
adopted  by  all  writers  on  the  medical  jurisprudence  of  insanity,  the 
facts  hitherto  observed  indicate  three  degrees  of  homicidal  mania  : — 

1.  In  the  first  degree  the  propensity  to  kill  is  connected  with  ab- 
surd or  irrational  motives  or  with  actual  delusion.  The  person  would 
be  at  once  pronounced  insane.  Cases  of  this  description  are  not  un- 
common, and  they  rarely  create  any  difficulty. 

2.  In  the  second  degree,  the  desire  to  kill  is  connected  with  no 
Jcnown  motive.  It  is  difficult  to  imagine  a  motive  for  the  deed;  the 
person  appears  to  have  been  led  on  by  some  impulse.  There  may 
have  been  delusion,  but  there  is  no  evidence  of  the  pre-existence  of 
this.  With  respect  to  this  class  of  cases,  Mr.  Stephen  observes: 
"  There  are  motives  for  all  acts  even  the  maddest,  but  it  is  frequently 
impossible  to  assign  them  specifically.  It  is,  however,  generally 
impossible  to  form  an  opinion  whether  a  given  act  was  done  from 
some  unknown  mad  motive,  or  from  some  unknown  sane  motive." 
(Op.  cit.  p.  88.) 

3.  In  the  third  degree,  the  impulse  to  kill  is  sudden,  instantaneous, 
unreflecting,  and  uncontrollable  {phis  forte  que  la  voloate).  The  act  of 
homicide  is  perpetrated  without  interest,  without  motive,  and  often 
on  persons  who  are  most  fondly  loved  by  the  perpetrator.  (Esquirol 
"Maladies  Mentales,"  vol.  ii.  p.  834.)  It  is  this  form,  which  has  been 
called  "  impulsive  insanity,"  which  has  given  rise  to  so  much  con- 
tention on  trials  for  murder  in  which  insanity  is  set  up  as  a  defence, 
and  therefore  it  will  be  well  to  consider  this  subject  in  a  legal  aspect. 
Mr.  Stephen  thus  comments  upon  it:  "It  is  said  that  on  particular 
occasions  men  are  seized  with  irrational  or  irresistible  impulses  to 
kill,  to  steal,  or  to  burn,  and  under  the  influence  of  such  impulses 


HOMICIDAL    INSANITY.  685 

may  sometimes  commit  acts  which  would  otherwise  be  most  atro- 
cious crimes.  It  would  be  absurd  to  deny  the  possibility  that  such 
impulses  may  occur,  or  the  fact  that  they  have  occurred  and  have 
been  acted  on.  Instances  are  given  in  which  the  impulse  was  felt 
and  resisted.  The  only  question  which  the  existence  of  such  im- 
pulses can  raise  in  the  administration  of  criminal  justice,  is  whether 
the  particular  impulse  was  irresistible  as  well  as  unresisted.  If  it  was 
irresistible,  the  person  accused  is  entitled  to  be  acquitted,  because 
the  act  would  not  then  be  voluntary  and  not  properly  his  act.  If 
the  impulse  was  resistible,  the  fact  that  it  proceeded  from  disease 
would  be  no  excuse  at  all.  If  a  man's  nerves  were  so  irritated  by  a 
baby's  crying  that  he  instantly  killed  it,  his  act  would  be  murder; 
it  would  not  be  less  murder  if  the  same  irritation  and  corresponding 
desire  were  produced  by  some  internal  disease.  The  great  object  of 
the  criminal  law  is  to  induce  people  to  control  their  impulses ;  and 
there  is  no  reason  why,  if  they  can,  they  should  not  control  insane  as 
well  as  sane  impulses.  The  proof  that  an  impulse  was  irresistible 
depends  on  the  circumstances  of  the  particular  case.  The  commonest 
and  strongest  cases  are  those  of  women  who,  without  motive  or  con- 
cealment, kill  their  children  after  recovery  from  childbed"  (puerperal 
mania).     (Op.  cit.  p.  95.) 

The  three  forms  in  which  a  homicidal  propensity  may  thus  present 
itself  in  cases  of  insanity  differ  from  each  other  only  in  degree — the 
two  first  being  strongly  analogous  to  but  lighter  modifications  of 
the  third.  All  the  cases  which  came  before  M.  Esquirol  had  these 
features  in  common — an  irritable  constitution,  great  excitability, 
singularity  or  eccentricity  of  character ;  and  previously  to  the  mani- 
festation of  the  homicidal  feeling  there  was  a  gentle,  kind,  and  affec- 
tionate disposition.  As  in  other  forms  of  insanity,  there  was  some 
well-marked  change  of  character  in  the  mode  of  life ;  and  this  may  be 
taken  as  a  proof  that  there  must  have  been  some  degree  of  intellec- 
tual disturbance.  The  period  at  Which  the  disorder  commenced  and 
terminated  could  be  easily  defined,  and  the  attack  could  be  almost 
always  referred  to  some  moral  or  physical  cause.  Attempts  at 
suicide  preceded  or  followed  the  attacks ;  all  wished  to  die,  and 
some  desired  to  be  put  to  death  like  criminals.  In  none  of  these  cases 
was  there  any  discoverable  motive  for  the  act  of  homicide. 

M.  Esquirol  believes  that  there  are  well-marked  distinctions  be- 
tween this  state  and  that  of  the  sane  criminal.  Among  these  he 
enumerates :  1.  The  want  of  accomplices  in  homicidal  mania.  2. 
The  sane  criminal  has  always  a  motive — the  act  of  murder  is  only  a 
means  for  gratifying  some  other  more  or  less  criminal  passion,  and 
is  almost  always  accompanied  by  some  other  wrongful  act;  the  con- 
trary exists  in  homicidal  mania.  3.  The  victims  of  the  criminal  are 
those  who  oppose  his  desires  or  his  wishes — the  victims  of  the 
monomaniac  are  among  those  who  are  either  indifferent  to  or  who 
are  the  most  dear  to  him.  4.  The  sane  criminal  endeavors  to  con- 
ceal, and  if  taken  denies  the  crime  ;  if  he  confesses  it,  it  is  only  with 
some  reservation,  and  when  circumstances  are  too  strong  against 
him ;  but  he  commonly  denies  it  to  the  last  moment — it  is  the  reverse 


686  LEGAL    TESTS. 

with  the  monomaniac.  The  exceptions  to  which  these  characters 
are  open  will  be  considered  hereafter.  They  have,  undoubtedly, 
greater  value  in  their  combined  than  in  their  individual  application, 
and  when  in  any  case  they  coexist,  there  is  strong  reason  to  believe 
that  the  person  accused  of  murder  is  laboring  under  a  homicidal 
mania.  The  great  difficulty  in  these  cases,  however,  is  to  distinguish 
moral  depravity  from  insanity.  I  agree  with  a  medico-legal  writer 
on  this  subject,  that  "no  hideousness  of  depravity  can  amount  to 
proof  of  insanity,  unsupported  by  some  evidence  of  a  judgment  in- 
capacitated, or  of  a  will  fettered  by  disease.  In  those  cases  in  which 
the  emotions  are  perverted,  and  where  there  is  no  clear  proof  of 
deranged  intellect — cases  which  do  from  time  to  time  occur — the  pre- 
sumption of  insanity  in  regard  to  a  criminal  action  has  to  be  upheld 
by  evidence  of  a  suspension  of  the  will  from  mental  disease.  If  it 
can  be  proved  that  the  act  was  not  voluntary,  this  does  away  with 
its  criminal  nature."  (Jamieson's  Lectures  on  the  Med.  Jur.  of  In- 
sanity! "  Med.  Gaz.,"  vol.  48,  p.  181.)  But  it  is  impossible  in  many 
cases  to  produce  satisfactory  evidence  of  the  suspension  of  the  will 
as  a  result  of  disordered  mind :  this  suspension  can  in  general  be 
assumed  only  from  the  act  itself — a  dangerous  assumption,  and  one 
that  might  lead  to  the  crime  of  insanity,  and  to  the  exculpation  of 
all  criminals. 

Legal  Tests. — Admitting  the  existence  of  homicidal  mania,  as  thus 
defined  by  Esquirol,  it  may  become  a  question,  how,  when  pleaded 
for  one  charged  with  murder,  it  is  to  be  practically  distinguished 
from  a  case  in  which  the  crime  has  been  perpetrated  by  a  really  sane 
person.  Tests,  both  medical  and  legal,  have  been  proposed.  The 
legal  test  was  explicitly  stated  in  the  following  terms  by  the  whole 
of  the  judges  in  conference,  in  answer  to  queries  put  by  the  House 
of  Lords  on  the  case  of  M.  Naughten,  who  was  tried  and  acquitted  on 
the  ground  of  insanity  (June  19,  1818): — 

"Notwithstanding  a  party  commits  a  wrong  act  while  laboring 
under  the  idea  that  he  was  redressing  a  supposed  grievance  or  injury, 
or  under  the  impression  of  obtaining  some  public  or  private  benefit, 
he  is  liable  to  punishment.  The  jury  ought  in  all  cases  to  be  told 
that  every  man  should  be  considered  of  sane  mind  until  the  con- 
trary was  clearly  proved  in  evidence;  that,  before  a  plea  of  insanity 
should  be  allowed,  undoubted  evidence  ought  to  be  adduced  that 
the  accused  was  of  diseased  mind,  and  that  at  the  time  he  committed 
the  act  he  was  not  conscious  of  right  or  wrong.  Every  person  was  sup- 
posed to  know  what  the  law  was,  and  therefore  nothing  could  jus- 
tify a  wrong  act,  except  it  was  clearly  proved  that  the  party  did  not 
know  right  from  wrong;  if  that  was  not  satisfactorily  proved,  the  ac- 
cused was  liable  to  punishment.  If  the  delusion  under  which  a  per- 
son labored  were  only  partial,  the  party  accused  was  equally  liable 
with  a  person  of  sane  mind.  If  the  accused  killed  another  in  self- 
defence,  he  would  be  entitled  to  an  acquittal;  but  if  the  crime  were 
committed  for  any  supposed  injury,  he  would  then  be  liable  to  the 
punishment  awarded  by  the  laws  to  his  crime."  ("Brit,  and  For. 
Med.  Kev."  July,  1813,  p.  273.)     [See  Dr.  Bucknill's  remarks  upon 


LEGAL    TESTS.  687 

M'Naughten's  case,  and  bis  criticism  upon  the  dicta  of  the  judges, 
in  answer  to  the  queries  of  the  House  of  Lords.  Bucknill's  Essay 
on  Criminal  Lunacy  ("Law  Library,"  vol.  92),  p.  -i-i  et  seq. — P.] 

It  would  appear  that  the  law,  as  thus  laid  down,  in  order  to  render 
a  man  responsible  for  crime,  looks  for  a  co7isciousness  of  right  and 
wrong,  and  a  knowledge  of  the  consequences  of  the  act;  while  the  ad- 
ministration of  justice  rests  on  the  principle  that  every  one  knows 
the  law  and  fears  its  punishment  Thus,  the  complete  possession 
of  reason  is  not  essential  to  constitute  the  legal  responsibility  of  an 
offender;  and  it  is  also  to  be  inferred,  from  the  results  of  several 
cases,  that  a  man  may  be  civilly  incompetent,  but  sufficiently  sane 
to  be  made  criminally  responsible.  The  proofs  required  in  the  two 
cases  are  essentially  distinct. 

It  has  been  objected  to  this  legal  test,  that  it  is  insufficient  for  the 
purpose  intended:  it  cannot,  in  a  large  majority  of  cases  enable  us 
to  distinguish  the  insane  homicide  from  the  sane  criminal.  Many 
insane  persons  have  committed  acts  which  they  knew  to  be  wrong, 
and  of  the  criminality  of  which  they  were  at  the  time  perfectly  con- 
scious. They  have  been  known  to  murder  others,  in  order  to  re- 
ceive the  punishment  of  death  at  the  hands  of  the  law;  and  there- 
fore they  must  have  been  conscious  of  the  wrongfulness,  or  rather 
of  the  illegality,  of  the  act  which  they  were  perpetrating,  and  have 
known  that  they  were  committing  an  offence  punishable  by  the  law 
of  man.  In  short,  the  criminal  nature  of  the  act  has  often  been  the 
sole  motive  for  its  perpetration!  ("Ann.  d'Hyg."  1852,  vol.  1,  p. 
363.)  It  has  been  suggested,  with  some  truth,  that  it  is  rather  the 
imperfect  or  defective  appreciation  of  the  motives  to  right  or  against 
wrong  action  which  leads  to  crime  among  the  insane,  and  not  the 
mere  ignorance  of  right  and  wrong.  Most  lunatics  have  an  abstract 
knowledge  that  right  is  right  and  wrong  wrong ;  but  in  true  in- 
sanity the  voluntary  power  to  control  thought  and  actions,  and  to 
regulate  conduct  by  this  standard,  is  impaired,  limited,  or  overruled 
by  insane  motives.  A  lunatic  may  have  the  power  of  distinguishing 
right  from  wrong,  but  he  has  not  the  power  of  choosing  right  from 
wrong.  A  criminal  is  punishable  not  merely  because  he  has  the 
power  of  distinguishing  right  from  wrong,  but  because  he  volun- 
tarily does  the  wrong,  having  the  power  to  choose  the  right.  (Jamie- 
son's  Lectures  on  Insanity,  "Med.  Gaz."  vol.  46,  p.  827.) 

[Dr.  Forbes  Winslow,  in  speaking  of  the  defence  of  insanity  in 
criminal  cases,  uses  the  following  language :  "  When  such  ques- 
tions have  come  before  the  judicial  tribunals  of  the  country,  the 
presiding  judge,  in  his  charge  to  the  jury,  has  invariably  referred 
to  the  dicta  of  preceding  administrators  of  the  law,  and  has  quoted 
their  definition  or  description  of  insanity  as  an  unerring  test  of  the 
presence  of  mental  derangement  in  any  case  in  which  the  malady  is 
alleged  to  exist. 

"  How  absurd,  upon  reflection,  must  such  a  course  of  procedure 
be.  Has  not  our  knowledge  of  the  disorders  of  the  mind  advanced 
during  the  last  fifty  years?  Do  we  not  know  more  of  insanity  than 
our  professional  brethren  did  who  lived  in  the  days  of  Coke,  Mans- 


688  LEGAL    TESTS. 

field,  and  Erskine  ?  If  so,  how  ridiculous  it  is  to  cite  their  opinions 
or  to  bind  us  down  to  the  authority  of  men  whose  information  on 
this  subject  must  of  necessity  have  been  extremely  limited  and  circum- 
scribed. The  judges  of  the  land  appear  to  have  had  no  settled  or  clear 
views  on  the  subject  of  insanity."  *  *  *  "  After  an  examination 
of  the  cases  which  have  been  brought  forward  in  this  work,  it  must 
be  evident  that  the  capability  of  '  distinguishing  between  right  and 
wrong,'  is  not  an  unerring  test  to  which  to  appeal.  A  person  may 
be  perfectly  competent  to  draw  a  correct  distinction  between  right 
and  wrong,  and  yet  labor  under  a  form  of  insanity  which  ought  un- 
questionably to  protect  him  from  legal  or  moral  responsibility.'' 
(Plea  of  Insanity,  p.  73.)  "  The  knowledge  attained  by  men,  of  a 
subject  which  they  have  grappled  all  their  lives,"  says  Chief  Justice 
Gibson,  in  Smith  v.  Kramer,  1  Am.  Law  Eeg.  358,  "  ought  surely  to 
prevail  against  knowledge  gleaned  from  the  hornbooks  of  a  pro- 
fession to  which  the  gleaners  did  not  belong." 

The  same  eminent  judge,  in  the  case  of  Corn.  v.  Jlosler,  -A  Barr. 
266,  admitted  that  moral  insanity,  if  established,  would  relieve  the 
defendant  from  criminal  responsibility.  "  There  may  be,"  said  he, 
in  his  charge  to  the  jury,  "  an  unseen  ligament  pressing  on  the 
mind,  drawing  it  to  consequences  which  it  sees  but  cannot  avoid,  and 
placing  it  under  a  coercion,  which,  while  its  results  are  clearly  per- 
ceived, is  incapable  of  resistance.  The  doctrine  which  acknowledges 
this  mania  is  dangerous  in  its  relations,  and  can  be  recognized  only 
in  the  clearest  cases.  It  ought  to  have  been  shown  to  have  been 
habitual,  or  at  least  to  have  evinced  itself  in  more  than  a  single  in- 
stance. It  is  seldom  directed  against  a  particular  individual ;  but 
that  it  may  be  so,  is  proved  by  the  case  of  the  young  woman  who 
was  deluded  by  an  irresistible  impulse  to  destroy  her  child,  though 
aware  of  the  heinous  nature  of  the  act.  The  frequency  of  this  con- 
stitutional malady  is  fortunately  small,  and  it  is  better  to  confine  it 
within  the  strictest  limits.  If  juries  were  to  allow  it  as  a  general 
motive,  operating  in  cases  of  this  character,  its  recognition  would 
destroy  social  order  as  well  as  personal  safety.  To  establish  it  as  a 
justification  in  any  particular  case,  it  is  necessary  either  to  show,  by 
clear  proofs,  its  contemporaneous  existence  evinced  by  present  cir- 
cumstances, or  the  existence  of  an  habitual  tendency  developed  in 
previous  cases,  becoming  in  itself  a  second  nature."  The  defence 
was  not  established  in  this  case,  and  the  prisoner  was  convicted. 

Judge  Lewis,  afterwards  Chief  Justice  of  Pennsylvania,  in  a  case 
which  was  tried  before  him  while  presiding  in  Lycoming  County, 
used  the  following  language,  in  speaking  upon  the  same  subject : 
"Moral  insanity  arises  from  the  existence  of  some  of  the  natural 
propensities  in  such  violence  that  it  is  impossible  not  to  yield  to 
them.  It  has  a  striking  resemblance  to  vice,  which  is  said  to  consist 
in  an  undue  excitement  of  the  passions  and  will,  and  in  their  irregular 
or  crooked  actions  leading  to  crime.  It  is  therefore  to  be  received 
with  the  utmost  scrutiny.  It  is  not  generally  admitted  in  legal  tri- 
bunals as  a  species  of  insanity  which  relieves  from  responsibility 
for  crime,  and  it  ought  never  to  be  admitted  as  a  defence,  until  it  is 


LEGAL    TESTS.  689 

shown  that  these  propensities  exist  in  such  violence  as  to  subjugate 
the  intellect,  control  the  will,  and  render  it  impossible  for  the  party 
to  do  otherwise  than  yield  where  its  existence  is  fully  established. 
This  species  of  insanity  relieves  from  accountability  to  human  laws. 
But  this  state  of  mind  is  not  to  be  presumed  without  evidence,  nor 
does  it  usually  occur  without  some  premonitory  symptoms  indicating- 
its  approach."     (See  Lewis's  Crim.  L.  404.) 

In  the  case  of  Commonwealth  v.  Shurloch,  in  the  Court  of  Oyer  and 
Terminer  of  Philadelphia,  in  January,  1857,  Judge  Allison,  now 
president  judge  of  the  court,  charged  the  jury  that  to  justify  a  verdict 
in  favor  of  the  defendant,  on  the  ground  of  insanity,  they  must  find 
from  the  evidence  in  the  cause,  that  at  the  time  of  the  commission 
of  the  act,  the  defendant  "  was  either  incapable  of  distinguishing 
between  right  and  wrong,  in  relation  to  the  act  perpetrated  by 
him,  and  of  judging  of  the  consequences,  which  would  be  likely 
to  flow  from  the  discharge  of  the  contents  of  his  loaded  pistol 
into  the  body  of  the  deceased — that  reason  as  to  the  act  in  ques- 
tion, must  have  been  overthrown  so  as  to  have  left  the  prisoner  un- 
conscious of  the  deed  committed  by  him  and  its  consequences ;"  or 
that,  "though  conscious  of  the  act  he  was  about  to  perpetrate,  and 
its  results,  yet  governed  by  an  uncontrollable  impulse,  his  will  no 
longer  in  subjection  to  his  reason,  owing  to  the  excited  and  continued  im- 
petuosity of  his  thoughts,  the  tumultuous  and  confused  condition  of  his 
mind,  goaded  by  a  sense  of  grievous  wrong,  he  was  wrought  up  to 
a  frenzy  bordering  upon  madness,  which  for  the  time  being  rendered 
him  unable  to  control  his  actions  or  to  direct  his  movements." 
("  Legal  Intelligencer,"  1857,  p.  33.)  In  the  case  of  Commonwealth 
v.  Sin i tli,  tried  before  the  same  court  in  1858,  the  above  instruction 
was  repeated.  "A  defence  of  this  character,"  said  Judge  Allison, 
in  this  case,  "requires,  however,  to  be  examined  with  the  greatest 
care ;  nor  should  it  be  relied  upon  unless  established  by  the  clearest 
proof.  That  there  is  a  moral  or  homicidal  insanity,  cannot  be  well 
questioned  at  the  present  day."  *  *  *  "  The  doctrine  should, 
however,  be  received  in  all  cases  with  caution,  lest  every  inclina- 
tion to  do  evil  be  set  up  as  an  excuse  for  crime,  and  every  perversion 
of  the  moral  sentiment  be  made  to  serve  as  a  shield  against  punish- 
ment for  a  violation  of  law.  Nothing  could  be  fraught  with  greater 
danger  to  the  peace  and  safety  of  society  than  the  recognition  of  the 
doctrine  that  a  perverted  or  disordered  state  of  the  affections  or 
moral  state  of  the  mind  should  afford  an  immunity  from  punish- 
ment. If  it  amounts  to  anything  short  of  an  absolute  dispossession 
of  the  free  and  natural  agency  of  the  mind,  it  should  be  discarded  as 
having  no  value  as  a  defence."    ("  Legal  Intelligencer,"  1858,  p.  33.) 

It  is  to  be  borne  in  mind,  however,  in  all  cases  of  this  sort,  that 
the  object  of  criminal  laws  is  twofold,  viz.,  reformation  of  the  offender 
and  protection  of  the  community ;  and  that  of  the  two,  the  latter 
is  by  far  the  most  important.  There  is  great  force  therefore  in  the 
remarks  of  Bramwell,  B.  in  the  case  of  Reg.  v.  Roberts,  Maidstone's 
Winter  Assizes,  1860.  The  prisoner  was  indicted  for  arson,  and 
convicted,  notwithstanding  evidence  of  moral  insanity — the  "right 
44 


690  MEDICAL    TESTS. 

and  wrong  test"  being  applied  to  his  case.  "  That  you  are  of  un- 
sound mind  I  believe,"  said  that  learned  judge,  "but  that  is  no 
reason  why  you  should  not  be  punished.  I  address  the  explana- 
tions of  the  reasons  why  I  pass  upon  you  the  sentence  which  I  am 
about  to  pronounce,  not  so  much  to  your  understanding  as  to  those 
around  who  hear  me,  and  to  those  whose  duty  it  is  to  notice  them. 
The  law  makes  unsoundness  of  mind  no  excuse  for  offences,  except 
it  were  such  that  you  did  not  at  the  same  time  know  the  nature  of 
what  you  were  doing,  and  that  it  was  wrong  and  unlawful.  No 
doubt  it  is  very  unfortunate  that  persons  of  unsound  mind  should 
become  by  that  affliction  less  under  the  influence  of  moral  restraints 
and  of  the  restraints  of  law,  but  it  would  be  sad  indeed  for  the  public 
if,  when  these  restraints  are  weakened,  the  protection  of  the  law 
were  to  be  withdrawn  by  the  extension  of  impunity  to  crime.  I  am 
not  sure  that  it  is  not  more  necessary  to  punish  a  madman  than  a 
sane  man,  so  far  as  the  protection  of  the  public  is  concerned.  I  feel 
bound  to  sentence  you  to  the  same  punishment  as  if  you  were  sane." 

The  objection  to  adhering  to  the  old  decisions  with  reference  to 
the  test  of  criminal  responsibility,  in  the  face  of  the  great  advance 
which  has  taken  place  in  the  last  fifty  years  in  the  scientific  know- 
ledge of  the  subject  of  insanity,  is  that  juries  rather  than  suffer  an 
insane  criminal,  whose  unsoundness  does  not  come  up  to  the  anti- 
quated standard,  to  be  punished  in  the  same  manner  as  if  he  were 
sane,  acquit  him  altogether.  He  is  thus  turned  loose :  if  his  insanity 
has  not  been  real,  a  criminal  escapes ;  if  it  has,  then  society  is  again 
exposed  to  the  dangerous  freaks  of  a  madman.  Even  if  they  con- 
vict, notwithstanding  the  actual  existence  of  moral  insanity,  the 
lunatic  is  restrained  only  during  the  period  of  his  sentence,  and  the 
same  result  ensues.  If  judges,  instead  of  "moving  in  the  ruts"  of 
their  predecessors,  would,  as  it  is  the  boast  of  the  common  law  they 
do,  keep  pace  with  the  advance  of  science;  if  juries  were  required, 
as  they  are  in  some  States,  to  find  the  fact  of  insanity  whenever  they 
acquit  on  this  ground ;  or,  if,  what  would  perhaps  be  still  better,  the 
jury,  as  it  has  been  suggested  (Whart.  &  Stille,  "Med.  Jur  "  §  277), 
were  permitted  simply  to  pass  upon  the  mere  fact  of  the  commission 
of  the  act,  leaving  the  consideration  of  the  prisoner's  sanity  for  a 
commission  or  jury  of  scientific  men,  competent  to  decide  so  difficult 
a  question ;  if  whenever  the  prisoner  is  acquitted  because  of  insanity, 
the  court  should  in  all  cases  commit  him  to  a  proper  asylum,  there 
to  remain  until  proved  before  the  same  tribunal  to  be  entirely  restored;  the 
plea  would  be  much  less  frequently  set  up,  and  would  be  much  more 
apt  to  be  properly  decided,  if  it  should  be.  Criminals  would  thus  be 
surer  of  punishment,  the  really  insane  have  an  opportunity  of  being- 
restored  by  proper  treatment,  and  society  have  the  protection  which, 
under  the  "right  and  wrong"  test,  it  so  often  loses.  Where  the 
offence  is  homicide,  as  Dr.  Taylor  very  properly  remarks,  the  confine- 
ment of  the  prisoner  acquitted  on  the  ground  of  moral  insanity, 
should,  for  the  reasons  he  mentions,  be  for  life. — P.] 

Medical  Tests. — The  tests  which  have  been  proposed  by  medical 
jurists  for  detecting  cases  of  homicidal  mania  are  as  follows: — 


HOMICIDAL    INSANITY.  691 

1.  The  acts  of  homicide  have  generally  been  preceded  by  other 
striking  'peculiarities  of  conduct  in  the  person — often  by  a  total 
change  of  character. 

2.  Those  persons  who  are  affected  with  it  have  in  many  instances 
previously  or  subsequently  attempted  suicide — they  have  expressed 
a  wish  to  die  or  to  be  executed  as  criminals.  These  supposed  cri- 
teria when  tendered  as  medical  proofs  of  insanity  in  courts  of  law, 
have  been  repeatedly  and  very  properly  rejected.  They  are  of  too 
vague  a  nature  for  practical  use,  and  apply  as  much  to  cases  of 
moral  depravity  as  of  actual  insanity;  in  short,  if  these  were  ad- 
mitted as  proofs,  they  would  serve  as  a  convenient  shelter  from  pun- 
ishment for  many  sane  criminals. 

3.  Motive  for  Crime. — The  acts  are  without  motive;  they  are  in 
opposition  to  all  human  motives.  A  man  known  to  have  been  ten- 
derly attached  to  his  wife  and  children  murders  them — a  fond 
mother  destroys  her  infant.  It  is  hereby  assumed  or  implied  that 
persons  who  are  sane  never  commit  a  crime  without  an  apparent 
motive,  and  that  in  the  perpetration  of  a  criminal  act  an  insane  per- 
son either  never  has  a  motive,  or  has  one  of  a  delusive  nature  only. 
If  these  propositions  were  true,  it  would  be  easy  to  distinguish  a 
sane  from  an  insane  criminal;  but  the  rule  wholly  fails  in  practice. 
In  the  first  place,  the  non-discovery  is  here  taken  as  a  proof  of  the 
non-existence  of  a  motive ;  while  it  is  undoubted  that  motives  may 
exist  for  many  atrocious  criminal  acts  without  our  being  able  to  dis- 
cover them — a  fact  proved  by  the  numerous  recorded  confessions  of 
criminals  before  execution,  in  cases  in  which  until  these  confessions 
were  made,  no  motive  for  the  perpetration  of  the  crime  had  appeared 
to  the  acutest  minds.     [Com.  v.  Mbsler,  4  Barr.  266. — P.] 

4.  Confessions. — The  subsequent  conduct  of  the  person :  he  seeks 
no  escape,  delivers  himself  up  to  justice,  and  acknowledges  the  crime 
laid  to  his  charge.  This  is  commonly  characteristic  of  homicidal 
mania ;  for  by  the  sane  criminal  every  attempt  is  generally  made  to 
conceal  all  traces  of  the  crime,  and  he  denies  it  to  the  last,  or  until 
he  sees  that  denial  can  be  no  longer  serviceable  to  him. 

5.  Accomplices. — The  sane  murderer  has  generally  accomplices  in 
vice  or  crime ;  the  homicidal  monomaniac  has  not.  Upon  this  it 
may  be  observed  that  some  of  the  most  atrocious  murders  com- 
mitted in  modern  times  have  been  proved  to  be  the  acts  of  persons 
who  had  neither  accomplices  nor  any  assignable  inducements  lead- 
ing to  the  commission  of  the  crimes.  It  is,  however,  a  fact  so  far 
in  favor  of  the  existence  of  homicidal  insanity,  that  the  insane  never 
have  accomplices  in  the  acts  which  they  perpetrate.  These  criteria 
can  hardly  be  described  as  medical ;  they  are  circumstances  upon 
which  a  non-professional  man  may  form  just  as  safe  a  judgment  as 
one  who  has  made  insanity  a  special  study. 

6.  Delusion  in,  the  Act. — The  presence  of  delusion  has  been  said  to 
characterize  an  act  of  homicidal  monomania,  while  premeditation, 
precaution,  and  concealment  have  been  considered  to  be  the  essen- 
tial features  of  the  act  of  a  sane  criminal.     Some  medical  men  think, 


692  HOMICIDAL    INSANITY. 

if  they  discover  anything  resembling  a  delusion  in  the  mind  of  an 
accused  person,  that  he  is  necessarily  irresponsible  for  the  act,  but 
the  theory  of  the  law  as  laid  down  by  the  judges  in  M'jtfaughteri's 
case,  is  that  notwithstanding  a  person  labors  under  a  delusion,  if  he 
commits  an  act  which  he  knows  to  be  contrary  to  law  he  is  liable 
to  punishment:  if  the  delusion  be  partial  the  party  accused  is  still 
responsible ;  and  if  the  crime  were  committed  for  an  imaginary  in- 
jury he  would  be  held  equally  responsible.  (See  ante,  p.  686.) 
Much  stress  was  formerly  laid  upon  the  delusion  being  connected  with 
the  act  in  cases  of  alleged  insanity  ;  but  it  must  be  remembered  that, 
except  by  the  confessions  of  insane  persons  during  convalescence, 
it  is  not  easy  for  a  sane  mind  to  connect  the  most  simple  acts  of  a 
lunatic  with  the  delusion  under  which  he  labors.  Every  act  of 
homicide  perpetrated  by  a  really  insane  person  is  doubtless  con- 
nected with  some  delusion  with  which  he  is  affected  ;  but  it  is  not 
to  be  supposed  that  one  who  is  sane  can  always  make  out  this  con- 
nection. 

It  may  be  further  observed  that  premeditation,  precaution,  con- 
cealment, and  flight  are  met  with  in  crimes  committed  by  both  sane 
and  insane  criminals,  although  these  acts  are  certainly  strong  char- 
acteristics of  sanity.  It  should  be  a  question  for  a  jury  whether, 
when  they  are  proved  to  have  existed  in  any  criminal  act,  there 
might  not  have  been  such  a  power  of  self-control  in  the  person,  al- 
though in  some  degree  insane,  as  to  justify  a  conviction.  It  is  not 
the  presence  of  a  slight  degree  of  mental  aberration  which  necessa- 
rily indicates  a  loss  of  power  of  controlling  actions.  Are  such  per- 
sons less  beyond  the  influence  of  example  than  one  half  of  the  sane 
criminals  who  are  punished  ? 

7.  A  Number  of  Murders  perpetrated  at  once. — In  the  acts  of  sane 
criminals  one  person,  or  at  the  most  two,  may  be  destroyed;  but,  in 
cases  of  homicidal  mania,  it  is  not  unusual  to  find  a  wife  and  several 
children  killed  by  the  husband,  or  four  or  five  children  at  once  de- 
stroyed by  the  wife.  In  these  cases  no  motive  but  that  which  is 
based  on  some  insane  delusion  can  be  suggested  for  such  a  series  of 
murders.  Thus,  four  infants  may  be  found  murdered  by  a  mother, 
who  admits  the  act  but  endeavors  to  account  for  it  by  asserting  that 
she  wished  to  convert  them  into  angels,  or  to  save  them  from  desti- 
tution and  exposure  to  worldly  temptations.  It  would  be  wrong, 
however,  to  infer  from  this  statement  that  because  a  man  has  heaped 
crime  upon  crime,  he  is  therefore  insane.  This  would  be  equal  to 
making  the  atrocity  of  the  crime  or  crimes  a  test  of  insanity.  In 
the  case  of  Southey  (Beg.  v.  Southey,  Maidstone  Winter  Assizes, 
1865),  it  was  proved  that  the  prisoner,  a  man  of  wicked  and  de- 
praved habits,  had  destroyed  three  of  his  children  in  London,  and 
had  then  proceeded  to  Kamsgate,  and  there  deliberately  destroyed 
his  wife  and  another  child.  He  pretended  to  justify  these  five  mur- 
ders, and  wished  to  make  it  appear  that  he  was  insane.  In  regard 
to  his  conduct  through  life,  nothing  but  moral  depravity  was  proved. 
Still  this  man  found  medical  defenders  who  brought  forward  as 
proofs  of  "delirium,"   statements  which   clearly  showed  that   they 


SUMMAEY.      MEDICAL    PROOFS.  693 

did  not  understand  the  meaning  of  the  term.  It  was  admitted  that 
if  the  man  had  committed  one  of  the  murders,  he  might  have  been 
sane,  but  having  committed  five  in  succession,  he  was  insane  and 
incompetent  to  judge  of  the  nature  of  his  acts  !  The  fallacy  of  such 
an  argument  needs  no  exposure. 

Summary. — The  foregoing  considerations  lead  to  the  inference  that 
there  are  no  certain  legal  or  medical  tests  whereby  homicidal  mania 
can  be  demonstrated  to  exist.  Each  case  must  be  determined  by  the 
circumstances  attending  it ;  but  the  true  criterion  of  irresponsibility 
in  all  ambiguous  cases  appears  to  be  whether  the  person,  at  the  time 
of  the  commission  of  the  crime,  had  or  had  not  a  sufficient  power  of 
self-control  to  govern  his  actions ;  or,  in  other  words,  whether  he  knew 
the  act  was  wrong,  and  could  avoid  the  perpetration  of  it.  This  in- 
volves, the  consideration,  not  only  whether  insanity  existed  in  the  ac- 
cused, but  whether  it  had  reached  a  degree  to  destroy,  not  merely  a 
consciousness  of  the  nature  of  the  act,  but  volition — the  will  to  do  or 
not  to  do  it.  If  from  circumstances  it  can  be  inferred  that  an  accused 
person  had  this  power,  whether  his  case  falls  within  the  above  rules 
or  uot,  he  should  be  made  responsible  and  rendered  liable  to  punish- 
ment. If,  however,  he  was  led  to  the  perpetration  of  the  act  by  an 
insane  impulse,  or,  in  other  words,  by  an  impulse  which  his  mental 
condition  did  not  allow  him  to  control  (lesion  de  volonte,  Esquirol), 
he  is  entitled  to  an  acquittal  as  an  irresponsible  agent.  The  power 
of  controlling  an  act  appears  to  me  to  imply  the  existence  of  such  a 
state  of  sanity  as  to  render  the  party  responsible  :  and  when  there 
is  this  want  of  control,  it  may  be  fairly  concluded  that  there  is  no 
sane  intention,  and  that  the  person  is  irresponsible.  A  test  some- 
what similar  to  this  is  constantly  applied  by  juries,  under  the  direc- 
tion of  our  judges,  to  distinguish  murder  from  manslaughter:  and 
it  is  quite  certain  that  sanity  and  homicidal  mania  are  not  more 
nicely  blended  than  those  shades  of  guilt  whereby  manslaughter 
passes  into  murder.  The  manner  and  circumstances  under  which  a 
crime  is  committed  will  often  allow  a  fair  inference  to  be  drawn  as 
to  how  far  a  power  of  self-corltrol  existed  or  was  exercised.  A  man 
in  a  violent  fit  of  mania  or  delirium  rushes  with  a  drawn  sword  into 
an  open  street,  and  stabs  the  first  person  whom  he  meets ;  another, 
worn  out  by  poverty  and  destitution,  destroys  his  wife  and  children 
to  prevent  them  from  starving,  and  then  probably  attempts  to  mur- 
der himself:  these  are  cases  in  which  there  is  a  fair  ground  to  enter- 
tain a  plea  of  irresponsibility.  But  when  we  find  a  man  not  show- 
ing any  previous  intellectual  disturbance,  lurking  for  many  days 
together  in  a  particular  locality,  having  about  him  a  loaded  weapon 
— watching  a  particular  person  who  frequents  that  locality — not 
facing  the  individual  and  shooting  him,  but  coolly  waiting  until  he 
has  an  opportunity  of  discharging  the  weapon  unobserved  by  his 
victim  or  others — the  circumstances  appear  to  show  such  a  perfect 
adaptation  of  means  to  ends,  and  such  a  power  of  controlling  actions, 
that  it  is  difficult  to  understand  on  what  principle  an  acquittal 
on  the  ground  of  insanity  could  have  been  allowed.  I  refer  here 
to  the  case  of  M  Naughten,  tried  for  the  murder  of  Mr.  Drummond, 


694:  ACQUITTALS    ON    THE 

January,  1843.  The  acquittal  in  this  case  was  the  more  remarkable 
because  there  was  no  proof  of  general  insanity,  and  the  crime  was 
committed  for  a  supposed  injury.  According  to  the  rules  laid  down 
by  the  fifteen  judges,  from  questions  submitted  to  them  in  connec- 
tion with  this  case,  this  man  should  certainly  have  been  convicted. 
These  acquittals  on  the  ground  of  insanity,  contrary  to  public  opin- 
ion, are  often  erroneously  ascribed  to  the  crotchets  of  medical 
experts.  They  are,  I  believe,  more  commonly  due  to  the  powerful 
and  impassioned  addresses  of  counsel,  who  in  civil  as  well  as  in 
criminal  cases  simply  fight  for  victory,  wholly  irrespective  of  any 
abstract  ideas  of  truth  or  justice.  Medical  opinions  are  brought 
forward  or  suppressed  in  order  to  complete  a  sensational  picture, 
which  is  intended  to  show  to  an  ignorant  jury,  either  that  a  lunatic 
is  perfectly  sane,  or  that  a  sane  man  who  has  committed  a  deliberate 
act  of  murder,  is  beyond  any  reasonable  doubt  insane.  Every  arti- 
fice of  argument  which  may  raise  a  doubt  in  the  minds  of  the  jury 
is  resorted  to  on  these  occasions,  and  the  last  words  of  the  last  elo- 
quent speaker  have  a  far  greater  influence  on  the  verdict  than  the 
opinions  of  "mad  doctors"  in  the  witness-box.  These  admit  of 
being  misrepresented  and  turned  into  ridicule  without  any  power  of 
reply  on  the  part  of  those  who  gave  them.  [Dr.  Bucknill  (Criminal 
Lunacy,  98,  99)  mentions  the  case  of  Margaret  Garrety,  who  was 
tried  in  1851,  at  Newark,  New  Jersey  (see  "Am.  Jour.  Ins.,"  Janu- 
ary, 1852)  for  "  the  assassination,  with  a  carving-knife,  of  a  young 
man  who  had  seduced  her  and  afterwards  married  another  woman. 
This  trial,"  he  says,  "presents  a  remarkable  instance  of  perver- 
sion of  the  plea  by  the  jury,  in  order  to  avoid  the  condemnation  and 
execution  of  an  ill-used  woman.  The  jury  were  sixty-two  hours  in 
deliberation;  their  verdict  of  'not  guilty  on  the  ground  of  insanity," 
was  greeted  with  applause  in  the  court-house,  and  with  universal 
congratulation  and  rejoicing  in  the  city.  The  celebrated  Hampshire 
verdict,. '  Served  him  right,'  would  perhaps  have  been  more  consist- 
ent, if  not  with  the  facts  of  the  case,  at  least  with  the  temper  of  the 
public.  After  the  trial,  the  court  appointed  a  commission  consisting 
of  six  physicians,  to  examine  her  case,  and  decide  whether  she 
should  be  sent  to  the  asylum  or  set  at  liberty.  They  unanimously 
reported,  that  after  careful  investigation,  they  found  existing  no 
evidence  of  unsound  mind." — P.] 

In  cases  of  alleged  homicidal  mania  very  vague  meanings  have 
been  sometimes  assigned  to  the  term  delusion.  In  Reg.  v.  Burton 
(Maidstone  Lent  Assizes,  1863),  the  prisoner,  a  youth  of  18,  was  in- 
dicted for  the  murder  of  a  boy  at  Chatham.  There  was  no  motive, 
but  it  was  argued  by  his  counsel  in  defence,  that  he  labored  at  the 
time  under  a  delusion — the  delusion  being  a  desire  to  be  hauged. 
Mr.  Joy,  the  surgeon  of  the  prison,  stated  that  he  had  had  frequent 
opportunities  of  examining  the  prisoner  while  in  gaol,  and  in  his 
opinion  he  was  perfectly  sane ;  so  far  as  witness  could  judge,  he  was 
under  no  delusion.  The  jury  returned  a  verdict  of  "guilty."  If 
the  youth  had  believed  that  he  had  been  already  hanged  for  murder, 
this  might  have  been  considered  a  delusion ;  but  a  desire  to  be 


GROUND    OF    INSANITY.  695 

hanged  or  to  die  from  any  violent  cause  cannot  be  so  regarded.  The 
remarks  of  the  learned  judge  (the  late  Mr.  Justice  Wightman)  upon 
this  kind  of  defence  contains  all  that  is  necessary  to  show  its  fallacy. 
In  passing  sentence  upon  the  prisoner  he  said :  "  It  is  stated  that  you 
labored  under  a  morbid  desire  to  die  by  the  hands  of  justice,  and 
that  for  this  purpose  you  committed  the  murder.  This  morbid  de- 
sire to  part  with  your  own  life  can  hardly  be  called  a  delusion :  and, 
indeed,  the  consciousness  on  your  part  that  you  could  effect  your 
purpose  by  designedly  depriving  another  of  life  (for  which  you  would 
have  to  suffer,  as  you  knew,  the  punishment  due  to  the  greatest 
of  crimes)  shows  that  you  were  perfectly  able  to  understand  the 
nature  and  consequences  of  the  act  which  you  were  committing,  and 
that  you  knew  it  was  a  crime  for  which  by  law  the  penalty  was  capi- 
tal. This  was,  in  truth,  a  further,  and  I  may  say  a  deeper,  aggrava- 
tion of  the  crime ;  for  you  designedly  intended  to  compass  your  own 
death  by  the  murder  of  another." 

It  has  been  a  disputed  question  whether  a  medical  witness  on  a 
trial  in  which  a  defence  of  insanity  is  raised,  can  be  asked  his  opin- 
ion from  the  evidence,  respecting  the  state  of  a  prisoner's  mind  at 
the  time  of  the  commission  of  the  alleged  crime,  i.  e.  whether  the 
accused  was  conscious  at  the  time  of  doing  the  act  that  he  was  doing 
something  contrary  to  law,  or  whether  he  was  then  laboring  under 
any  and  what  delusion.  It  has  been  decided,  by  fourteen  judges 
out  of  fifteen,  that  facts  tending  to  lead  to  a  strong  suspicion  of  in- 
sanity must  be  proved  and  admitted,  before  the  opinion  of  a  medical 
witness  can  be  received  on  these  points.  (See  "  Med.  Gaz."  vol.  46, 
p.  240.) 

In  forming  a  judgment  of  the  mental  condition  of  an  accused 
person,  it  is  no  part  of  the  province  of  a  witness  to  modify  his 
opinion  according  to  the  punishment  which  may  follow  if  the  plea 
be  rejected,  but  simply  according  to  the  medical  facts  of  the  case. 
The  legislature  only  is  responsible  for  the  punishment  adjudged  to 
crimes.  Dr.  Mayo  has  justly  observed,  that  a  medical  witness  is 
summoned  to  a  court  of  justice  in  order  to  enable  the  judge  and 
jury  to  arrive  at  certain  practical  conclusions.  The  question  pro- 
posed to  him  involves  a  simple  fact  and  not  its  consequences;  and 
if  the  latter  consideration  be  entertained  by  him,  it  will  be  liable  to 
bias  his  evidence  on  the  fact,  which  is  his  legitimate  topic.  The 
definition  of  insanity  becomes  very  expansive  when  its  expansion 
may  become  protective  to  a  criminal  with  whom  we  may  happen  to 
sympathize.  The  question  whether  the  accused  is  a  responsible 
agent  is  of  a  judicial  nature :  our  evidence  should  be  confined  to 
the  question  whether  the  accused  is  insane  in  a  certain  sense  or 
meaning  in  which  it  is  understood  and  defined  by  law.  ("  Medical 
Testimony  and  Evidence  in  Cases  of  Lunacy,"  1854,  p.  9.  A  medi- 
cal witness  in  these  cases  generally  moulds  his  evidence  to  a  fore- 
gone conclusion  on  the  criminal  responsibility  of  the  accused,  and 
he  thus  lays  himself  open  to  a  remark  from  the  judge  that  he  must 
not  encroach  on  the  functions  of  the  jury.  It  is  certainly  a  great 
evil  that,  under  the  present  mode  of  laying  this  question  before  a 


696  THE    DEFENCE    OP    INSANITY. 

jury,  the  law  operates  unequally.  One  case  becomes  a  subject  of 
prominent  public  interest,  and  every  exertion  is  made  to  construe 
the  most  trivial  eccentricities  of  character  into  proofs  of  insanity, 
and  to  magnify  the  effects  of  an  hereditary  tendency  by  proving 
that  a  maternal  grandmother's  sister  or  some  remote  relative  had 
been  confined  as  a  lunatic  :  an  acquittal  follows.  Another  case  may 
excite  no  interest — it  is  left  to  itself :  the  accused  is  convicted,  and 
either  executed  or  otherwise  punished,  although  the  evidence  of 
insanity,  had  it  been  as  carefully  sought  for  and  brought  out,  would 
have  been  perhaps  stronger  in  this  than  in  the  former  instance. 

Probably  no  case  in  modern  times  Las  produced  greater  excite- 
ment in  the  public  mind,  or  so  strongly  directed  attention  to  the 
modern  defence  of  insanity  in  trials  for  murder,  as  that  of  George 
Victor  Townley,  who  was  charged  with  the  murder  of  a  young  lady 
to  whom  he  was  engaged  to  be  married  (Beg.  v.  Toivnley,  Derby 
Winter  Assizes,  1863).  In  this  case  there  was  a  clear  and  distinct 
motive ;  there  was  a  full  consciousness  of  the  nature  of  the  act  and 
of  its  penal  consequences,  as  well  as  an  absence  of  any  delusion  or 
of  anything  indicative  of  intellectual  insanity  in  the  conduct  of  the 
prisoner  up  to  within  a  short  time  of  the  act,  or  in  the  numerous 
letters  which  he  wrote.  There  was  no  proof  that  he  had  lost  self- 
control  or  that  he  was  fettered  in  his  actions.  The  prisoner  had 
entered  into  an  engagement  with  the  deceased  (Miss  Goodwin). 
Shortly  before  the  murder  she  had  written  to  him,  requesting  to  be 
released  from  her  engagement ;  she  candidly  told  him  that  she  had 
formed  an  attachment  to  another  man.  In  his  correspondence  with 
her  he  requested  a  last  interview,  to  hear  (as  he  said)  her  determina- 
tion from  her  own  lips.  The  prisoner  went  to  her  house  on  the  21st 
August,  1863,  induced  the  deceased  to  take  a  walk  with  him:  and 
in  about  an  hour  she  was  found  bleeding  from  severe  wounds  in  the 
throat,  from  the  effects  of  which  she  soon  died.  No  sane  murderer 
intending  to  destroy  another  would  have  pursued  a  different  course. 
Townley  it  is  true  made  no  attempt  to  escape  :  he  admitted  that  he 
had  stabbed  her,  and  assisted  in  carrying  her  dead  body  to  Wigwell 
Hall,  where  she  resided.  At  the  trial  there  was  no  answer  to  the 
charge  of  murder,  except  that  the  prisoner  was  insane  when  he  per- 
petrated the  act ;  that  he  was  maddened  partly  by  the  refusal  of  the 
deceased  to  marry  him,  and  partly  by  the  knowledge  that  she  was 
engaged  and  would  probably  be  married  to  another  man.  This 
theory  found  some  medical  support,  but  the  jury  returned  a  verdict 
of  guilty.  An  attempt  was  afterwards  made  to  rescue  this  criminal 
from  punishment,  but  it  failed.  He  was  condemned  to  penal  servi- 
tude and  subsequently  destroyed  himself. 

Tested  by  the  rules  respecting  criminal  responsibility  assigned  by 
Mr.  Fitzjames  Stephen,  the  evidence  in  Townley's  case  showed 
clearly  intention,  will,  and  malice.  There  was  an  absence  of  proof 
of  delusion,  and  the  allegation  that  the  act  arose  from  an  irre- 
sistible impulse  was  a  mere  assumption,  without  any  fact  in  the 
previous  or  subsequent  conduct  of  the  prisoner  to  give  to  it  sup- 
port.    It  may  well  be  inquired  of  those  who  adopt  the  theory  of 


IRRESISTIBLE    IMPULSES    TO    CRIME.  697 

irresponsibility  in  this  case — If  this  is  insanity,  what  is  crime?  If 
Townley  was  irresponsible  for  an  act  thus  coolly  perpetrated,  in 
which  the  motive  was  so  clear,  no  person  should  hereafter  be 
convicted  of  mnrder  who  stabbed  a  woman  from  jealousy,  revenge, 
or  mortified  pride.  There  was  no  doubt  that  Townley  had  a  con- 
sciousness of  right  and  wrong — that  he  knew  the  act  was  illegal  and 
punishable  by  the  law  of  the  land ;  but  his  guilt  did  not  rest  upon 
these  judicial  tests  of  criminal  responsibility.  He  had  this  knowl- 
edge in  common  with  all  sane  and  some  really  insane  persons.  In 
his  case,  however,  insanity  was  neither  proved  nor  rendered  even 
probable,  while  it  was  disproved  by  his  conduct  and  all  the  circum- 
stances connected  with  the  act  of  murder.  It  may  be  wrong  to  con- 
vict all  men  who  come  up  to  this  judicial  standard,  i.  e.,  who  know 
right  from  wrong,  because  insanity  may  coexist  with  such  knowledge: 
but  it  would  be  a  reductio  ad  absurdum  to  contend  that,  in  the  ab- 
sence of  any  clear  proofs  of  insanity,  a  man  is  to  be  acquitted  of 
crime  when  he  knew  that  the  act  was  wrong,  and  had  well  calculated 
the  legal  consequences.  One  medical  defender  of  Townley,  in  order 
to  account  for  the  absence  of  symptoms  of  insanity,  suggested  that 
the  duration  of  the  homicidal  impulse  was  short,  and  did  not  extend 
beyond  the  period  of  the  commission  of  the  act  to  which  it  impelled ! 
There  would  be  no  difficulty  on  these  principles  in  making  out  that 
every  act  of  murder  was  the  result  of  impulsive  insanity,  and  that 
all  murderers  while  stabbing  others  are  morally  insane,  and  there- 
fore, although  they  may  stow  sanity  afterwards,  they  are  irrespon- 
sible for  their  acts !  The  legal  test  of  a  consciousness  of  right  and 
wrong  is  much  complained  of,  but  in  practice  it  certainly  cannot  be 
said  to  err  on  the  side  of  harshness  or  severity  ;  for  it  is  much  more 
common  to  find  that  sane  persons  are  acquitted  on  the  ground  of 
insanity,  than  that  one  who  is  really  insane  is  convicted  and  pun- 
ished as  a  sane  criminal.  But  the  niedical  assumption  here  suggested 
to  extenuate  Townley's  crime  would  go  far  to  exculpate  every  crimi- 
nal who  committed  murder. 

The  doctrine  of  "irresistible  impulse"  and  the  theory  of  impulsive 
insanity,  have  been  strained  in  recent  times  to  such  a  degree  as  to 
create  in  the  public  mind  a  justifiable  distrust  of  medical  evidence 
on  these  occasions.  It  is  obviously  easy  to  convert  this  into  a  plea 
for  the  extenuation  of  all  kinds  of  crimes  for  which  motives  are  not 
at  once  apparent,  and  thus  medical  witnesses  often  expose  themselves 
to  severe  rebuke.  They  are  certainly  not  justified  in  setting  up 
such  a  defence,  unless  they  are  prepared  to  draw  a  clear  and  com- 
mon-sense distinction  between  impulses  which  are  "unresisted"  and 
those  which  are  irresistible.  As  a  learned  judge  once  remarked  in 
his  address  to  a  jury:  "What  is  the  meaning  of  not  being  able  to 
r  ist  an  impulse?  Every  crime  is  committed  under  an  impulse, 
and  the  object  of  the  law  is  to  compel  persons  to  control  or  resist 
these  impulses.  If  it  is  made  an  excuse  for  a  person  who  has  com- 
mitted a  crime,  that  he  was  goaded  to  it  by  some  impulse  which 
medical  men  might  choose  to  say  he  could  not  control,  such  a  doc- 
trine would  be  fraught  with  vary  great  danger  to  society." 


698  IRRESISTIBLE    IMPULSES    TO    CRIME. 

While  the  truth  of  these  remarks  is  obvious,  it  must  be  admitted 
that  the  ordinary  legal  test  for  responsibility  is  not  satisfactory.  In 
addressing  the  jury  in  Be//,  v.  Cocker  oft  involving  a  trial  for  murder 
(Leeds  Autumn  Assizes,  1865),  Mr.  Justice  Mellor  made  the  follow- 
ing observations  on  the  defence  of  insanity  which  had  been  set  up : 
"It  would  be  dangerous  if  the  idea  went  abroad  that  persons  com- 
mitting crime  under  sudden  impulse  were  therefore  to  be  excused. 
At  the  same  time,  he  thought  that  the  definition  of  insanity  which 
would  excuse  from  criminal  responsibility,  as  given  in  M'Naughten's 
case,  hardly  went  far  enough.  He  was  of  opinion  that  a  man  might 
know  that  he  was  doing  an  act  which  was  wrong,  and  still  he  might 
be  laboring  under  such  disease  of  the  mind  as  not  to  be  able  to  re- 
strain his  impulse  to  do  that  act,  and  he  should  therefore  not  be 
amenable  to  the  criminal  law.  The  mere  fact,  however,  of  the  pri- 
soner being  ignorant  and  of  a  low  type  of  mind  would  be  no  excuse. 
If  the  jury  thought  that  the  prisoner  knew  at  the  time  when  he 
committed  the  act  that  he  was  doing  wrong,  and  was  not  laboring 
under  such  a  disease  of  the  mind  as  incapacitated  him  from  control- 
ling his  impulses,  he  was  not  entitled  to  acquittal  on  the  ground  of 
insanity.  The  doctrine  of  uncontrollable  impulse,  as  laid  down  by 
some  writers,  was  a  very  dangerous  one,  and  required  to  be  watched 
with  the  utmost  care.  Passion  arising  from  provocation,  however 
trivial,  offered  to  a  mind  however  ill  regulated,  did  not  relieve  the 
person  from  criminal  responsibility." 

Hence  it  follows  that  a  man  might  know  that  he  was  doing  wrong 
and  committing  an  act  against  the  law  of  God  and  man,  yet  if  with 
this  consciousness  of  the  illegality  of  the  act,  there  was  a  diseased 
condition  of  mind  which  prevented  him  from  controlling  his  actions, 
he  will  be  entitled  to  an  acquittal  on  the  ground  of  insanity.  With 
this  admission  it  appears  to  me  unnecessary  to  occupy  space  with 
metaphysical  discussions  regarding  criminal  responsibility ;  for 
however  objectionable  the  theory — if  the  "practice  of  the  law  be  in 
any  one  case  in  conformity  with  that  which  has  been  advised  by 
writers  on  the  Medical  Jurisprudence  of  Insanity,  although  it  may 
be  even  adverse  to  the  theory  on  which  it  is  professedly  based,  this 
is  all  with  which  we  have  to  concern  ourselves : — the  principle  is 
admitted.  The  great  defect  in  the  English  law  is,  not  that  it  will 
not  go  even  to  the  full  extent  of  exculpating  a  person  who  has  com- 
mitted a  crime  with  a  full  knowledge  of  its  illegality,  and  under 
what  is  called  an  "uncontrollable  impulse,"  or  an  impulse  which 
owing  to  mental  disease  his  reason  was  not  sufficient  to  control,  but 
the  uncertainty  of  its  application.  There  are  many  cases  report  oil 
which  show  that  an  acquittal  on  the  ground  of  insanity  is  frequently 
a  mere  matter  of  accident. 


SUICIDAL    MONOMANIA. 


CHAPTER    LXIV. 

Suicidal  mania. — suicide  not  necessaeily  an  indication  of 
insanity.  —  suicide  a  felony.  —  in  eelation  to  life-insur- 
ance.— hereditary  taint. — puerperal  mania. — pyromania. — 
kleptomania. — dipsomania. — responsibility  of  drunkards. — • 
delirium  tremens. — somnambulism. — deafness  and  dumbness. 

Suicidal  Monomania,1  or  suicidal  mania,  is  the  name  given  to  that 
form  of  insanity  which  is  marked  by  the  prominent  idea  of  self- 
destruction.  Its  approach  is  insidious:  it  is  foreshadowed  by  im- 
paired appetite  and  sleeplessness  arising  from  some  cause  of  mental 
anxiety  too  trivial  to  create  alarm.  It  may  proceed  either  from 
sudden  impulse  or  be  the  result  of  long  deliberation ;  it  may  be 
committed  with  or  without  apparent  motive;  it  may  proceed  either 
from  a  delusive  or  a  real  apprehension  of  poverty,  disgrace  or  ruin. 
Suicide  from  sudden  impulse  is  not  uncommon ;  persons  have  been 
known  to  destroy  themselves  who  had  not  previously  manifested 
any  symptoms  of  intellectual  disorder.  Sir  Charles  Bell  relates  that 
one  of  the  surgeons  of  the  Middlesex  Hospital  was  in  the  habit  of 
going  every  morning  to  be  shaved  by  a  barber  in  the  neighborhood, 
who  was  known  as  a  steady  industrious  man.  One  morning  the 
surgeon  was  conversing  with  the  barber  about  an  attempt  at  suicide 
which  had  recently  occurred,  and  the  surgeon  observed  that  the  man 
had  not  cut  his  throat  in  the  right  place.  The  barber  then  inquired, 
casually,  where  the  cut  should  have  been  made ;  the  surgeon  pointed 
on  his  neck  to  the  situation  of  the  carotid  artery.  The  barber  in  a 
few  minutes  retired  to  the  back  of  his  shop,  and  there  cut  his  throat 
with  the  razor  with  which  he  had  been  shaving  the  surgeon  ;  he  had 
wounded  the  carotid  artery  in  the  place  indicated  by  the  surgeon, 
and  died  before  any  assistance  could  be  rendered  to  him.  Although 
this  act  was  quite  sudden  and  unexpected,  it  may  have  been  only 
the  final  result  of  a  delusion  which  had  long  existed,  concealed  from 
others,  in  the  mind  of  this  man — just  as  the  sight  of  a  weapon  has 
often  led  to  its  use  for  the  purpose  of  suicide. 

Dr.  Forbes  "Winslow  remarks  "that  a  person  is  often  impelled  to 
self-destruction  by  the  overpowering  and  crushing  influence  of  a 
latent  delusion  that  has  for  weeks,  and  perhaps  months,  been  pressing 
like  an  incubus  on  his  imagination.  Patients  sometimes  confess  that 
they  have  been  under  the  influence  of  monomaniacal  ideas  and 
terrible  hallucinations  for  a  long  period  without  their  existence 

1  [So  much  of  this  chapter  as  relates  to  the  subject  of  suicidal  mania  and  suicide 
is  taken  from  Dr.  Taylor's  "  Principles  and  Practice  of  Medical  Jurisprudence." — P.] 


700  SUICIDAL    MONOMANIA. 

being  suspected  even  by  their  most  intimate  associates.  "For  six 
months," "writes  one  patient,  "I  have  never  had  the  idea  of  suicide, 
night  or  day,  out  of  my  mind.  Wherever  I  go  an  unseen  demon 
pursues  me,  impelling  me  to  self-destruction  !  My  wife,  friends,  and 
children  observe  my  listlessness  and  perceive  my  despondency,  but 
they  know  nothing  of  the  worm  that  is  gnawing  within.'  Is  this 
not  a  type  of  cases  more  generally  prevalent  than  we  imagine?7' 
("  Obscure  Diseases  of  the  Brain,"  p.  265.)  The  want  of  power  to 
shake  off  this  delusion  shows  clearly  that  the  mind  is  not  in  a 
healthy  state — that  the  person  is  not  sane. 

Men  who  are  thus  mentally  affected  generally  retain  a  certain 
control  over  their  actions ;  thus  they  will  voluntarily  give  up  pistols, 
razors,  or  other  weapons  by  which  suicide  might  be  perpetrated.  A 
friend  suffering  from  an  attack  of  suicidal  mania,  while  residing  with 
me  in  Paris  in  1830,  delivered  to  me  one  night  his  razors,  with  a 
request  that  I  would  lock  them  up  and  keep  them  out  of  his  sight, 
as  otherwise  he  feared  that  he  might  destroy  himself  at  any  moment. 
Although  he  recovered  from  this  attack,  he  had  a  relapse,  and  sub 
sequently  destroyed  himself  by  taking  prussic  acid.  Persons  labor- 
ing under  this  form  of  monomania  may  go  to  bed  perfectly  collected, 
and  suddenly  awake  in  the  night  and  destroy  themselves  by  hanging, 
drowning,  or  precipitating  themselves  from  a  window.  These 
cases  probably  depend  on  the  persistence  of  some  horrible  halluci- 
nation which  may  have  occurred  in  dreaming,  and  in  the  reality  of 
which  they  cannot  at  the  time  disbelieve.  Some  years  ago  I  saw  a 
case  of  this  kind  in  a  man  who  was  a  patient  at  Guy's  Hospital. 
The  man  attempted  to  strangle  himself  in  the  dusk  of  the  evening 
with  the  cord  of  his  bed ;  he  was  fortunately  saved,  and  he  recovered 
after  having  been  nearly  strangled.  On  asking  him  what  led  him 
to  the  attempt  he  told  me  that  he  suddenly  saw  a  large  black  figure 
round  his  bed  (the  devil),  which  by  signs  and  words  compelled  him 
to  try  and  hang  himself.  It  appeared  that  this  man  had  previously 
shown  symptoms  of  suicidal  monomania. 

When  the  impulse  to  suicide  is  checked  by  any  great  moral  shock 
it  may  suddenly  disappear.  My  friend,  to  whose  case  I  have  above 
referred,  recovered  under  the  shock  from  the  sudden  outbreak  of  the 
French  Eevolution  in  1830.  The  danger  to  which  he  was  exposed, 
while  residing  with  me  in  Paris  in  the  early  days  of  the  revolution, 
for  a  time  at  least  dispelled  the  idea  of  self-destruction.  Pinel  men- 
tions the  case  of  a  man  who  while  hurrying  to  one  of  the  bridges 
of  Paris  to  throw  himself  into  the  river,  was  suddenly  attacked  by 
robbers  ;  he  made  a  desperate  resistance,  and  escaped  from  them. 
He  could  not  then  account  for  his  being  where  he  was,  and 
quietly  walked  home,  having  abandoned  the  intention  of  destroying 
himself.  There  is  but  little  doubt  that  many  acts  of  suicide  would 
be  prevented  if  circumstances  only  gave  a  slight  opportunity  for 
reflection;  the  mind  would  then  be  diverted  from  the  dominating- 
idea  of  self-destruction. 

Suicidal  mania  is  susceptible  of  being  spread  by  imitation,  espe- 
cially when  the  mode  of  self-destruction  adopted  is  accompanied  by 


IS    SUICIDE    A    PROOF    OF    INSANITY?  701 

circumstances  of  a  horrible  kind,  or  by  such  as  excite  great  notoriety. 
The  sight  of  a  particular  spot  where  an  act  of  suicide  has  been  al- 
ready committed  will  often  induce  a  person,  who  may  hitherto  have 
been  unsuspected  of  any  such  disposition,  at  once  to  destroy  himself. 
Thus  a  second  and  a  third  suicide  took  place  from  the  Monument 
near  London  Bridge,  soon  after  the  first  had  occurred.  Acts  of 
incendiarism  have  been  also  observed  to  lead  to  arson  in  the  same 
or  in  a  neighboring  district ;  but  there  is  here  a  criminal  as  well  as 
a  monomaniacal  imitation,  and  experience  has  clearly  shown  that 
there  is  no  check  so  effectual  for  this  as  the  rigorous  application  of 
the  law. 

Does  the  Act  of  Suicide  Necessarily  Indicate  the  Existence  of  Insanity? 
— Suicide  is  often  set  down  as  furnishing  positive  evidence  of  in- 
sanity :  a  doctrine  which  commonly  finds  expression  in  the  verdicts 
of  coroners'  juries — not  so  much  from  the  fact  of  insanity  being 
thereby  established,  as  that  any  verdict  but  this  would  weigh  heavily 
not  on  the  deceased,  but  on  his  surviving  relations  and  friends. 

In  the  opinion  of  Dr.  Davey,  the  suicidal  propensity  is  in  all  cases 
and  under  all  circumstances  a  positive  sign  or  symptom  of  disor- 
dered mind  (insanity).  ("  Journal  of  Mental  Science,"  April,  1861, 
p.  110.)  This,  however,  is  not  in  accordance  with  the  views  of  many 
psychologists.  In  one  case  a  person  will  fancy  that  he  is  constantly 
watched — that  he  is  oppressed  and  persecuted  by  all  around  him, 
and  that  his  prospects  in  life  are  ruined  when,  on  the  contrary,  his 
affairs  are  known  to  be  flourishing:  he  destroys  himself  under  this 
delusion,  in  order  to  avoid  imaginary  evils.  In  cases  of  this  descrip- 
tion, whether  arising"  from  a  momentary  insane  impulse  or  from 
delusive  reasoning,  there  cannot  be  a  doubt  that  the  act  is  one  of 
insanity.  It  is  very  different,  however,  when  a  real  motive  is 
obviously  present — as  when  a  person  destroys  himself  to  avoid 
actual  disgrace  or  impending  ruin.  The  motive  is  here  based  on  a 
reality — on  a  real  estimate  of  tne  man's  position ;  the  results  are 
clearly  foreseen,  and  the  suicide  calculates  that  the  loss  f>f  life  would 
be  to  him  a  smaller  evil  than  the  loss  of  honor  and  fortune.  It  may 
be  urged  that  a  motive  of  this  kind  is  itself  delusive,  and  will  appear 
insufficient  to  the  minds  of  most  men ;  but  what  known  motive  is 
there  sufficient  to  account  for  parricide,  infanticide,  or  any  other 
crime  of  the  like  horrible  nature  ?  It  appears  to  me,  we  must  allow 
either  that  all  crime  is  the  offspring  of  insanity,  or  that  suicide,  like 
infanticide,  may  be  the  deliberate  act  of  a  sane  person.  To  affirm 
that  suicide  is  always  per  se  evidence  of  insanity  is  to  affirm,  sub- 
stantially, that  there  is  no  criminality  in  self-murder:  for  it  is  im- 
possible to  regard  that  act  as  a  crime  which  is  committed  under  a 
really  insane  delusion.  (See  "Ann.  d'Hyg.,"  1881,  vol.  i.  p.  225; 
for  some  additional  remarks  on  this  subject  see  Lectures  by  Dr. 
Jamieson,  "Med.  Gaz.,"  vol.  10,  p.  523,  and  "Jour.  Psychol.  Med.," 
1850,  p.  19.) 

The  law  of  England  very  properly  treats  suicide  as  a  felony;  those 
who  have  attempted  and  failed  in  its  perpetration  are  held  to  be  sane 
and  responsible  agents,  unless  there  should  be  clear  evidence  of  their 


702  IS    SUICIDE    A    PROOF    OF    INSANITY? 

(intellectual)  insanity  from  other  circumstances;  and  it  is  certain, 
that  the  evidence  required  to  establish  this  must  be  much  stronger 
than  that  sometimes  admitted  in  cases  of  homicide. 

Some  singular  medico-legal  cases  have  occurred,  involving  the 
question  how  far  the  act  of  attempting  suicide  is  indicative  of  in- 
sanity. In  the  case  of  the  Queen  v.  Rumball  (Cent.  Crim.  Court, 
May,  1843),  a  woman  was  charged  with  attempting  to  drown  her 
•child.  It  appeared  in  evidence  that  she  had  fastened  her  child  to 
her  dress,  and  thrown  herself  into  a  canal  with  the  intention  of  des- 
troying herself.  She  was  rescued,  and  was  subsequently  tried  and 
convicted  of  the  felony  of  attempting  to  murder  her  child  by  drown- 
ing. Had  she  not  been  rescued,  and  had  she  succeeded  in  her  pur- 
pose of  self-destruction,  it  is  probable  that  the  verdict  of  a  jury 
would  have  been,  as  it  so  frequently  is  on  these  occasions — "Tempo- 
rary insanity."  In  Reg.  v.  Furley  (Cent.  Crim.  Court,  April,  1844). 
the  prisoner  was  convicted  of  murder  under  similar  circumstances, 
but  the  sentence  was  subsequently  commuted.  In  Reg.  v.  Gathercole 
(1839),  a  man  was  charged  with  manslaughter,  under  the  following 
singular  circumstances.  The  prisoner  threw  himself  into  a  canal 
for  the  purpose  of  drowning  himself;  the  deceased,  who  was  passing, 
jumped  in  and  rescued  him,  but  by  some  accident  he  was  himself 
drowned  in  the  humane  attempt.  The  defence  was,  that  the  prisoner 
was  at  the  time  insane,  and  therefore  not  responsible  for  the  death 
of  the  person  who  attempted  to  save  him ;  but  this  was  negatived, 
and  the  prisoner  was  convicted.  So  if  a  man  intending  to  shoot 
himself  fails,  and  by  accident  shoots  a  bystander,  he  will  be  held  re- 
sponsible, unless  there  be  a  clear  proof  of  intellectual  insanity ; 
the  act — the  attempt  itself,  taken  alone,  will  not  be  admitted  as  evi- 
dence. 

If  two  persons  agree  to  commit  suicide,  and  one  only  dies,  the 
survivor  is  guilty  of  murder.  In  Reg.  v.  Fisher  (Taunton  Spring- 
Assizes,  1865),  the  prisoner  was  indicted  for  the  murder  of  bis  wife 
by  poison.*  It  appeared  from  the  evidence  that  they  had  been  mar- 
ried fourteen  years,  and  had  lived  happily  together.  The  man  was 
well-conducted  and  industrious;  but  he  fell  into  a  desponding  state 
of  mind,  and  thought  that  by  the  introduction  of  machinery  into  his 
trade  of  a  shoemaker,  he  and  his  wife  would  be  reduced  to  poverty. 
He  communicated  this  feeling  to  his  wife ;  they  pondered  over  it 
together,  and  they  both  agreed  to  destroy  themselves.  The  man 
procured  a  quantity  of  laudanum,  and  shared  it  with  his  wife ;  they 
took  about  an  ounce  each.  The  wife  died,  but  owing  to  early  vom- 
iting the  prisoner  recovered.  It  was  proved  that  before  marriage 
the  prisoner  had  been  confined  in  a  lunatic  asylum  ;  still,  he  had 
perfectly  recovered,  and  just  before  this  occurrence  it  was  observed 
that  both  husband  and  wife  were  low  and  dispirited.  There  was 
then  no  indication  of  intellectual  insanity  about  him ;  and  the  only 
delusion  appeared  to  be  that  machinery  would  ruin  his  trade.  In 
answer  to  the  charge  he  said,  "  According  to  my  notion  I  am  not 
guilty  of  murder."  The  case  is  like  that  of  many  others — of  two 
poor,  weak-minded,  infatuated  people  agreeing  to  commit  suicide. 


SUICIDE    IN    RELATION    TO    LIFE-INSURANCE.    ,      703 

Under  the  direction  of  the  judge,  the  jury  returned  a  verdict  of 
guilty. 

Suicide  in  Relation  to  Life-insurance. — It  is  well  known  that  accord- 
ing to  the  rules  of  some  English  offices  a  policy  of  life-insurance  is 
forfeited  by  the  act  of  suicide ;  but  supposing  it  to  have  been  really 
an  act  of  insanity,  it  has  been  doubted  whether  the  policy  would  be 
legally  forfeited.  In  an  equitable  view  the  policy  should  not  be 
forfeited  under  these  circumstances,  any  more  than  if  the  party  had 
died  accidentally  by  his  own  hands.  The  condition  equitably  im- 
plies that  the  assured  party  puts  himself  to  death  deliberately  and 
not  unconsciously  through  a  delusion  as  the  result  of  a  fit  of  delirium 
or  an  attack  of  insanity.  This  question  was  raised  in  the  case  of 
Borradaile  v.  Hunter  (Dec.  1841).  An  action  was  brought  to  recover 
the  amount  of  a  policy  of  insurance  effected  on  the  life  of  a  clergy- 
man who  threw  himself  into  the  Thames  from  Vauxhall  Bridge,  and 
was  drowned.  The  whole  case  turned  upon  the  legal  meaning  of  the 
words  " die  by  his  own  hands"  which  formed  the  exception  in  the 
proviso  to  the  payment  of  the  policy.  At  the  trial  of  the  case, 
Erskine,  J.,  directed  the  jury,  that  if  the  deceased  threw  himself 
into  the  river  knowing  that  he  should  destroy  himself  and  intending 
to  do  so,  the  policy  would  be  void ;  they  had  further  to  consider 
whether  the  deceased  was  at  the  time  capable  of  distinguishing  be- 
tween right  and  wrong,  or,  in  other  words,  whether  he  had  a  suffi- 
cient knowledge  of  the  consequences  of  the  act  to  make  him  a  felo- 
de-se.  The  jury  found  that  the  deceased  threw  himself  into  the 
water  intending  to  destroy  himself,  and  that  previously  to  this  act 
there  was  no  evidence  of  insanity.  They  were  then  directed  to  take 
the  act  itself  with  the  previous  conduct  of  the  deceased  into  consid- 
eration, and  say  whether  they  thought  he  was  at  the  time  capable  of 
knowing  right  from  wrong.  They  then  found  that  he  threw  himself 
from  the  bridge  with  the  intention  of  destroying  himself,  but  that 
he  was  not  then  capable  of  judging  between  right  and  wrong.  The 
jury  were  here  evidently  perplexed  with  the  strict  meaning  of  the 
words  right  and  wrong ;  the  first  part  of  the  verdict  made  the  case 
one  of  felo-de-se,  the  last  part  made  it  one  of  insanity.  The  verdict 
was  entered  for  the  defendants,  i.  e.,  that  the  deceased  was  a  felo- 
de-se,  and  that  the  policy  was  therefore  void. 

This  case  was  subsequently  argued  before  the  four  judges  in  the 
Common  Pleas  (May,  1843).  It  was  then  contended  for  the  plaintiff,  that 
according  to  the  terms  of  the  policy  there  must  have  been  an  ink  n- 
tion  by  the  party  assured  to  "  die  by  his  own  hand,"  and  that  an 
insane  person  could  have  no  controllable  intention.  The  judges  dif- 
fered ;  three  thought  there  was  no  ground  for  saying  that  the  de- 
ceased was  affected  by  an  uncontrollable  impulse ;  on  the  contrary, 
the  jury  had  found  that  he  threw  himself  into  the  river  knowing 
that  he  should  destroy  himself,  and  intending  to  do  so.  In  their 
opinion  the  act  was  one  of  felo-de-se,  and  the  policy  was  void.  Tin- 
did,  C.  J.,  considered,  that  the  verdict  should  be  for  the  plaintiff, 
thereby  leading  to  the  inference  that  the  act  of  suicide  was  in  this 
case  the  result  of  insanity,  and  not  of  a  felonious  killing,  to  which 


704  SUICIDE    AXD    INSANITY. 

alone  lie  considered  the  exception  in  the  proviso  should  apply.  It- 
is  probable  if  the  term  "suicide"  had  been  inserted  in  the  policy, 
instead  of  the  words  "die  by  his  own  hands"  that  the  decision  would. 
have  been  in  favor  of  the  plaintiffs;  for  to  vitiate  a  policy  from 
an  accidental  result  depending  on  an  attack  of  insanity  and  flowing 
directly  from  that  attack,  is  virtually  vitiating  it  for  the  insanity  itself ! 
In  this  respect,  it  appears  that  the  learned  Chief  Justice  took  a  sound 
and  equitable  view  of  this  question,  so  important  to  the  interests  of 
those  who  have  insured  their  lives.  It  is  impossible  for  a  man  to 
enter  into  a  contract  against  an  attack  of  insanity,  any  more  than 
against  an  attack  of  apoplexy!  The  jury  found  that  the  deceased 
was  irresponsible  for  the  act,  and  it  is  clear  that  the  insurers  and  in- 
sured intended  no  more  by  using  the  terms  "  die  by  his  own  hands," 
than  the  act  of  suicide.  By  this  decision,  therefore,  the  insurers  re- 
ceived the  benefit  of  a  wider  interpretation  of  the  terms  than  that 
which  either  party  could  have  foreseen  or  contemplated. 

The  question  was  again  raised  in  the  case  of  Schicabe  v.  Cliff,  Liver- 
pool Summer  Assizes,  1845.  ("  Med.  Gaz."  vol.  36,  p.  826.)  Thede- 
ceased,  whose  life  was  insured,  destroyed  himself  by  taking  sulphuric 
acid ;  there  was  clear  evidence  of  his  being  at  the  time  in  a  state  of  in- 
sanity. The  jury  here,  under  the  direction  of  Creswell,  J.,  returned 
a  verdict  for  the  plaintiffs,  thereby  deciding  that  the  policy  was  not 
vitiated  by  the  mere  act  of  suicide.  The  learned  judge  held  that  to 
bring  the  case  within  the  terms  of  the  exception,  the  party  taking 
his  own  life  must  have  been,  at  the  time  of  the  act,  an  accountable 
moral  agent  and  able  to  distinguish  right  from  wrong.  In  this  instance 
the  term  used  in  the  policy  was  "  suicide,"  which  according  to  the 
learned  judge  meant  "  a  felonious  killing."  Supposing  that  the  in- 
sured party  was  killed  by  voluntarily  precipitating  himself  from  a 
window  while  in  a  fit  of  delirium  from  fever,  this  would  be  an  act 
of  suicide  or  dying  by  his  own  hand ;  but  it  surely  cannot  be  equi- 
tably contended  that  his  heirs  should  lose  the  benefit  of  the  insurance 
in  consequence  of  an  event  depending  on  an  accidental  attack  of  a 
disease  which  no  one  could  have  foreseen,  and  against  which  no  one 
could  guard  ?  If  this  principle  be  not  admitted,  the  decision  which 
must  necessarily  follow  would  appear  to  be  against  all  equity ;  if  it 
be  admitted,  then  it  must  apply  equally  to  every  case  of  mental  dis- 
order, the  proof  of  the  existence  of  this  resting  with  those  who 
would  benefit  by  the  policy. 

On  an  appeal,  the  judgment  in  this  case  was  however  reversed, 
the  judges  again  differing.  It  was  argued  for  the  insurers,  that  if  a 
man  retained  just  enough  of  intelligence  to  produce  death  by  com- 
petent means,  but  was  deprived  of  all  moral  sense,  the  policy  was 
void.  Against  this  view  it  was  urged  by  one  of  the  judges,  that 
whether  the  intellect  was  destroyed  altogether,  or  only  partially,  it 
could  make  no  difference.  If  death  was  the  result  of  disease,  whether 
by  affecting  the  senses  or  by  affecting  the  reason  (thus  leading  to 
suicide),  the  insurance  office  was  liable  under  the  policy.  If  the  act 
was  not  the  act  of  a  sane  and  reasonable  creature,  it  was  not  an  act 
of  suicide  within  the  meaning  of  the  proviso.     Those  judges  who 


SUICIDE    IN    RELATION    TO    LIFE    INSURANCE,  705 

adopted  the  opposite  view  held  that  the  meaning  of  the  words,  as 
introduced  into  the  exception  was — if  the  party  should  kill  himself 
intentionally:  the  words  were  considered  to  include  all  cases  of  vol- 
untary self-destruction.  If  a  party  voluntarily  killed  himself,  it  w:  s 
of  no  consequence  whether  he  was  sane  or  not.  The  majority  of  the 
court  held  this  view,  and  a  new  trial  was  granted.  Had  all  the 
judges  been  present  to  give  their  opinions,  the  decision  might  have 
been  different;  for  five  had  expressed  themselves  at  various  times 
in  favor  of  the  view  that  the  term  suicide  in  policies  applies,  as  it 
ought  to  do,  only  to  cases  in  which  there  is  no  evidence  of  insanity; 
while  four  had  declared  their  opinion  to  be,  that  it  includes  all  cases 
of  "intentional"  self-killing,  whether  the  person  be  sane  or  insane. 
It  is  difficult  to  understand  how  a  man  in  a  fit  of  delirium  or  insanity 
can  be  said  to  kill  himself  voluntarily  or  intentionally.  Will  and 
intention  imply  the  judgment  of  a  sane  man  in  regard  to  civil  and 
criminal  acts,  but  a  delirious  or  really  insane  person  acts  under  a 
delusion;  and  as  the  law  would  hold  him  irresponsible  in  regard  to 
others,  his  representatives  should  not  suffer  for  an  act  which  he  was 
himself  incapable  of  controlling.  (See  "  Law  Times,"  July  18,  1846, 
p.  812.) 

The  decision  in  this  case  is  of  great  importance  to  persons  whose 
lives  are  insured,  for  it  may  be  made  to  govern  others;  and  on  this 
principle,  a  man  attacked  with  delirium,  and  who  during  the  fit  pre- 
cipitated himself  from  a  window  and  was  killed,  would  be  declared 
a  suicide  within  the  meaning  of  the  proviso,  and  a  policy  of  insur- 
ance on  his  life  would  be  ipso  facto  void.  It  will  be  perceived  that 
the  law,  as  interpreted  by  a  majority  of  the  judges,  is  that  whenever 
a  person  destroys  himself  intentionally,  whatever  may  be  the  state  of 
his  mind,  the  policy  becomes  void.  It  also  appears  that,  according 
to  this  legal  view  of  the  question,  a  person  may  have  and  exercise 
his  intention  although  undoubtedly  insane.  Whether  he  has  been 
found  so  under  a  commission,  or  a  verdict  to  this  effect  has  been 
returned  by  a  coroners  jury,  is  therefore  unimportant.  It  must  be 
proved  by  those  who  would  benefit  by  the  policy,  that  the  party 
died  'from  his  own  act  without  intending  to  destroy  himself.  If  a 
man  take  poison,  or  shoot  himself,  or  commit  any  other  act  leading 
to  his  own  death,  it  must  be  shown  that  it  was  the  result  of  accident, 
and  not  of  design  on  his  own  part.  Some  Insurance  offices  now 
insert  in  the  contract  a  proviso  by  which,  whether  the  person  be 
found  felo-de-se  or  not,  the  policy  shall  be  forfeited;  but  they  reserve 
to  themselves  the  power  of  returning  a  part  or  the  whole  value  of 
the  policy,  calculated  up  to  the  day  of  death.  In  the  meantime  they 
have  the  power  of  taking  the  full  benefit  arising  from  an  act  of 
suicide  committed  during  a  fit  of  delirium  or  insanity,  in  which,  as 
medical  men  know,  there  can  exist  no  controllable  intention,  no 
freedom  of  judgment,  and  no  real  exercise  of  will.  (See  case  "Prov. 
Med.  Jour.,"  Aug.  9,  1818,  p.  428.)  [See  chap,  on  Life  Insurance, 
post,  p.  721  et  sty.] 

There  is  a  form  of  suicide  not  unlikely  to  present  itself  for  con- 
sideration, namely,  where  a  man,  in  the  habit  of  usimr  a  powerful 
15 


706  PUERPERAL    INSANITY. 

drug  for  medicinal  purposes,  takes  a  large  dose  while  in  a  state  of 
intoxication  and  dies.  In  May,  1857,  a  Mr.  George  Fife  died  from 
an  overdose  of  morphia,  and  it  was  proved  to  the  satisfaction  of  the 
jurv  that  this  must  have  been  taken  while  he  was  intoxicated.  In 
such  a  case  a  man  may  have  no  sane  intention  of  destroying  himself, 
yet  he  dies  by  his  own  hands.  As  drunkenness  does  not  excuse  or 
justify  any  act  of  homicide,  so  it  would  not  probably  be  allowed  to 
affect  the  question  of  suicide ;  and  death  under  such  circumstances 
would  probably  be  held  to  be  a  felonious  killing. 

From  these  cases  one  fact  is  clear — the  act  of  suicide  is  not  treated  by 
the  law  as  a  necessary  proof  of  insanity ;  and  therefore  the  ingenious 
arguments  which  have  been  held  on  this  subject  have  but  little 
interest  for  a  medical  jurist  in  a  practical  view.  It  has  been  else- 
where stated  that  acts  of  suicide  have  been  mistaken  for  homicide, 
merely  because  the  deceased  had  expressed  no  intention  of  destroy- 
ing himself,  and  had  manifested  no  disposition  to  the  act  by  his 
previous  conduct.  This,  however,  is  a  fallacious  view  of  the  sub- 
ject, since  suicide  from  sudden  impulse  is  by  no  means  unfrequent ; 
and  even  when  the  act  bears  about  it  marks  of  deliberation,  it  is  not 
to  be  expected  that  a  person  should  previously  announce  his  inten- 
tion, for  this  would  be  a  sure  way  of  defeating  his  object. 

If,  as  it  is  alleged,  the  act  of  suicide  was  in  all  cases  the  offspring 
of  insanity,  suicide  should  be  frequent  among  the  insane.  Experi- 
ence, however,  is  not  in  favor  of  this  assumption.  The  Report  of 
the  Commissioners  of  Lunacy  for  1850  shows  that  there  were  then 
confined  as  lunatics  15,079  persons,  while  the  suicides  for  the  year 
among  this  large  number  amounted  to  only  eight,  of  which  six  were 
perpetrated  by  strangulation.  As  mechanical  restraint  is  either 
abolished  or  considerably  diminished  in  most  asylums,  lunatics  have 
now  much  more  liberty  than  formerly,  and  yet  suicides  among  them 
are  comparatively  rare.  This  favorable  result  must  be  in  part  as- 
cribed to  active  superintendence  and  watching. 

The  tendency  to  suicide  appears  to  be  in  some  cases  hereditary. 
Dr.  Burrows  relates  an  instance  in  which  this  propensity  declared 
itself  through  three  generations :  in  the  first,  the  grandfather  hanged 
himself:  he  left  four  sons — one  hanged  himself,  another  cut  his 
throat,  and  a  third  drowned  himself  in  an  extraordinary  manner, 
after  having  been  some  months  insane:  the  fourth  died  a  natural 
death,  which,  from  his  eccentricity  and  irregularity  of  mind,  was 
scarcely  to  be  expected.  Two  of  these  sons  had  large  families  :  one 
child  of  the  third  son  died  insane,  two  others  drowned  themselves, 
another  became  insane  and  made  the  most  determined  attempts  on 
his  life.  Several  of  the  progeny  of  this  family,  being  the  fourth 
generation,  when  they  had  arrived  at  puberty,  showed  a  tendency 
to  the  same  fatal  propensity. 

Puerperal  Insanity. — Mania  may  present  itself  in  other  forms 
than  those  hitherto  considered.  Women  who  have  been  recently 
delivered  are  liable  to  sudden  attacks,  in  which  a  disposition  to 
murder  their  offspring  is  the  most  marked  symptom.  This  has 
been  long  known  and  recognized  by  physicians  as  "puerperal  mania. 


CAUSES    AND    SYMPTOMS.  707 

The  disorder  seldom  attacks  a  woman  before  the  third  day — often 
not  for  a  fortnight,  and  in  some  instances  not  until  several  weeks 
after  delivery.  Out  of  ninety-two  cases,  Dr.  Simpson  observed  that 
the  attack  occurred  in  twenty-one  between  the  fifth  and  the  fifteenth 
day.  ("Med.  Times  and  Gaz."  Sept.  1,  1860,  p.  201.)  The  most 
frequent  period  is  at  or  about  the  commencement  of  lactation,  and 
between  that  and  the  cessation  of  the  uterine  discharges  (lochia). 
According  to  Esquirol,  it  is  generally  preceded  or  attended  by  a 
suppression  of  the  lochia  and  milk.  The  late  Dr.  Ashwell  remarked 
that  undue  lactation  might  give  rise  to  an  attack  of  mania  under 
which  the  murder  of  the  offspring  might  be  perpetrated.  ("  Disea-es 
of  Women,"  p.  732.  See  the  case  of  Reg.  v.  Lacey,  Nottingham 
Summer  Assizes,  1858.)  It  may  also  come  on  after  forced  or  volun- 
tary weaning. 

The  symptoms  do  not  differ1  from  those  of  mania  generally  but  it 
may  assume  any  of  the  other  forms  of  insanity :  and  in  one- half  of 
the  cases,  it  may  be  traced  to  hereditary  tendency.  There  is  a 
childish  disposition  for  harmless  mischief.  The  woman  is  gay  and 
joyous,  laughing,  singing,  loquacious,  inclined  to  talk  obscenely, 
and  careless  of  everything  around.  She  imagines  that  her  food  is 
poisoned ;  she  may  conceal  the  suspicion,  and  merely  avoid  taking 
what  is  offered  to  her.  She  can  recognize  persons  and  things ;  and 
can,  though  perhaps  she  will  not,  answer  direct  questions.  Occa- 
sionally there  is  great  depression  of  spirits  with  melancholia.  These 
facts  are  of  some  importance  in  reference  to  cases  of  alleged  child- 
murder.  This  state  may  last  a  few  hours,  or  for  some  days  or  weeks. 
The  murder  of  the  child  is  generally  either  the  result  of  a  sudden 
fit  of  delirium,  or  a  sudden  impulse,  with  a  full  knowledge  of  the 
wickedness  and  illegality  of  the  act;  so  that  the  legal  test  of  re- 
sponsibility of  a  knowledge  of  right  and  wrong  cannot  be  applied 
to  such  cases,  except  on  the  assumption  that  insanity  already  exists 
and  taints  the  consciousness  of  the  individual,  (p.  tiS6.)  A  woman 
has  been  known  to  request  her  attendants  to  remove  the  child,  but 
she  has  afterwards  taken  an  opportunity  to  destroy  it.  Such  cases 
are  commonly  distinguished  from  deliberate  child-murder  by  there 
being  no  motive,  no  attempt  at  concealment,  nor  any  denial  of  the 
crime  on  detection.  There  is  in  general  a  full  consciousness  of  the 
illegality  of  the  act,  but  apparently  an  entire  want  of  power  to  con- 
trol the  murderous  feeling. 

"Women  in  the  pregnant  state  have  been  known  to  perpetrate 
murder  apparently  from  some  sudden  perversion  of  their  moral 
feelings :  there  has  been  probably  latent  intellectual  disturbance, 
but  not  sufficient  to  attract  the  notice  of  friends.  There  is  a  great 
sympathy  between  the  uterine  organs  and  the  brain,  which  may 
account  for  the  occurrence  of  such  cases;  but  I  am  not  aware  that 
irresponsibility  on  the  ground  of  insanity  has  been  admitted  in  this 
country  under  these  circumstances. 

P  yromania.  Propensity  to  Incendiarism. — This  is  described  as  a 
variety  of  monomania  in  which  there  is  a  morbid  disposition  of 
mind  leading  to  impulsive  acts  of  incendiarism  without  any  motive. 


708  KLEPTOMANIA.      DRUNKENNESS. 

It  is  a  condition  not  specially  recognized  by  English  jurists  or  in 
English  courts  of  justice. 

Kleptomania.  Propensity  for  Thieving. — This  term  has  been  ap- 
plied by  Marc  fo  that  form  of  monomania  which  is  said  to  manifest 
itself  by  a  propensity  to  acts  of  theft.  It  is  alleged  by  him  and 
others  that  this  propensity  has  often  shown  itself  in  females  labor- 
ing under  disordered  menstruation,  or  among  those  who  were  far 
advanced  in  pregnancy— the  motive  being  the  mere  wish  of  posses- 
sion. Pregnancy,  according  to  him,  should  be  a  good  exculpatory 
plea  when  a  well-educated  woman,  of  strictly  moral  conduct,  steals 
some  unimportant  article  of  no  value  compared  with  her  worldly 
means  and  position  in  society.  There  are  several  instances  on  record 
showing  that  well-educated  persons  moving  in  a  respectable  sphere 
of  society  have  been  guilty  of  petty  acts  of  theft.  The  articles 
taken  have  been  valueless  compared  with  their  means.  Instances 
of  this  kind  have  been  brought  before  our  Police-courts,  and  this 
motiveless  impulse  to  theft  has  been  occasionally  pleaded ;  but  in 
most  of  them  the  following  facts  have  been  clearly  established  by 
evidence:  1.  A  perfect  consciousness  of  the  act  and  of  its  illegal- 
ity. 2.  The  article,  though  of  trifling  value,  has  still  been  of  some 
use  to  the  person — thus  women  have  stolen  articles  either  adapted 
to  female  use,  or  on  which  money  could  be  raised.  3.  There  have 
been  art  and  precaution  in  endeavoring  to  conceal  the  theft ;  and  4, 
either  a  denial  of  the  act  when  detected,  or  some  evasive  excuse. 
When  circumstances  of  this  kind  are  proved,  either  the  parties 
should  be  made  responsible,  or  theft  should  be  openly  tolerated. 
The  evidence  of  a  disordered  state  of  mind  should  not  be  allowed 
to  depend  on  the  nature  of  the  act,  or  every  morally  depraved  per- 
son might  bring  forward  a  plea  of  insanity  for  any  crime  or  offence. 
When  the  plea  of  insanity  is  raised  in  respect  to  other  cases  of 
stealing,  the  rule  appears  to  be  (per  Tindal,  C.  J.),  that  there  should 
be  proof  that  the  prisoner  was  incompetent  to  know  that  the  par- 
ticular act  in  question  was  a  wrong  one.  {Reg.  V.  Vaughan,  Mon- 
mouth Sum.  Ass.,  1844.) 

Dipsomania.  Drunkenness.  Civil  Responsibility  of  Drunkards. — 
This  state,  which  is  called  in  law  frenzy  or  "dementia  affectata" 
is  regarded  as  a  temporary  form  of  insanity.  Jurists  and  legislators 
have  differed  widely  respecting  the  degree  to  which  drunkards 
should  be  made  responsible  for  their  acts.  When  the  mind  of  a 
man  is  completely  weakened  by  habitual  drunkenness,  the  law  infers 
irresponsibility,  unless  it  plainly  appears  that  the  person  was  at  the 
time  of  the  act,  whether  of  a  civil  or  of  a  criminal  nature,  endowed 
with  full  consciousness  and  reason  to  know  its  good  or  evil  tend- 
ency. Any  deed  or  agreement  made  by  a  party  when  drunk  is  not 
invalidated  by  our  law,  except  in  a  case  in  which  the  intoxication 
has  proceeded  so  far  as  to  deprive  him  of  all  consciousness  of  what 
he  is  doing;  and  a  Court  of  Equity  will  not  interfere  in  other  cases, 
unless  the  drunkenness  was  the  result  of  collusion  by  others  for  the 
purposes  of  fraud.  When  the  drunkenness  lias  occasioned  a  tem- 
porary loss  of  the  reasoning   powers,  the  person   is  incapable  of 


CRIMINAL    RESPONSIBILITY.  709 

giving  a  valid  consent,  and  therefore  cannot  enter  into  a  contract 
or  agreement;  for  this  implies  aggregatio  mentium,  i.  e.  a  mutual 
assent  of  the  parties.  Partial  drunkenness  therefore,  provided  the 
person  knew  what  lie  was  about,  does  not  vitiate  a  contract  or 
agreement  into  which  he  may  have  entered.  Thus  the  law  appears 
to  define  two  states  in  drunkenness: — one  in  which  it  has  proceeded 
to  but  a  slight  extent,  and  it  is  considered  that  there  is  still  a  power 
of  rational  consent;  another  in  which  it  has  proceeded  so  far  that 
the  person  has  no  consciousness  of  the  transaction,  and  therefore 
can  give  no  rational  consent.  The  proof  of  the  existence  of  this  last 
state  would  render  all  the  civil  acts  of  a  person  void.  A  confession 
made  by  a  man  while  in  a  state  of  drunkenness  is  legally  admissible 
as  evidence  against  him  and  others,  provided  it  be  corroborated  by 
circumstances.  In  a  case  tried  a  few  years  since  the  prisoner  con- 
fessed, while  drunk,  that  he  had  committed  a  robbery  and  murder 
which  had  taken  place  some  time  before,  but  of  which  he  had  not 
been  suspected.  He  mentioned  a  spot  where  the  property  of  the 
murdered  person  had  been  concealed  by  him,  and  the  whole  of  the 
circumstances  of  the  murder.  The  property  was  found  as  he  had 
described  it,  and  the  case  was  clearly  brought  home  to  him,  chiefly 
by  collateral  evidence  from  his  own  confession.  He  was  convicted. 
In  a  case  tried  at  the  Central  Criminal  Court,  in  October,  1849,  a 
man  pleaded  his  drunkenness  at  the  time  of  his  first  marriage  as  a 
defence  to  a  charge  of  bigamy.  There  was  some  evidence  to  show 
that  he  was  partly  intoxicated  when  the  ceremony  was  performed; 
it  was  proved,  however,  that  he  was  sufficiently  conscious  of  the 
whole  of  the  proceedings,  and  he  was  convicted.  ("Med.  Gaz."  vol. 
44,  p.  762.) 

Criminal  Responsibility  of  Drunkards. — When  homicide  is  committed 
by  a  man  in  a  state  of  drunkenness,  this  is  held  to  be  no  excuse  for 
the  crime.  If  voluntarily  induced,  whatever  may  be  its  degree,  it 
is  not  admitted  as  a  ground  of  irresponsibility,  even  although  the 
party  might  not  have  contemplated  the  crime  when  sober.  {Reg.  v. 
Reeves,  Derby  Winter  Assizes,  1844.)  Thus  it  appears  that  when 
the  state  of  drunkenness  is  such  that  any  civil  act  would  be  void,  a 
person  may  still  be  held  legally  responsible  for  a  crime  like  mur- 
der. Some  judges  have  admitted  a  plea  of  exculpation  when  the 
crime  has  been  committed  in  a  state  of  frenzy  arising  from  habitual 
drunkenness;  but  even  this  is  not  general.  The  question  whether 
"In'  person  was  or  was  not  drunk  at  the  time  of  committing  a  crime 
may  be,  however,  occasionally  of  some  importance.  It  was  held  by 
Patteson,  J.,  that  although  drunkenness  is  no  excuse  for  any  crime 
whatever,  yet  it  is  of  very  great  importance  in  cases  in  which  there 
is  a,  question  of  intention.  A  person  may  be  so  drunk  as  to  be  utterly 
unable  to  form  n\\y  intention  at  all,  and  yet  he  may  be  gnilty  of 
very  great  violence.  {Reg.  v.  Cruse,  8  C.  &  P.  p.  546.)  If  the  drunk- 
-  has  produced  a  diseased  state  of  the  mind,  then  a  criminal 
ad  perpetrated  by  the  person,  might  admit  of  exculpation  either  on 
the  ground  of  insanity  or  of  the  want  of  sane  consciousness  at  the 
time  of  the  act:  but  the  difficulty  is  to  prove  in  such  cases  the  ex- 


710  CRIMINAL    RESPONSIBILITY    OF    DRUNKARDS. 

istence  of  actual  disease  to  a  sufficient  degree  to  render  the  person 
irresponsible  in  a  legal  sense.  When  it  is  a  question  whether  the 
accused  was  actuated  by  malice  or  not,  a  jury  may  under  certain 
circumstances  be  required  to  take  the  fact  of  drunkenness  into  their 
consideration,  and  this  may  have  some  influence  npon  their  verdict. 
While,  then,  drunkenness  does  not  furnish  any  excuse  for  a  crime, 
it  may  become  material  with  reference  to  the  intent  with  which  an 
act  has  been  perpetrated.  ("Law  Times,"  Sept.  27,  1845,  p.  542.) 
It  is  obvious  that  if  drunkenness  were  to  be  readily  admitted  as  a 
defence,  three-fourths  of  the  crimes  committed  in  this  country  would 
go  unpunished ! 

In  cases  in  which  the  head  has  sustained  any  physical  injury,  as 
among  soldiers  and  sailors,  drunkenness,  even  when  existing  to  a 
slight  extent,  produces  sometimes  a  fit  of  temporary  insanity,  leav- 
ing the  mind  clear  when  the  drunken  fit  is  over.  The  law  makes 
no  distinction  between  this  state  and  ordinary  drunkenness,  although 
juries  occasionally  show  by  their  verdicts  that  some  difference  ought 
to  be  made.     (See  cases  in  Alison,  p.  6"»-">.) 

Hallucinations  and  illusions  are  a  common  effect  of  drunkenness, 
and  may  lead  to  the  commission  of  criminal  acts.  Marc  relates  a 
case  where  two  friends  being  intoxicated,  the  one  killed  the  other 
under  an  illusion  that  he  was  an  evil  spirit.  The  drunkenness  of 
the  accused  was  held  to  have  been  voluntary :  and  he  was  con- 
demned to  ten  years'  imprisonment  with  hard  labor.  A  case  of  this 
description  {Reg.  v.  Patteson)  was  tried  at  the  Norfolk  Lent  Assizes, 
1840.  A  man  while  intoxicated  killed  his  friend,  who  was  also  in- 
toxicated, under  the  illusion  that  he  was  some  other  person  who  had 
come  to  attack  him.  It  is  reported  that  the  guilt  of  the  prisoner 
was  made  to  rest  upon  the  fact,  whether,  had  he  been  sober,  he 
would  have  perpetrated  the  act  under  a  similar  illusion !  As  he 
had  voluntarily  brought  himself  into  a  state  of  intoxication,  this 
was  no  justification:  he  was  found  guilty  of  manslaughter,  and  sen- 
tenced to  two  months'  imprisonment. 

The  proof  of  drunkenness  may  fail,  but  still,  if  the  person  charged 
with  the  death  acted  under  an  illusion,  he  will  be  acquitted.  In  Reg. 
v.  Price  (Maidstone  Summer  Assizes,  1846),  it  was  proved  that  the 
prisoner,  who  had  been  on  friendly  terms  with  deceased,  was  going 
home  at  night,  having  previously  been  in  company  with  deceased  at 
a  public  house.  According  to  the  prisoner's  statement,  a  man  sprang 
upon  him  from  the  hedge  by  the  roadside,  and  demanded  his  money 
and  his  watch,  or  else  he  said  he  would  have  his  life ;  the  prisoner 
closed  with  and  beat  him  severely,  inflicting  such  injuries  that  he 
died  shortly  afterwards.  The  supposed  robber  turned  out  to  be  his 
friend,  and  it  was  believed  that  he  had  made  an  attempt  to  rob  the 
prisoner  jokingly ;  the  result,  however,  was  that  the  attempt  had 
ended  in  this  fatal  manner.  The  prisoner  throughout  told  the  same 
story,  and  there  did  not  appear  to  be  the  slightest  ground  for  sug- 
gesting that  it  was  untrue.  Coltman,  J.,  after  hearing  the  evidence 
of  the  witnesses,  said  it  appeared  to  be  quite  clear  that  the  prisoner 
had  acted  under  an  impression  that  he  was  protecting  his  own  life 


DELIRIUM    TREMENS.  711 

from  the  attack  of  a  robber,  and  under  such  circumstances  lie  could 
not  be  held  to  be  criminally  responsible.  The  jury  accordingly  re- 
turned a  verdict  of  not  guilty,  and  the  prisoner  was  discharged. 

An  excessive  indulgence  in  habits  of  drinking  does  not  necessa- 
rily derange  the  mind,  but  it  practically  renders  a  person  unfit  for 
the  control  of  himself  and  the  management  of  his  property.  It  is 
therefore  a  question  whether  it  would  not  be  for  the  benefit  of  such 
persons  and  of  those  dependent  on  them,  if  the  law  interfered  and 
placed  them  under  the  same  restraint  as  those  whose  minds  had  been 
actually  rendered  unsound  by  this  pernicious  habit.  [The  law  does 
so  interfere  in  Pennsylvania — vide  note  to  p.  667  ante. — P.] 

Delirium  Tremens. — This  is  a  disordered  state  of  mind  which  pro- 
ceeds from  an  abuse  of  intoxicating  liquors.  Habitual  drunkenness 
appears  to  be  the  predisposing,  while  abstinence  from  drink  is  the 
immediately  exciting  cause.  Thus,  the  disorder  frequently  does  not 
show  itself  until  the  accustomed  stimulus  has  been  withdrawn  for  a 
certain  period.  It  commences  with  tremors  of  the  hands,  by  which 
it  is  known  from  ordinary  delirium  and  restlessness ;  and  the  indi- 
vidual is  subject  to  hallucinations  and  illusions,  sometimes  of  a  hor- 
rible kind,  referring  to  past  occupations  or  events.  The  patients  are 
often  violent,  and  prone  to  commit  suicide  or  murder — more  com- 
monly the  former ;  hence  they  require  close  watching.  Persons  la- 
boring under  this  disorder  are  incompetent  to  the  performance  of 
any  civil  act,  unless  the  mind  should  clear  up  before  death ;  they  are 
not  responsible  for  criminal  acts  committed  while  they  are  laboring 
under  an  attack.  Acquittals  have  even  taken  place  on  charges  of 
murder,  when  there  was  deliberation  as  well  as  an  apparent  motive 
for  the  act.  Thus  then,  although  this  disorder  may  have  been  vol- 
untarily brought  on  by  habitual  drunkenness,  the  law  admits  it  as 
a  sufficient  plea  for  irresponsibility,  while  in  a  case  of  confirmed 
drunkenness  it  rejects  the  plea.  In  delirium  there  is  a  formed  disease 
of  the  brain,  while  voluntary  drunkenness  merely  produces  a  tem- 
porary disturbance  of  its  functions.  In  one  trial  the  evidence  showed 
that  homicide  had  been  committed  by  the  accused  while  he  was  la- 
boring under  an  attack  of  delirium  tremens.  (Beg.  v.  Simpson,  Ap- 
pleby Summer  Assizes,  18-15.)  The  prisoner's  mind  had  become 
unsettled  from  this  disorder,  brought  on  by  habitual  drunkenness. 
In  another  case  the  plea  was  also  admitted  by  the  jury,  although  it 
was  scarcely  supported  by  the  medical  evidence.  (Reg.  v.  Watson, 
York  Winter  Assizes,  1845.)  In  a  case  tried  at  Liverpool  Assizes 
(Beg.  v.  Burns,  Aug.  1865),  a  man  laboring  under  delirium  tremens, 
Avas  charged  with  the  murder  of  his  wife.  After  the  act  he  appeared 
calm,  and  said  that  he  knew  perfectly  well  what  he  had  done;  "his 
wife  was  in  league  with  men  who  were  hidden  in  the  walls."  Baron 
Bramwell,  in  charging  the  jury,  said,  "  There  were  two  kinds  of  in- 
sanity by  reason  of  which  a  prisoner  was  entitled  to  be  acquitted ; 
and  said  that  probably  the  jury  would  not  be  of  opinion  that  the 
prisoner  knew  not  the  quality  of  his  act ;  that  it  would  kill,  and  Avas 
wrong;  but  it  was  still  open  to  them  to  acquit  him  if  they  were  of 
opinion  that  he  was  suffering  from  a  delusion  leading  him  to  sup 


712  DRUNKENNESS    AS    AFFECTING    DEGREE    OF 

pose  that  which ,  if  true,  Avould  have  justified  him  in  the  act.  One 
more  remark  he  would  make,  viz :  that  drunkenness  was  no  excuse, 
and  that  a  prisoner  cannot  by  drinking  qualify  himself  for  the  per- 
petration of  crime ;  but  if  through  drink  his  mind  had  become 
substantially  impaired,  a  ground  of  acquittal  would  then  fairly  arise." 
The  prisoner  was  acquitted. 

[Many  of  the  States  of  the  Union  hare  statutes  defining  murder, 
and  dividing  it  into  degrees.  Where  this  is  the  case,  the  existence 
of  intoxication  and  its  effect  upon  the  mind  of  one  charged  with 
homicide  become  of  much  importance,  upon  the  question  of  intent 
and  premeditation. 

The  "American  Law  Journal,"  for  October.  1848  (p.  1-15),  contains 
the  following  admirable  article  upon  this  subject. 

"  The  mental  status  produced  by  drunkenness  is  frequently  deter- 
mined by  the  testimony  of  physicians.  But  the  effect  of  that  state 
of  mind,  voluntarily  produced,  in  relieving  from  responsibility  for 
crime,  is  to  be  determined  by  the  courts.  Sir  William  Blackstone 
quotes  the  language  of  Sir  Edward  Coke,  who  declares  that  'a 
drunkard  who  is  voluntaries  daemon,  hath  no  privilege  thereby:  but 
what  hurt  or  ill  soever  he  doth,  his  drunkenness  doth  aggravate  it.' 
And  Sir  William  adds,  that  'the  common  law  of  England,  consider- 
ing how  easy  it  is  to  counterfeit  this  excuse,  and  how  weak  an  ex- 
cuse it  is,  though  real,  will  not  suffer  any  man  thus  to  privilege  one 
crime  by  another.'  (Plow.  19,  4  Bl.  26.  1  Inst.  247.)  The  effect  of 
this  severe  rule  of  the  common  law  is  frequently  to  fix  upon  the 
accused  the  legal  guilt  of  a  crime  of  much  greater  enormity  than  he 
ever  intended  to  commit.  But  the  great  value  of  the  common  law 
is  that  it  is  founded  upon  far-reaching  views  of  policy,  which  look 
beyond  the  justice  of  the  particular  case,  for  the  purpose  of  protect- 
ing the  higher  interests  of  society.  It  seems  to  be  conceded  as  a 
principle  of  the  common  law  that  a  man  who  wilfully  perpetrates 
an  unlawful  act  is  responsible  for  all  its  consequences.  Hence,  a 
man  who  accidentally  kills  another  by  discharging  a  gun  at  a  sheep, 
or  a  domestic  fowl,  for  the  purpose  of  stealing  it,  is  guilty  of  murder 
at  common  law,  although  his  mind  never  in  fact  assented  to  the 
enormity  of  taking  the  life  of  a  fellow  being.  On  the  same  princi- 
ple, it  would  seem  that  a  man  who  voluntarily  puts  himself  in  a 
state  of  mind  which, causes  him  to  take  the  life  of  another  is  guilty, 
by  construction,  of  the  common  law  crime  of  murder. 

"  The  hardship  of  this  rule  has  sometimes  caused  the  scales  of  jus- 
tice to  vibrate  in  its  application  to  capital  cases.  In  1810,  Mr.  Jus- 
tice Holroyd,  in  Rex  v.  Grindley,  under  the  influence  of  his  feelings, 
held  that  '  though  voluntary  drunkenness  cannot  excuse  from  the 
commission  of  crime,  yet  where,  as  upon  a  charge  of  murder,  the 
material  question  is  whether  the  act  was  premeditated,  or  done  only 
with  a  sudden  beat  and  impulse,  the  fact  of  the  party  being  intoxi- 
cated is  a  circumstance  proper  to  be  taken  into  consideration.'' 
(Lewis's  Grim.  L.  602  ;  1  Spear's  884.)  This  decision  has  doubtless 
had  its  influence  elsewhere.  The  error  of  Mr.  Justice  Holroyd 
consist'',!  in  supposing  that  at  common  law  it  was  always  'a  material 


GUILT    IN    HOMICIDE.  713 

question'  in  murder  'whether  the  act  was  'premeditated'1  or  not.  We 
have  seen  that  premeditated  killing  was  not  always  essential  to  con- 
stitute the  crime ;  otherwise  it  never  could  have  been  held  murder 
to  kill  a  human  being  accidentally  in  the  premeditated  perpetration 
of  larceny.  There  is  some  reason  to  believe  that  subsequent  reflec 
tion  brought  the  mind  of  that  enlightened  judge  to  an  acknowledg- 
ment of  his  error.  In  1835,  in  the  case  of  Rex  v.  Carroll,  Mr.  Jus- 
tice Parke,  after  citing  the  case  of  Rex  v.  Orindley,  decided  by  Mr. 
Justice  Holroyd,  remarked  that  '  highly  as  I  respect  that  late  ex- 
cellent judge,  I  differ  from  him,  and  my  brother  Littledale  agrees 
with  me.  He  once  acted  upon  that  case,  but  afterwards  retracted 
his  opinion,  and  there  is  no  doubt  that  case  is  not  law.  I  think  that 
there  would  be  no  safety  for  human  life  if  it  were  to  be  considered 
as  law.'  (7  Car.  and  Payne,  145 ;  32  Eng.  Com.  Law,  471 ;  Lewis's 
Crim.  Law,  602,  note.) 

"Mr.  Justice  Story,  in  the  United  States  v.  Drew,  took  a  distinction 
on  the  effect  of  intoxication  which,  on  account  of  its  humanity,  has 
received  general  commendation.  That  learned  judge  held  that  in- 
sanity, of  which  the  remote  cause  is  habitual  drunkenness,  is  an 
excuse  for  an  act  done  by  the  party  while  so  insane,  hut  not  at  the 
time  under  the  influence  of  liquor.  The  crime  (to  be  punishable)  must 
take  place  during  a  fit  of  intoxication,  and  be  the  immediate  result 
of  it,  and  not  a  remote  consequence  superinduced  by  the  antecedent 
drunkenness  of  the  party.  In  cases  therefore  of  delirium  tremens  or 
mania  a  potu,  the  insanity  excuses  the  act,  if  the  party  he  not  intoxi- 
cated when  it  is  committed.  (5  Mason,  28  ;  Am.  Jurist,  vol.  3,  p.  5 
to  30 ;  Burnet  v.  The  State,  Martin  &  Yerger,  133 ;  Cormvell  v.  The 
State,  ib.  147 ;  Lewis's  Criminal  Law,  602,  note.) 

"  Thus  stands  the  law  on  this  question  where  the  trial  is  for  mur- 
der, as  defined  by  the  common  law,  uninfluenced  by  any  statutory 
division  into  degrees.  But  the  unreasonableness  of  fixing  the  pen- 
alty of  death  upon  one  whose  whole  guilt,  so  far  as  his  mind  was 
considered,  consisted  of  an  intention  to  steal,  or  the  criminal  folly 
of  becoming  intoxicated,  induced  many  States  of  this  Eepublic  to 
enact  statutes  dividing  murder  into  degrees,  according  to  the  attend- 
ing circumstances.  By  the  act  of  22  April,  1794  (Pennsylvania), 
no  crime  whatever,  thereafter  committed  (except  murder  in  the  first 
degree)  was  punishable  with  death.  And  '  all  murder  which  shall 
be  perpetrated  by  means  of  poison,  or  by  lying  in  wait,  as  by  any 
other  kind  of  wilful^  deliberate  and  premeditated  icillinrj,  or  which  shall 
be  committed  in  the  perpetration  or  attempt  to  perpetrate  any  arson, 
rape,  robbery  or  burglary,  shall  be  deemed  murder  of  the  first  de- 
gree; and  all  other  kinds  of  murder  shall  be  deemed  murder  of  the 
second  degree.'  By  this  act  it  is  evident  that  the  legislature  con- 
sidered that  the  intention  to  commit  either  of  the  high  crimes  of 
arson,  rape,  robbery,  or  burglary  was  to  be  regarded  as  equal  in  point 
of  enormity  to  an  intention  to  kill,  and  involved  the  perpetrator  in 
the  constructive  guilt  of  wilful,  deliberate,  and  premeditated  murder, 
if  tin/  death  of  a  human  being  was  caused  by  the  perpetration  or 
attempt  to  perpetrate  either  of  the  high  crimes  thus  enumerated  in 


714  DRUNKENNESS    AS    AFFECTING    DEGREE    OF 

the  statute.  But  not  so  with  the  crime  of  larceny,  drunkenness,  or 
any  other  crime  not  enumerated.  A  death  happening,  without  an 
intention  to  kill,  in  the  perpetration  of  any  of  the  non-enumerated 
offences,  fell  within  the  class  of  constructive  murders,  which,  al- 
though punishable  with  death,  at  common  law,  was  not  thus  punished 
under  the  Act  of  179-1.  It  follows  that,  under  the  benign  provisions 
of  that  act,  any  circumstance  may  be  given  in  evidence  to  show  that 
the  mind  of  the  prisoner  was  deprived  of  the  power  to  form  a  de- 
sign— to  deliberate — to  premeditate.  To  admit  this  defence  is  not 
to  privilege  one  crime  by  another,  but  to  show  that  the  ingredients 
expressly  required  by  the  statute  to  constitute  the  capital  crime,  did 
not  exist,  and  that  therefore  the  crime  itself,  to  the  degree  alleged, 
could  not  have  been  committed. 

"  It  is  true  that  this  defence  should  be  admitted  with  great  cau- 
tion and  examined  by  the  jury  with  the  most  careful  scrutiny.  But 
it  is  certain  that  where  it  is  satisfactorily  shown  that  the  mind  of 
the  accused,  by  reason  of  intoxication,  or  otherwise,  was  for  the  time 
so  totalhy  deranged  as  to  be  incapable  of  deliberation  and  premedi- 
tation,  he  cannot  be  guilty  of  a  crime  in  which  these  operations  of 
the  mind  are  demanded  by  statute  as  essential  in  its  constitution. 
The  iron  rule  of  the  common  law  has  nothing  to  do  with  such  a 
case.  The  statute  is  imperative ;  and  no  judge  can  lawfully  deprive 
a  prisoner  of  his  life  under  the  pretext  of  a  constructive  deliberation, 
where  the  mind  was  incapable  of  such  deliberation  in  fact.  It  is 
feared  that  some  unfortunate  prisoners  have  gone  to  the  gallows 
for  want  of  a  proper  explanation  of  the  law  in  this  respect.  The 
judge,  without  due  reflection,  may  occasionally  adopt  the  language 
of  the  common  law  writers  upon  the  effect  of  drunkenness,  with- 
out noticing  the  material  alterations  produced  by  the  statute.  Such 
a  course  is  perilous  to  the  prisoner;  and,  it  seems  to  us,  equally 
perilous  to  the  peace  of  mind  of  a  conscientious  judge. 

"  The  first  case  which  we  have  noticed  in  the  books  in  which  the 
alteration  made  by  the  Act  of  1794,  in  this  respect,  was  distinctly 
placed  before  the  jury,  is  the  case  of  the  Com.  v.  Dunlap,  who  was 
convicted  of  the  murder  of  his  wife  in  Lycoming  County  in  1838. 
Judge  Lewis,  who  presided  on  that  occasion,  in  reference  to  the  de- 
fence of  insanity  occasioned  by  intoxication,  charged  the  jury  as 
follows :  '  To  constitute  murder  of  the  first  degree  the  statute  ex- 
pressly requires  that  the  crime  be  "wilful,  deliberate,  and  premedi- 
tated." Except  in  the  case  of  murder  which  happens  in  consequence 
of  actual  or  attempted  arson,  rape,  robbery,  or  burglary,  a  deliberate 
intention  to  kill  is  the  essential  ingredient  of  murder  of  the  first 
degree.  Where  this  ingredient  is  absent ;  where  the  mind,  from 
intoxication,  or  any  other  cause,  is  deprived  of  its  power  to  form  a 
design,  with  deliberation  and  premeditation,  the  offence  is  stripped 
of  the  malignant  feature  required  by  the  statute  to  place  it  on  the 
list  of  capital  crimes:  and  neither  courts  nor  juries  can  lawfully  dis- 
pense with  what  the  Act  of  Assembly  requires.'  Nearly  ten  years 
afterwards  the  same  judge,  after  the  fullest  consideration,  repeated 
the  same  doctrine  in  the  Com.  v.  lla>jgert>/,  who  Avas  tried  and  eon- 


GUILT    IN    HOMICIDE.  715 

victecl  of  murder  of  the  first  degree  in  Lancaster,  in  January,  1847.1 
('  Lewis's  Grim.  Law,'  405.)  These  instructions,  it  is  true,  did  not 
save  the  lives  of  the  prisoners,  but  it  is  no  doubt  satisfactory  to  all 
parties  that  they  enjoyed  the  advantage  of  having  the  law  humanely, 
and,  as  is  believed,  correctly  expounded. 

"In  Virginia,  where  there  is  a  statute  dividing  murder  into  de- 
grees, like  that  of  Pennsylvania,  it  is  believed  that  a  similar  view 
of  the  law  prevails.     [Com.  v.  Jones,  1  Leigh,  612.) 

"In  Tennessee,  Mr.  Justice  Reese,  in  1843,  in  delivering  the  opi- 
nion of  the  Supreme  Court  upon  a  similar  statute,  has  explained 
the  law  on  this  interesting  question  in  language  so  clear  and  for- 
cible as  neither  to  be  misunderstood  or  refuted.  In  the  case  of 
Swan  v.  The  State,  4  Humphreys,  136,  the  judge  makes  the  follow- 
ing remarks : — 

"'The  characteristic  quality  of  murder  of  the  first  degree,  and 
that  which  distinguishes  it  from  murder  in  the  second  degree  or  any 
other  homicide,  is  the  existence  at  the  time  of  the  death  of  the  as- 
saulted, of  a  settled  purpose  and  a  fixed  deliberate  design  on  the 
part  of  the  assailant  that  his  assault  should  produce  death.  The 
length  of  time  which  the  assailant  deliberates  on  his  intention  is 
not  material.  Drunkenness  is  no  excuse  for  or  justification  of 
crime.  But  although  drunkenness  in  point  of  law  constitutes  no 
excuse  or  justification  for  crime,  still,  when  the  nature  and  essence 
of  a  crime  is  made  by  law  to  depend  upon  the  peculiar  state  and 
condition  of  the  criminal's  mind  at  the  time,  and  with  reference  to 
the  act  done,  drunkenness,  as  a  matter  of  fact  affecting  such  state 
and  condition  of  the  mind,  is  a  proper  subject  for  consideration  and 
inquiry  by  the  jury.  The  question  in  such  a  case  is,  what  is  the 
mental  status  f  Is  it  one  of  self-possession,  favorable  to  the  forma- 
tion of  a  fixed  purpose  by  deliberation  or  premeditation  ?  or  did  the 
act  spring  from  existing  passion,  excited  by  inadequate  provocation, 
acting  it  may  be  on  a  peculiar  temperament,  or  upon  one  already 
excited  by  ardent  spirits  ?  In  such  case  it  matters  not  that  the 
provocation  was  inadequate,  or  the  spirits  voluutarily  drank.  The 
question  is,  did  the  act  proceed  from  sudden  passion  or  from  delibe- 
ration and  premeditation  ?  To  regard  the  fact  of  intoxication  as 
meriting  consideration  in  such  a  case,  is  not  to  be  held  that  drunken- 
ness will  excuse  crime,  but  to  inquire  whether  the  very  crime  which  the 
law  defines  and  punishes  has  in  fact  been  committed.  If  the  mental 
state  required  by  law  to  constitute  the  crime  be  one  of  deliberation 

1  The  case  of  Ilaggerty  (Oyer  and  Terminer  of  Lancaster  County)  was  a  remark- 
able one,  and  the  conviction  of  the  defendant  can  only  be  accounted  for  by  the  exist- 
ence of  an  intense  popular  feeling  (in  a  community  in  which  homicide  was  of  very  rare 
occurrence)  caused  by  the  number,  and  inoffensive  character  of  his  victims — an  old 
man,  named  Fordney,  his  wife,  and  a  little  child.  There  was  no  motive  for  the  act  nor 
any  evidence  of  a  grudge  ;  and  there  can  be  no  doubt  that  the  defendant  was  suffering 
from  an  attack  of  mania  a  potu.  It  was  proved  that  under  the  delusion  that  his 
horse  was  the  devil,  he  had  shot  him  with  a  silver  coin ,  just  before  or  just  after  kill- 
ing the  persons  mentioned.  Yet  notwithstanding  this,  and  the  charge  of  Judge  Lewis, 
he  was  convicted  of  murder  of  the  first  degree  and  subsequently  executed. — 1\ 


716  SOMNAMBULISM. 

and  premeditation,  and  drunkenness  or  other  cause  excludes  the  ex- 
istence of  such  mental  state,  then  the  crime  is  not  excused  by 
drunkenness,  or  such  other  cause,  but  has  not  in  fact  been  com- 
mitted.' 

"  We  have  drawn  attention  to  the  change  in  the  law  which  the 
statutory  division  of  murder  into  degrees  produces,  because  many 
of  the  States  have  statutes  of  this  character  in  operation.  Our  read- 
ers in  Maine,  New  Hampshire,  New  Jersey,  Michigan,  Maryland, 
Virginia,  Ohio,  Tennessee,  Alabama,  and  other  States,  where  similar 
statutes  exist,  will  not,  we  trust,  complain  of  the  space  occupied  in 
this  discussion.  It  should  always  be  remembered,  in  cases  of  the 
kind  under  consideration,  that  the  doctrine  that  a  man  '  shall  not 
be  permitted  to  privilege  one  crime  by  another,'  applies  not  to  cases 
expressly  provided  for  by  statute.  The  principle  of  the  common 
law  gives  place  to  the  omnipotence  of  legislative  enactment.  Were 
this  not  so,  the  statutory  amelioration  of  the  code  would  be  abor- 
tive, and  a  man  might  still  be  hung  in  Pennsylvania,  and  in  some 
other  States  for  accidentally  killing  another,  when  his  intention  was 
only  to  kill  a  fowl  for  the  purpose  of  stealing  it.  The  same  prin- 
ciple which  reduces  the  unintentional  killing,  in  the  perpetration  of 
a  larceny,  to  murder  in  the  second  degree,  places  in  the  same  ame- 
liorated category  the  act  of  killing  by  one  whose  mind,  from  ex- 
treme intoxication,  was  incapable  of  forming  a  murderous  design." 

Of  course  it  is  not  to  be  understood  from  the  foregoing  article 
that  drunkenness  is  any  defence  to  the  factum  of  guilt.  It  is  only 
with  reference  to  the  question  of  intent,  and  with  the  view  to  reduce 
the  degree  of  guilt  from  murder  of  the  first  degree,  which  in  most 
of  the  States  is  punishable  with  death,  to  murder  of  the  second  de- 
gree or  to  manslaughter,  the  punishment  of  which  is  only  imprison- 
ment more  or  less  extended,  that  evidence  of  intoxication  is  receiv- 
able. Commonwealth  v.  Kilpatrich,  7  Casey,  203  ;  Com  v.  Miller,  17 
Legal  Intel.  276  (Ludlow,  J.). 

Nor  will  it  be  sufficient  even  for  this  purpose,  unless  the  intoxi- 
cation be  so  great  as  to  render  the  prisoner  unable  to  form  a  wilful, 
deliberate,  and  premeditated  design  to  kill,  or  incapable  of  judging 
of  his  acts  and  their  legitimate  consequences.  (Keenan  v.  Common- 
wealth, 8  Wright,  55 ;    Com.  v.  Miller ;  lb.  v.  Kilpairick,  supra). — P.] 

iSomnamfadism.  —  This  term  applies  to  sleep-walking,  but  the 
medico-legal  facts  are  chiefly  confined  to  acts  of  violence  perpetrated 
unconsciously  during  the  state  of  sleep,  in  which  it  is  presumed  that 
malice  and  intention,  the  chief  ingredients  of  crime,  are  wanting. 
It  has  been  a  contested  question  among  medical  jurists,  how  far  a 
person  should  be  held  responsible  for  a  criminal  act  perpetrated  in 
that  half-conscious  state  which  exists  when  he  is  suddenly  roused 
from  sleep.  There  is  no  doubt  that  the  mind  is  at  this  time  subject 
to  hallucinations  and  illusions,  which  may  be  more  active  and  per- 
sistent in  some  persons  than  in  others  ;  but  it  is  difficult  to  suppose, 
unless  we  imagine  there  is  a  sudden  access  of  insanity,  that  a  person 
should  not  recover  from  the  delusion  before  he  could  perpetrate  ;m 
act  like   murder.     A   remarkable  case   of  this  description,  thai 


SOMNAMBULISM.  717 

Bernard  Schedmaizig,  will  be  found  reported  by  Marc.  (Op.  cit.  vol. 
1,  p.  56.)  This  man  suddenly  awoke  at  midnight,  and  saw,  as  lie 
believed,  a  frightful  phantom.  He  twice  called  out,  "  Who  is  that?" 
and  receiving  no  answer,  and  imagining  that  the  phantom  was  ad- 
vancing upon  him,  he  seized  a  hatchet  which  Avas  beside  him, 
attacked  the  supposed  spectre,  and  it  was  found  that  he  had  mur- 
dered his  wife.  He  was  charged  with  the  murder,  but  pronounced 
"  not  guilty"  on  the  ground  that  he  was  not  at  the  time  conscious  of 
his  actions.  A  trial  involving  this  question  occurred  in  England. 
A  peddler  in  the  habit  of  walking  about  the  country  armed  with  a 
sword-stick,  while  lying  asleep  on  the  high  road,  was  roused  by  a 
man  accidentally  passing,  who  seized  and  shook  him  by  the  shoulders. 
The  peddler  suddenly  awoke,  drew  his  sword  and  stabbed  the  man, 
who  soon  afterwards  died.  The  peddler  was  tried  for  manslaughter. 
His  irresponsibility  was  strongly  urged  by  his  counsel,  on  the  ground 
that  he  could  not  have  been  conscious  of  an  act  thus  perpetrated 
while  in  a  half- waking  state  ;  and  this  defence  was  supported  by  the 
opinion  of  a  medical  witness.  The  prisoner  was,  however,  found 
guilty.  Under  such  circumstances,  it  was  not  unlikely  that  an  idea 
had  arisen  in  the  prisoner's  mind  that  he  had  been  attacked  by  rob- 
bers, and  therefore  had  stabbed  the  man  in  self-defence.  (Bex  v. 
Milligan,  Lincoln  Autumn  Assizes,  1836.)  In  Beg.  v.  Byron  (Win- 
chester Winter  Assizes,  1863),  it  was  proved  that  a  blow  struck  by 
a  drunken  person  during  sleep  had  caused  death.  The  man  was 
charged  with  manslaughter,  under  the  following  circumstances  :  The 
prisoner  and  deceased  were  soldiers  in  the  same  regiment,  at  Alder- 
shot.  The  prisoner  was  in  the  street  drunk,  and  deceased  seeing  this 
took  him  in  to  prevent  his  being  arrested  for  drunkenness,  and  placed 
him  on  his  bed.  In  this  state  he  lay  for  some  time  quite  drunk  and 
insensible.  In  the  course  of  the  afternoon  *  deceased  went  up  stairs 
to  see  him ;  he  tried  to  awaken  him,  when  the  prisoner  suddenly 
kicked  out,  and  his  boot  came  violently  against  the  lower  part  of 
the  abdomen  of  deceased.  The  prisoner  did  not  awake,  but  appeared  - 
then  to  be  quite  insensible.  The  deceased  died,  and  it  was  found 
that  the  blow  had  caused  rupture  of  the  intestines.  As  in  order  to 
constitute  the  crime  of  manslaughter,  it  must  be  shown  that  the  per- 
son charged  did  something  knowingly,  and  the  prisoner  was  not  in 
a  state  to  have  known  anything,  it  was  held  that  there  was  no  case 
against  him,  and  he  was  acquitted.  The  act  was  committed  during 
sleep,  but  the  sleep  appears  to  have  been  the  sleep  of  drunkenness. 
Somnambulism  ma}'-  become  a  subject  of  discussion  under  a  con- 
tested policy  of  life-insurance,  in  which  it  may  be  provided  that  it 
shall  be  vitiated  by  suicide.  If  a  man  falls  from  a  height  and  is 
killed  while  in  a  state  of  somnambulism,  would  this  be  considered 
an  act  of  suicide  within  the  meaning  of  the  policy?  The  proviso 
against  suicide  has  been  held  to  include  only  intent/ anal  killing  (case 
of  Borradaile  v.  Hunter,  "  Med.  Gaz.,"  vol.  36,  p.  826),  and  in  death 
under  these  circumstances  the  killing  cannot  be  said  to  be  inten- 
tional :  it  can  only  be  regarded  as  an  accident — therefore  it  is  rea- 
sonable to  infer  that  the  policy  would  not  be  void.     It  is  impossible, 


718  KESPONSIBILITY    OF    THE    DEAF    AND    DUMB. 

however,  to  lay  down  any  general  rules  relative  to  cases  of  this 
description  ;  since  the  circumstances  attending  each  case  will  suffi- 
cientty  explain  how  far  the  act  of  murder  or  suicide  had  been 
committed  during  a  state  of  somnambulism,  or  under  an  illusion 
continuing  from  a  state  of  sleep. 

The  Deaf  axd  Dumb. 

It  was  formerly  laid  down  in  the  old  law-books,  that  a  person  born 
deaf  and  dumb  was  by  presumption  of  law  an  idiot,  but  in  modern 
practice,  want  of  speech  and  hearing  does  not  imply  want  of  capacity 
either  in  the  understanding  or  memory,  but  only  a  difficulty  in  the 
means  of  communicating  knowledge  ;  and  when  it  can  be  shown 
that  such  a  person  has  understanding,  which  many  in  this  condition 
reveal  by  signs,  he  may  be  tried  and  suffer  judgment  and  execution. 
(Archbold.)  A  deaf-and-dumb  person  is  not  incompetent  to  give 
evidence,  unless  he  is  also  blind :  he  may  be  examined  through  the 
medium  of  a  sworn  interpreter  who  understands  his  signs.  This 
condition  does  not  justify  restraint  or  interdiction,  unless  there  is  at 
the  same  time  mental  deficiency.  A  deaf-and-dumb  person  who  has 
never  been  instructed,  is  altogether  irresponsible  for  any  action  civil 
or  criminal.  Such  a  person  cannot  even  be  called  on  to  plead  to  a 
charge,  when  there  is  reason  to  suppose  that  he  cannot  understand 
the  nature  of  the  proceedings.  A  deaf-and-dumb  woman  was  charged 
with  cutting  off  the  head  of  her  child.  By  signs  she  pleaded  "  not 
guilty,"  but  she  could  not  be  made  to  understand  the  nature  of  the 
other  proceedings  against  her.  Upon  this  she  was  discharged,  and 
subsequently  confined  as  a  criminal  lunatic.  In  Reg.  v.  Goodman 
(Stafford  Summer  Assizes,  1841),  a  deaf-and-dumb  man  was  con- 
victed of  theft  and  sentenced  to  imprisonment.  He  was  made  to 
comprehend  the  proceedings  by  signs  and  talking  with  the  fingers. 
In  Reg.  v.  Brook  (Buckingham  Summer  Assizes,  18-12),  the  prisoner 
could  read  and  write  well.  He  was  charged  with  feloniously  cutting 
and  stabbing.  The  proceedings  were  reported  to  him  in  writing. 
He  was  convicted,  and  the  judge  (Alderson  B.)  having  sentenced  him 
to  a  year's  imprisonment,  handed  down  his  judgment  in  writing, 
which  he  recommended  him  to  read  and  ponder  over  in  prison!  In 
Reg.  v.  Jackson  (Bedford  Summer  Assizes,  181-1),  Alderson  B.  held 
that  before  the  evidence  of  a  dumb  Avitness  can  be  received,  the 
court  must  be  satisfied  that  he  understands  the  obligation  of  an  oath. 

It  has  been  decided  in  the  ecclesiastical  courts  that  the  consent  of 
a  deaf-and-dumb  person  given  by  signs,  renders  a  matrimonial  con- 
tract valid,  provided  the  person  has  a  full  and  proper  understanding 
of  their  meaning.  An  incompetency  to  enter  into  contracts  or  un- 
soundness of  mind,  must  not  be  inferred  to  exist  merely  in  conse- 
quence of  a  person  being  deaf  and  dumb.  In  the  case  of  Harrod 
v.  Harrod  (Vice-Chancellor's  Court,  June,  185-1),  an  attempt  was 
made  to  deprive  the  plaintiff  of  his  rights'  on  the  ground  that  he 
was  an  illegitimate  child.  The  marriage  of  his  parents  took  place 
thirty  years  previousljr,  but  the  marriage  was   said  to  be  void  by 


FEIGNED    DEAFNESS    AND    DUMBNESS.  719 

reason  of  the  alleged  incapacity  of  his  mother  to  eater  into  the  con- 
tract ;  the  mother  was  deaf  and  dumb,  and  of  more  than  ordinarily 
dull  intellect.  Sir  W.  P.  Wood  said  there  was  an  important  differ- 
ence between  "unsoundness  of  mind"  and  "  dulness  of  intellect." 
The  presumption  in  such  cases  was  always  in  favor  of  sanity,  and 
the  fact  of  a  person  being  deaf  and  dumb  did  not  raise  a  presump- 
tion the  other  way.  Experience  in  asylums  showed,  that  the  deaf 
and  dumb  were  not  necessarily  of  unsound  mind.  The  woman  had 
assented  to  the  marriage  in  form  and  substance,  and  with  a  perfect 
knowledge  of  what  she  was  doing.  In  the  ceremony  of  marriage 
it  had  never  been  held  that  the  repetition  of  the  words  was  necessary. 
The  woman  conducted  herself  with  great  propriety  before  and  after 
the  marriage,  and  a  child  was  born  in  due  course.  There  was  no 
ground  for  an  issue. 

Feigned  Deafness  and  Dumbness. — From  these  statements  it  will  be 
perceived  that  medical  evidence  is  of  but  little  importance  in  relation 
to  the  deaf  and  dumb.  Indeed,  there  are  only  two  cases  in  which 
this  kind  of  evidence  is  likely  to  be  called  for — 1st,  when  there  is 
accompairying  mental  deficiency,  in  which  case  the  general  rules  else- 
where given  are  applicable ;  and  2dly,  when  there  is  a  suspicion 
that  the  deafness  and  dumbness  are  feigned.  There  will  be  no  great 
difficulty  in  detecting  an  imposition  of  this  kind.  It  may  be  found 
that  the  alleged  deafness  and  dumbness  did  not  come  on  until  a 
motive  existed,  and  that  there  was  no  apparent  cause  but  the  very 
suspicious  one  of  evading  responsibility  for  some  offence  committed. 
The  use  of  ether  or  chloroform-vapor  may  be  occasionally  resorted 
to  with  advantage  for  the  detection  of  such  an  imposition.  In  one 
instance  a  strong  shock  of  the  induced  current  from  a  large  magneto- 
electrical  apparatus,  by  means  of  moistened  conductors  applied  over 
the  larynx,  brought  out  after  a  few  minutes  the  power  of  speech  in 
a  lad  who  had  successfully  imposed  on  many  persons.  ("Med. 
Times  and  Gaz.,"  March  30,  1861;  p.  339.)  It  requires  great  skill 
to  maintain  an  imposture  of  this  kind.  Such  persons  are  immediately 
thrown  off  their  guard  by  addressing  them  in  a  voice  a  little  above 
or  a  little  below  the  common  conversational  tone ;  a  change  in  the 
eye  or  the  features  will  at  once  indicate  that  they  hear  and  under- 
stand what  is  said.  An  ignorant  impostor  may  be  dealt  with  on  the 
principle  of  "artis  est  celare  artem"  by  seriously  proposing  in  a  low 
voice  to  a  medical  friend  who  may  be  present,  the  necessity  for  the 
performance  of  some  formidable  surgical  operation.  The  production 
of  amputating  instruments  has  been  known  to  have  a  wonderful  effect ! 

In  Reg.  v.  Yaquierdo  (Herts  Summer  Assizes,  1851:)  the  prisoner, 
who  was  charged  with  wilful  murder,  was  found  by  the  jury  to  be 
wilfully  mute.  The  man  refused  to  plead,  although  it  was  obvious 
that  he  was  well  aware  of  the  nature  of  the  proceedings.  No  coun- 
sel could  be  assigned  to  him,  as  this  could  not  be  done  without  the 
prisoner's  consent.  He  was  convicted  and  sentenced.  If  the  im- 
postor can  write,  he  may  perhaps  be  detected  by  the  ingenious  plan 
adopted  by  the  Abbe  Sicard.  When  the -deaf  and  dumb  are  taught 
to  write  they  are  taught  by  the  eye.     The  letters  are  only  known  to 


720  FEIGNED    DEAFNESS    AND    DUMBNESS. 

them  by  their  form,  and  their  value  in  any  word  can  be  understood 
only  by  their  exact  relative  position  with  respect  to  each  other.  A 
half-educated  impostor  will  spell  his  words,  or  divide  them  incor- 
rectly :  and  the  errors  in  spelling  will  always  have  reference  to 
sound — thereby  indicating  that  his  knowledge  has  been  acquired 
through  the  eai\  and  not  alone  through  the  eye.  A  man  who  had 
defied  all  other  means  of  detection  wrote  down  several  sentences,  in 
which  the  misspelling  was  obviously  due  to  errors  produced  by  the 
sound  of  the  words,  thereby  showing  that  he  must  have  heard  them 
pronounced.  The  Abbe  concluded  that  the  man  was  an  impostor 
without  seeing  him,  and  he  subsequently  confessed  the  imposition. 


PRINCIPLES    OF    LIFE    INSURANCE.  721 


LIFE  INSURANCE.1 


CHAPTER   LXV. 

Principles  of  life  insurance. — questions  to  persons  who  in- 
sure THEIR  LIVES. — MEDICAL  QUESTIONS. — WHAT  DISEASES  HAVE 
AND  WHAT  HAVE  NOT  A  TENDENCY  TO  SHORTEN  LIFE  ? — LEGAL 
DECISIONS  RESPECTING  THE  MEANING  OF  THESE  WORDS. — CON- 
CEALMENT   OF    DISEASES. WHAT   IS    MATERIAL    CONCEALMENT  ? 

CONCEALMENT  OF  HABITS. — WHAT  IS  INTEMPERANCE? — PROXI- 
MATE   AND    REMOTE    EFFECTS. DELIRIUM   TREMENS. — EPILEPSY. 

PHTHISIS. — ABSTINENCE. — VEGETARIANISM. —  OPIUM-EATING. IN- 
VETERATE SMOKING. — INSANITY. VOIDANCE  OF  POLICIES  BY  SUI- 
CIDE.— SECRET  POISONING  OF  PERSONS  WHOSE  LIVES  ARE  IN- 
SURED. 

The  subject  of  Life  Insurance  in  a  medico-legal  view  is  almost 
peculiar  to  the  medical  jurisprudence  of  Great  Britain.  This  arises 
from  the  extent  to  which  insurances  on  lives  are  effected  in  this 
country,  and  from  the  peculiar  nature  of  the  provisions  which  regu- 
late contracts  of  this  description. 

The  insurance  of  a  life  is  a  contract  whereby  the  insurer,  in  con- 
sideration of  a  certain  sum  of  money,  called  a  premium,  either  in  a 
gross  sum  or  in  periodical  payments — proportioned  to  the  age,  sex, 
profession,  health,  and  other  circumstances  of  the  person  whose  life 
is  insured — undertakes  to  pay  to  the  person  for  whose  benefit  the  in- 
surance is  made  a  stipulated  sum  or  an  equivalent  annuity,  upon 
the  death  of  the  individual  whose  life  is  insured,  whenever  this 
event  shall  happen,  if  the  insurance  be  for  the  whole  life ;  or,  in  case 
this  shall  happen  within  a  certain  period,  if  the  insurance  be  for  a 
limited  time. 

The  deed  by  which  this  contract  is  made  is  called  a  policy,  and  it 
is  concerning  the  stipulations  of  the  policy,  and  the  meaning  to  be 
put  upon  certain  medical  terms  used  in  it,  that  litigation  commonly 
arises.  The  amount  of  premium  payable  will  be  regulated  by  the 
mean  expectation  or  duration  of  life  of  the  individual ;  and  this  it  is 
well  known  is  not  only  different  at  different  ages,  but  is  greater  at 
certain  periods  of  life  in  women  than  in  men.     One  fact,  however, 

1  [This  chapter  is  taken  from  Dr.  Taylor's  work  on  the  "Principles  and  Practice 
of  Medical  Jurisprudence,"  Loudon,  1865.  See  further  upon  the  subject  of  Life  In- 
surance, "Angell  on  Fire  and  Lite  Insurance,"  pp.  296-45(5. — P.] 

46 


722  EXPECTATION    OF    LIFE. 

is  certain, — the  most  successful  Insurance  Offices  have  considerably 
underrated  the  probability  or  expectation  of  life  among  adults,  and 
thus  have  derived  enormous  profits  by  demanding  higher  premiums 
on  the  insured  than  a  fair  view  of  the  rate  of  mortality  would  jus- 
tify. The  calculations  of  some  of  the  older  Offices  were  based  on 
what  is  called  the  Northampton  Table,  which  represents  in  an  ex- 
aggerated degree  the  mortality  not  only  of  the  class  of  persons  who 
commonly  effect  insurances,  but  of  the  entire  population.  This 
table  has  been  thus  improperly  applied  to  determine  the  mortality 
of  men  in  the  middle  classes,  holding  the  most  durable  tenure  of 
life.  Besides  this,  as  Mr.  Edmonds  has  shown,  some  of  the  Offices 
have  entirely  excluded  from  insurance  the  sick  class,  out  of  which 
the  greater  part  of  the  mortality  indicated  in  the  table  necessarily 
takes  place.  By  excluding  the  sick,  and  requiring  strong  medical 
certificates  respecting  the  condition  of  healthy  applicants,  it  follows 
that  the  mortality  among  the  insured  falls  immeasurably  short  of 
that  which  is  indicated  by  the  ordinary  Tables  of  Mortality  from 
which  the  amount  of  premium  is  really  calculated. 

The  sum  for  which  a  person's  life  has  been  insured  cannot  be  re- 
covered until  after  the  death  of  the  person  and  distinct  proof  of  death. 
Those  who  would  benefit  by  the  death  must  prove  the  fact  of  death 
when  this  is  open  to  doubt.  In  the  "  Principles  and  Practice  of 
Medical  Jurisprudence"  (p.  120)1  a  case  is  reported  in  which  a  claim 
was  made  on  an  insurance  company  for  the  amount  of  a  policy  on 
the  life  of  a  man  who  suddenly  disappeared,  while  at  Brighton,  within 
a  week  after  the  insurance  on  his  life  had  been  effected.  The  man's 
clothes  were  found  on  the  beach,  and  the  jury  were  asked  to  infer 
from  this  fact  that  the  man  was  drowned,  and  that  his  body  had  been 
carried  out  to  sea.  No  one  had  seen  him  go  into  the  water.  The 
jury  were  discharged  without  a  verdict.  It  was  quite  possible  that 
the  clothes  had  been  designedly  placed  there,  and  that  the  man  had 
gone  off  in  another  direction,  and  was  still  living. 

1  "  A  remarkable  case  was  tried  in  the  Court  of  Exchequer,  Guildhall,  in  February, 
186*2  {Hiorns  and  Drew  v.  The  Railway  Passengers'  Insurance  Company),  which  in- 
volved a  question  of  the  presumption  of  death  from  circumstantial  evidence;  but  in 
which  it  was  suggested  that  a  grave  fraud  bad  been  perpetrated  by  the  parties  con- 
cerned. The  action  was  to  recover  from  defendants  the  sum  of  250/.,  on  a  policy  of 
insurance  on  the  life  of  one  F.  D.  Hiorns.  The  alleged  deceased,  Hiorns,  was  a 
single  man,  aet.  26.  He  insured  his  life  against  accident,  for  the  above  mentioned 
sum,  on  the  6th  September,  1^56  ;  and  on  Saturday  the  13th  September,  he  went  to 
Brighton  by  an  evening  train,  taking  a  return  ticket.  He  spent  Sunday  and  Monday 
with  his  friends,  and  on  the  morning  of  the  latter  day  (the  15th)  he  had  a  bath  in 
the  sea  ;  in  the  evening  he  parted  from  his  friends,  at  about  seven  o'clock,  to  go  to 
his  lodgings  before  returning  to  London,  expressing  his  intention  of  taking  a  second 
bath  before  doing  so.  He  was  seen  to  go  towards  the  sea,  and  from  that  time  up  to 
the  date  of  the  action  be  had  not  been  seen  alive.  On  the  day  that  he  was  missing, 
a  person  discovered  a  suit  of  clothes  lying  on  the  top  of  the  steps  of  a  bathing  ma- 
chine, but  no  trace  of  the  owner  of  them  could  be  discovered.  The  police  took  pos- 
session of  the  clothes,  and  upon  searching  the  pockets  a  purse,  containing  a  return- 
ticket,  was  found,  and  they  were  identified  as  belonging  to  Hiorns.  Advertisements 
were  issued,  and  every  inquiry  made  to  discover  the  missing  man,  but  without  avail. 
On  the  30th  of  October,  forty-five  days  after  the  disappearance  of  Hiorns  from  Brighton, 
the  naked  body  of  a  man  was  washed  up  at  Walton-on-the-Naze.  on  the  Essex  coast, 
about  150  or  160  miles  from  Brighton.     The   body,  according  to  the  opinion  of  some 


PROOF    OF    DEATH,    ETC.  723 

[This  case  is  reported  under  the  name  of  Treiv  and  Hiorns,  execu- 
tors of  Frederick  Hiorns  v.  The  Passengers'  Assurance  Co.,  in  5  Iiurls. 
&  Norm.  211.  It  was  tried  before  Pollock,  C.  B.,  who  non-suited 
the  plaintiffs,  because,  1st,  there  was  no  sufficient  evidence  of  death: 
and,  2d,  there  was  no  evidence  that  the  death  was  caused  by  an  acci- 
dent within  the  meaning  of  the  policy.  The  motion  to  take  of  the 
non-suit  was  argued  before  the  court  in  banc,  consisting  of  Pollock, 
C.  B.,  Martin,  B.,  and  Watson,  B.  By  the  terms  of  the  policy,  the 
insurance  was  against  any  injury  caused  by  accident  or  violence  within 
the  meaning  of  the  policy,  in  case  the  assured  should  die  within  three 
calendar  months  from  the  happening  of  the  accident.  It  was  also 
provided  that  no  claim  should  be  made  in  respect  to  any  injury, 
unless  the  same  should  be  caused  by  some  outward  and  visible  means  of 
which  satisfactory  proof  could  be  furnished  to  the  directors.  Martin,  B., 
was  of  opinion  that  there  was  evidence  from  which  the  jury  might 
infer  the  death  of  the  assured;  but  that  even  if  the  body  found  was 
the  body  of  Hiorns,  drowned  while  bathing,  there  was  no  evidence 
that  he  died  from  an  injury  caused  by  accident  within  the  meaning  of  the 
policy.  "  It  seems  to  me,"  said  the  learned  judge,  "that  the  whole 
evidence  is  quite  consistent  with  the  fact  that  this  person  might  have 
died  from  natural  disease ;  and  that  upon  his  getting  into  the  water 
the  effect  was  such  as  to  cause  his  death  by  apoplexy  or  cramp. 
The  cases  referred  to  by  the  defendant's  counsel  show  that  where 
the  death  takes  place  in  such  manner  that  it  may  have  happened 
from  natural  causes  the  assurers  are  not  liable."  In  this  opinion  Wat- 
son, B.,  concurred.  Pollock,  C.  B.,  agreed  with  the  other  judges 
that  there  was  no  proof  of  injury  within  the  meaning  of  the  policy, 
still,  however,  adhering  to  his  opinion  that  there  was  not  even 
proof  of  death.  "It  appears  to  me,"  he  said,  "to  be  a  case  of  grievous 
suspicion ;  and  in  fact  I  believe  the  body  found  wras  not  the  body  of 
the  assured,  and  he  will  some  day  appear  alive." 

A  case  is  mentioned  in  Angell  on  "Fire  and  Life  Insurance,"  p. 
379,  note  4,  where  the  defence  of  want  of  proof  of  death  was  set  up, 
but  not  successfully.  In  the  winter  of  1848,  Rev.  Thomas  Waring 
very  mysteriously   disappeared   near    Elizabethtown,    Hardin  Co., 

medical  men,  had  been  in  the  water  some  six  or  seven  weeks,  and  it  was,  of  course, 
very  much  decomposed,  all  traces  of  the  features  being  destroyed.  An  inquest  was 
held,  at  which  the  plaintiff,  G.  B.  Hiorns,  attended,  giving  evidence  that  the  remains 
were,  to  the  best  of  his  belief,  those  of  his  brother.  In  consequence  of  the  complete 
destruction  of  the  features,  according  to  the  meilical  evidence,  there  was  nothing 
whatever  on  which  to  base  a  proof  of  identity,  and  the  jury  found  that  it  was  the 
body  of  a  person  unknown.  The  defence  to  the  action  was  :  that  the  assured  was 
still  living  and  within  reach  of  his  friends,  awaiting  the  receipt  of  the  money  from 
the  office.  It  seems  that  the  alleged  deceased  had  been  a  bankrupt  in  1855  ;  and  in 
September,  185(5,  he  effected  several  policies  of  insurance  in  different  offices,  and  made 
his  will,  directing  that  the  policies  after  his  death  should  be  realized  and  the  money 
appropriated  to  the  payment  of  his  debts.  The  jury  could  not  agree,  and  were  dis- 
eharged  without  a  verdict.  As  in  this  case  the  body  of  Hiorns  was  not  found,  there 
was  no  proof  of  death.  Tin'  discovery  of  the  clothes  was  only  a  circumstance  from 
which  a  presumption  might  be  raised  either  way.  Considering  that  the  man's  life 
had  been  insured  in  this  anil  other  offices  for  only  one  week,  at  the  time  ot  this  mys- 
terious disappearance,  there  was  strong  reason  for  suspicion."  Principles  and  Prac- 
tice of  Medical  Jurisp.  p.  120. 


721  PRESUMPTION    OF    DEATH. 

Kentucky,  and  was  then  and  still  believed  by  his  relatives  and 
friends  to  have  been  murdered.  Some  years  before  his  death  he 
had  effected  an  insurance  on  his  life,  in  favor  of  his  wife,  in  the 
Nautilus  Mutual  Life  Insurance  Co.  of  New  York,  for  $5000.  In 
January,  1853,  suit  was  instituted  in  Jefferson  Circuit  Court  by  Mrs. 
Waring,  for  the  recovery  of  the  sum  named.  One  of  the  points  relied 
upon  by  the  defence  was  that  he  was  not  dead,  but  had  absconded. 
The  whole  case  turned  upon  this.  The  case  was  submitted  to  the 
jury  upon  the  evidence,  and  a  verdict  rendered  for  plaintiff  for  the 
amount  of  the  policy  with  interest. 

The  law  applicable  to  such  cases  is  thus  stated  by  Mr.  Angell 
("  Fire  and  Life  Insurance,"  §  351) :  "In  order  to  render  the  insurers 
upon  a  life  liable,  the  event  of  death  may  (must)  happen  within  the 
time  prescribed  by  the  policy,  and  as  a  doubt  may  exist  whether 
the  person  upon  whose  death  the  liability  depends  is  dead,  a  question 
of  fact  may  be  raised  to  be  determined  by  the  jury.  All  the  authori- 
ties concur  in  stating  the  rule  of  the  common  law  to  be  that  the 
presumption  of  life,  with  respect  to  persons  of  whom  no  account 
can  be  given,  ends  at  the  expiration  of  seven  yea/rs  from  the  time 
they  were  last  known  to  be  living ;  and  that,  after  such  a  period  of 
time,  the  burden  of  proof  is  devolved  on  the  party  insuring  the  life 
of  the  individual  in  question.  The  issue  in  such  case  being  an  issue 
of  fact,  the  jury  are  at  liberty  to  find  the  fact  of  death  within  the 
period  of  seven  years,  upon  the  circumstances  proved  in  the  case. 
The  circumstances  which  have  been  stated  to  lie  material  to  this 
issue,  are  the  age  of  the  party,  his  situation,  habits,  employment, 
state  of  health,  physical  constitution,  the  place  or  climate  of  the 
country,  whether  he  went  by  sea  or  land,  the  facilities  of  communi- 
cation between  that  country  and  his  former  home,  his  habit  of  cor- 
respondence with  his  relatives,  the  terms  of  intercourse  upon  which 
he  lived  with  them,  in  short,  any  circumstances  tending  to  aid  the 
jury  in  finding  the  fact  of  life  or  death — all  these  circumstances  have 
been  stated  by  Prof.  Greenleaf  as  material.  There  must  also  be 
evidence,  that  learned  author  proceeds  to  say,  of  diligent  inquiry  at 
the  place  of  the  person's  last  residence  in  this  country,  and  among  his 
relatives,  and  any  others  who  would  have  probably  heard  from  him, 
if  living;  and  also  at  the  place  of  his  fixed  foreign  residence,  if  he 
was  known  to  have  any.  In  Loring  v.  Steinman,  1  Met.  (Mass.)  R. 
204,  Shaw,  C.  J.,  in  giving  the  judgment  of  the  court,  says:  '*  It  is 
a  well  settled  rule,  that  upon  a  person's  leaving  his  usual  home  and 
place  of  residence  for  temporary  purposes  of  business  or  pleasure, 
and  not  being  heard  of,  or  known  to  be  living,  for  the  term  of  seven 
years,  the  presumption  of  life  then  ceases,  and  that  of  his  death 
arises.  The  presumption  is  greatly  strengthened  when  the  depar- 
ture of  an  individual  was  from  his  native  place,  the  seat  of  his  an- 
cestors, and  the  home  of  his  brothers  and  sisters,  and  family  connec- 
tions; and  still  further  when  it  was  to  enter  upon  the  perilous  em- 
ployment of  a  seafaring  life." 

Upon  this  subject,  see  also  Best  on  Fresump.,  59-61 ;    Whites 


PRESUMPTION    OF    DEATH.  —  SURVIVORSHIP.  725 

Ap.  11  Harris,  114;  Campbell  v.  Read,  12  lb.  498;  Holmes  v.  John- 
son, 6  Wright,  159  ;    Winship  v.  Conner,  42  N.  H.  341. 

When  the  person  whose  life  is  in  question  has  gone  to  sea,  the 
presumption  of  death  may  arise  much  sooner  than  seven  years. 
Thus  in  Patterson  v.  Black,  Park  on  Ins.  433-34  (2  Am.  Ed.)  the 
question  was  whether  the  assured  died  before  the  30th  January, 
1778.  It  appeared  that  about  the  20th  November,  1777,  he  sailed 
from  the  Cape  of  Good  Hope,  in  the  sloop  of  war  Swallow,  which 
ship,  not  being  afterwards  heard  of,  was  supposed  to  have  been  lost 
in  a  storm  off  the  Western  Islands.  The  plaintiff  proved  the  de- 
parture, and  also  called  several  captains  who  sailed  at  the  same  time 
who  swore  that  the  vessel  must  have  been  as  forward  in  her  course 
as  they  were  on  the  13th  or  14th  of  January,  the  period  of  a  most 
violent  storm,  in  which  she  was  probably  lost ;  and  that  the  Swallow 
was  much  smaller  than  their  vessels,  which  with  difficulty  weathered 
the  storm.  Lord  Mansfield,  who  tried  the  cause,  left  it  to  the  jury 
to  say  whether,  under  all  the  circumstances,  they  thought  the  evi- 
dence sufficient  to  convince  them  that  the  assured  died  before  the 
time  limited;  adding,  that  if  they  thought  it  so  doubtful  as  not  to 
be  able  to  form  an  opinion,  the  defendants  should  have  their  verdict. 
They  found  for  the  plaintiff. 

The  rule  is  stated  to  be  that  where  a  vessel  is  missing  and  no  intel- 
ligence of  her  has  been  received  within  a  reasonable  time  after  she 
sailed,  it  is  presumed  that  she  foundered  at  sea.  Thus,  where  a  ship 
was  insured  in  1739,  from  North  Carolina  to  London,  an  action  was 
brought  against  the  underwriters.  The  only  evidence  was  that  she 
had  sailed  on  her  intended  voyage,  and  had  never  since  been  heard 
from.  The  defendant  objected  that  as  captures  and  seizures  were 
excepted  by  the  policy,  it  lay  in  the  assured  to  prove  a  loss  by  sink- 
ing, &c.  The  Chief  Justice  (Lee),  however,  said  that  it  would  be 
unreasonable  to  expect  evidence  of  that,  for  as  everybody  on  board 
was  presumed  to  be  drowned,  the' plaintiff  had  given  the  best  proof 
the  nature  of  the  case  admitted  of.  The  case  being  left  to  the  jury, 
they  found  for  the  plaintiff.     Green  v.  Brown,  2  Strange,  1199. 

In  order  to  raise  this  presumption,  however,  it  must  be  distinctly 
shown  that  the  ship  left  the  port  bound  on  her  intended  voyage ; 
and  although  her  not  being  heard  of  for  many  months  or  years, 
raises  a  presumption  of  her  crew  having  perished,  it  affords  none  as 
to  the  precise  time  of  the  death  of  any  person  on  board.  This  must 
be  collected  by  the  jury  from  the  circumstances  of  the  case.  Watson 
v.  King,  1  Stark.  R.  121 ;  Sillick  v.  Booth,  1  Y.&  C.  N.  C.  117  ;  Best 
on  Presump.  145-6. 

Where  two  or  more  persons  perish  by  the  same  calamity,  the 
question  sometimes  arises,  when  the  circumstances  of  their  deaths 
are  unknown,  which  one  is  to  be  presumed  to  be  survivor.  By  the 
Roman  law,  if  it  were  the  case  of  father  and  son,  where  the  latter 
■was  under  the  age  of  puberty,  he  was  presumed  to  have  died  first; 
but  if  above  that  age,  the  presumption  was  the  other  way.  By  the 
French  code,  if  the  persons  perishing  are  under  the  age  of  fifteen,  the 
eldest  is  presumed  to  have  survived;  if  above  the  age  of  sixty,  the 


726  EXPECTATION    OF    LIFE. 

youngest.  If  between  those  ages  and  of  different  sexes,  the  male  is 
presumed  to  have  survived;  if  of  the  same  sex  the  presumption  is  in 
favor  of  the  younger.     (Greenleaf's  Ev.  vol.  1,  §  29.) 

But  in  the  common  law,  no  rule  on  the  subject  has  been  laid  down  ; 
and  the  better  opinion  is  that  the  presumption  is  that  all  perished 
together.  lb.  §  80.  However,  in  the  case  of  Moehling  v.  Mitchell, 
1  Barb.  Ch.  (N.  Y.)  264,  where  a  married  woman  procured  an  in- 
surance on  the  life  of  her  husband,  for  her  own  use,  the  money  to 
be  paid  to  her,  unless  she  died  before  him,  and  in  that  case  to  her 
child,  pursuant  to  the  act  of  1840  (2  K.  S.  3  ed.  207,  §§  60,  61),  and 
sailed  with  her  husband  and  child  in  a  ship  which  was  never  heard 
of  again ;  held,  there  being  no  presumption  that  the  child  survived 
her,  or  that  she  survived  her  husband,  that  the  case  did  not  full 
within  the  act,  and  that  the  insurance  money  was  part  of  the  per- 
sonal estate  of  the  husband. 

"  If  any  circumstances  of  the  death  of  either  party  can  be  proved, 
there  can  be  no  inconvenience  in  submitting  the  question  to  a  jury, 
to  whose  province  it  properly  belongs."     1  Greenl.  Ev.  ;?  30. 

Thus  in  the  case  cited  by  Blackstone,  from  Cro.  Eliz.  503  (2  Black. 
Com.  132),  upon  the  question  of  what  constituted  a  sufficient  seisin  on 
the  part  of  the  husband  to  entitle  the  wife  to  dower,  where  a  father  and 
son  were  both  hanged  in  one  cart,  but  the  son  was  supposed  to  have 
survived  the  father  by  appearing  to  struggle  longest ;  the  jurv  found 
that  he  was  the  survivor,  whereby  he  became  seized  of  an  estate  in 
fee  by  survivorship,  in  consequence  of  which  seisin  his  widow  had 
a  verdict  for  her  dower. 

See  also  upon  this  subject,  Best  on  Presump.  190-202. — P.] 

Different  rules  have  been  given  by  actuaries  for  calculating  the 
expectation  or  duration  of  life  at  different  ages.  It  is  difficult  to  test 
their  accuracy,  except  in  reference  to  large  numbers  of  persons  liv- 
ing under  similar  circumstances,  and  for  these  groups  of  the  popu- 
lation statistics  do  not  fairly  provide.  Age  is  the  point  from  which 
nearly  all  the  Tables  of  Mortality  start,  without  reference  to  health, 
trade,  occupation,  or  social  position.  One  of  the  most  simple  of  these 
rules  for  calculating  the  duration  of  life  from  5  to  60  years  has  been 
given  by  Willich  :  he  considers  it  to  be  equal  to  two-thirds  of  the 
difference  between  the  age  and  80.  Thus,  in  a  man  20  years  of  age 
the  difference  is  equal  to  60,  and  two  thirds  of  this  are  equal  to  40, 
the  probable  duration  of  life  for  a  person  of  average  health  at  20. 
Each  office  has  its  own  rules  for  calculating  the  amount  of  premium 
to  be  paid  by  the  person  who  effects  an  insurance.  As  insurance 
offices  are  very  numerous  and  their  profits  are  large,  it  is  obvious 
that  their  calculations  must  be  very  much  in  their  own  favor.  The 
expectation  of  life  in  the  insured  is  ordinarily  much  greater  than 
they  assign  to  it ;  at  the  same  time  the  amount  payable  in  the  form 
of  premium  is  kept  down  by  competition. 

With  respect  to  the  influence  of  profession,  a  higher  premium  is 
demanded  by  some  offices  for  the  insurance  of  the  lives  of  persons 
whose  occupations  expose  them  to  great  risk — as,  for  instance,  of 
persons  actually  engaged  in  military  or  naval  service.  The  rule 
adopted  with  respect  to  professions  in  one  of  the  best  London  offices 


EXPECTATION    OF    LIFE.  727 

is  as  follows :  "  No  extra  premium  is  required  from  any  person  in 
the  army  or  navy  unless  on  actual  service,  but  the  assurance  will 
be  void  if  the  party  whose  life  is  assured  enter  into  any  naval  or 
military  service  whatever,  unless  by  consent  of  the  Directors  en- 
dorsed on  the  policy." 

Above  all  other  conditions,  the  general  state  of  health  of  the  person 
is  likely  to  have  a  most  important  influence  on  the  mean  duration 
of  life;  and  it  is  here  that  medical  science  lends  its  aid — 1st,  by 
showing  how  far  a  contract  may  be  safely  entered  into  when  the 
person  is  affected  with  disease;  and  2dly,  by  showing  whether  a 
diseased  state  of  the  body  really  existed  in  the  person  insured,  al- 
though at  the  time  of  insurance  it  may  have  been  alleged  that  he 
was  healthy  and  free  from  disease. 

By  improved  methods  of  diagnosis,  the  existence  of  disease  under 
a  proper  examination  is  easily  made  known,  or  it  may  be  at  once 
inferred  from  symptoms  described  by  non-professional  persons. 
Then,  again,  the  influence  of  particular  diseases  in  shortening  life 
are  now  so  much  better  understood  than  formerly,  that  the  numer- 
ous offices  have  of  late  years  been  especially  established  for  the  in- 
surance of  diseased  as  well  as  of  healthy  lives,  the  amount  of  pre- 
mium being  of  course  regulated  by  the  nature  of  the  disease  and  the 
degree  to  which  it  may  have  advanced.  In  these  cases  lives  are 
insured  as  if  the  persons  had  reached  a  greater  age,  the  amount  paid 
being  calculated  on  the  theory  that  the  person  is  ten,  fifteen,  or 
twenty  years  older  than  he  is. 

As  in  the  case  of  all  civil  contracts  the  law  requires  that  there 
should  be  a  strict  compliance  with  the  conditions  by  each  party,  it 
follows  that,  if  any  fraud  has  been  committed  by  the  insured — if  he, 
or  those  to  whom  he  trusted  in  his  dealings  with  the  office,  have  con- 
cealed from  the  insurers  the  existence  of  any  disease  under  which 
he  was  at  the  time  laboring,  or  any  symptoms  indicative  of  a  pro- 
bable attack  of  disease  ;  or  if  he  of  they  have  knowingly  and  wilfully 
misrepresented  or  misdescribed  his  actual  bodily  condition,  then  the 
contract  will  be  void,  and  the  amount  of  the  premiums  forfeited. 
This  forfeiture  is  a  usual  condition  in  the  policy.  Actions  on  poli- 
cies of  life  insurance  are  not  unfrequent ;  and,  unfortunately,  the 
medical  evidence  given  on  these  occasions,  as  in  cases  of  insanity,  is 
of  a  very  conflicting  character.  This  is  by  no  means  creditable  to 
the  profession,  for  it  either  proves  the  existence  of  great  bias  in  the 
witnesses,  or  that  medical  rules  are  devoid  of  all  certainty,  and  are 
therefore  practically  useless.  A  writer,  in  commenting  upon  these 
professional  conflicts,  says :  "  One  of  the  most  unsatisfactory  parts 
of  our  law  of  evidence  is  that  which  relates  to  the  testimony  of  ex- 
perts. It  is  impossible  to  shut  out  such  evidence  altogether,  but 
there  is  nothing  which  brings  more  discredit  upon  the  administra- 
tion of  justice.  There  is  one  consequence  of  its  admission  which  is 
common  to  all  cases  in  which  it  occurs.  It  is,  that  no  difficulty  has 
ever  been  found  in  obtaining  any  amount  of  evidence  of  this  des- 
cription on  either  side  of  any  point  at  issue."  It  will  be  therefore 
necessary  to  enter  into  an  examination  of  the  circumstances  under 


728       QUESTIONS    CONNECTED    WITH    LIFE    INSURANCE. 

which  medical  men  are  called  upon  to  appear.  An  action  is  never 
likely  to  be  brought  for  the  recovery  of  the  amount  of  a  policy, 
except  in  those  cases  where  there  is  reason  to  suspect  that  a  wilful 
fraud  has  existed  in  the  contract.  Juries  always  regard  such  actions 
with  disfavor ;  and  while  judges  interpret  the  law  strictly,  the  onus 
of  proof  is  entirely  thrown  upon  the  offices.  Hence  the  insured  are 
placed  in  a  very  advantageous  position.  These  actions  in  nine  cases 
out  of  ten  depend  upon  the  construction  put  on  the  medical  terms  of 
the  contract ;  hence  it  is  our  duty  to  see  how  medical  defects  are 
likely  to  arise  in  reference  to  the  policy.  The  conditions  of  insu- 
rance vary  in  different  offices.  The  following  are  taken  from  the 
papers  issued  by  one  of  the  principal  London  offices : — 

Questions. — The  name,  residence,  and  profession  of  the  party  whose 
life  is  to  be  assured  ?  Place  of  birth  ?  Date  of  birth  ?  The  —  day 
of — .  Age  next  birthday — years1?  {Proof  should  be  furnished?) 
Married  or  single  ?  Sum  to  be  assured,  £  .  Term  for  which  the 
assurance  is  required  ?  Have  you  ever  been  afflicted  with  gout, 
rupture,  asthma,  fit  or  fits,  spitting  of  blood,  or  any  other  disease 
or  disorder  which  tends  to  shorten  life?  Have  you  had  the  small- 
pox, or  been  vaccinated  ?  Have  any  of  your  relatives  died  of  con- 
sumption? Are  you  now,  and  have  you  always  been,  of  temperate 
habits  of  life  ?  Are  you  employed  in  any  naval  or  military  service  ? 
State  if  there  be  any  other  material  circumstance  touching  your  past 
or  present  state  of  health  or  habits  of  life  to  which  the  foregoing 
questions  do  not  extend?  Name  and  residence  of  your  usual  medi- 
cal attendant  ?  Has  attended  me  —  years.  Name,  residence,  and 
profession  of  two  friends  well  acquainted  with  your  health  and 
habits  of  living  ?  Has  known  me  —  years.  Has  known  me  —  years. 
Has  a  proposal  ever  been  made  on  your  life  at  any  other  office  or 
offices?     If  so,  where?     Was  it  accepted  at  the  ordinary  premium? 

or  at  an  increased  premium  ?  or  declined  ?    I,  the  above  named , 

do  hereby  declare  that  the  foregoing  statements,  and  the  answers  and 
replies  made  by  me  to  the  several  above-mentioned  questions  and 
requisitions,  and  each  and  every  of  them,  is  and  are  true  in  substance 
and  matter  of  fact.  And  that  I  have  not  omitted  or  concealed  any 
fact,  matter,  or  thing  in  anywise  touching  or  affecting  my  state  of 
health,  constitution,  or  habits  of  life.  And  I  also  declare,  that  it  is 
expressly  understood  and  agreed  between  myself  and  the  Company, 
that  the  foregoing  particulars,  statements,  and  this  declaration  are  to 
be  considered  and  taken  as  the  basis  of  the  contract  of  assurance  be- 
tween me  and  the  Company,  for  this  assurance.  And  in  case  the 
foregoing  particulars,  statements,  and  declaration  be  untrue,  or  con- 
tain any  untrue  averment,  the  policy  of  assurance  affected  in  pur- 
suance thereof  shall,  in  any  or  either  of  such  cases,  be  absolutely 
null  and  void,  and  the  premiums  paid  thereon  shall  become  and  be 
absolutely  forfeited  to  the  Company,  and  not  be  receivable  or  re- 
coverable by  me  or  by  my  representatives.  Dated  the  —  day  of  — 
186 — .     Signature  of  the  person. 

[Statements  in  an  application  for  life  insurance,  "upon  the  faith  of 
which  the  policy  is  expressed  to  be  made,  with  a  stipulation  that,  if 


QUESTIONS    PROPOSED    TO    MEDICAL    MEN.  729 

the}7  shall  be  found  in  any  respect  untrue,  the  policy  shall  be  void,  are 
warranties,  and  if  untrue,  even  in  a  point  immaterial  to  the  risk,  avoid 
the  policy.  Miles  v.  Connecticut  Mutual  Co.,  3  Gray  (Mass.)  580 ;  Caze- 
noue  v.  Ins.  Co.,  6  C.  B.  (N.  S.)437.— P.] 

The  following  questions  are  submitted  to  the  usual  medical  attend- 
ant of  the  person  whose  life  is  proposed  for  insurance  :  1.  How  long 
have  you  known  him  ?  2.  Are  you  his  usual  medical  attendant  ? 
and  have  you  seen  him  with  reference  to  this  report  ?  3.  When  was 
he  last  ill?  and  what  have  been  the  nature  and  duration  of  the  com- 
plaints for  which  you  have  attended  him  ?  4.  Has  he  to  your  know- 
ledge, or  have  you  reason  to  believe  that  he  has  had,  any  giddiness, 
or  affection  of  the  head,  or  any  particular  determination  of  blood  to 
the  head  ;  or  has  he  suffered  from  apoplexy,  palsy,  epileptic  or  other 
fits,  or  other  disease  of  the  brain,  or  from  insanity  ?  5.  Has  he  ever 
suffered  from  pulmonary  disease  ?  from  habitual  cough,  shortness  of 
breath,  spitting  of  blood,  asthma,  inflammation,  or  other  disease  of 
the  lungs,  or  from  disease  of  the  heart  ?  6.  Has  he  ever  had  dropsy, 
inflammation,  or  severe  disease  of  the  bowels,  disease  of  the  liver, 
of  the  kidneys,  or  other  urinary  organs,  or  any  affection  of  the  ali- 
mentary canal  ?  7.  Has  he  had  gout  or  rheumatism  ?  If  so,  in 
what  form  ?  and  have  the  attacks  been  frequent  ?  8.  Has  he  ever 
been  affected  with  hernia?  If  so,  in  what  situation?  Is  it  reduci- 
ble? And  does  he  wear  a  truss  ?  9.  Has  he  had  any  serious  wound, 
hurt,  or  other  accident,  causing  any  bodily  infirmity  ?  10.  Do  you 
consider  he  is  now  in  perfect  health  ?  11.  Has  he  been,  and  is  he 
now,  habitually  sober  and  temperate  ?  12.  Is  he  of  active  or  seden- 
tary habits?  13.  Does  his  occupation  expose  him  to  the  chances  of 
disease  ?  14.  Have  his  parents  been  healthy  and  long-lived,  or  other- 
wise ?  15.  Have  any  of  his  near  relatives  died  of  consumption  or 
any  hereditary  disease  ?  16.  State  any  material  circumstance  touch- 
ing his  health  or  habits,  to  which  the  foregoing  questions  do  not 
extend,  which  may  affect  the  eligibility  for  life  assurance  ?  Dated 
this  —  day  of  —  186  — .     Signed . 

In  order  to  show  the  searching  nature  of  these  inquiries,  and  how 
one  set  of  answers  is  made  to  act  as  a  check  upon  another,  it  is  only 
necessary  to  refer  to  the  following  list  of  queries  which  are  put  to 
private  individuals  acquainted  with  the  person.  This  paper  is  to  be 
filled  up  and  transmitted  with  a  proposal  for  life-insurance: — 

State  whether  you  have  been  acquainted  with  the  person  whose 
life  is  proposed  to  be  insured,  and  how  long.  Whether  you  have 
ever  heard  or  known  of  his  being  ill,  and,  if  so,  state  the  time  of 
the  illness  and  nature  of  the  complaint.  Whether  he  is  at  this  time, 
to  the  best  of  your  knowledge  ami  belief,  in  perfect  health.  Whether 
his  habits  and  manner  of  living  are  temperate  and  regular.  (You 
will  be  pleased  to  direct  your  particular  attention  to  this  subject  of 
inquiry.)  Whether  his  appearance  indicates  health  and  a  good  con- 
stitution. AVhether  there  is  any,  and  what,  apparent  defect  in  the 
formation  of  his  person.  When  you  last  saw  him.  Whether  he  is 
in  person  thin  or  middle-sized,  stout  or  bloated.  Whether  lii-  i 
plexioD  is  pale,  sallow,  brown  or  florid.     Whether  he  is  married  or 


780  MEDICAL    REFEREES. 

single.  Whether  he  has  had  any  brothers  or  sisters.  If  so,  how 
many;  the  number  now  living;  the  ages  at  which  the  others  have 
died,  and  the  cause  of  their  decease.  Ascertain  and  state  whether 
his  parents  are  living,  and  if  not,  the  age  at  which  they  have  died, 
and  the  causes  of  their  death ;  communicate  all  the  information  you 
can  acquire  as  to  the  health  and  longevity  of  his  other  relatives ; 
also  whether  any  of  them  have  died  of  consumption,  or  have  been 
subject  to  fits  or  mental  derangement.  Whether  the  persons  referred 
to,  respecting  the  life  to  be  insured,  are  worthy  of  credit ;  and 
whether  the  medical  referee  is  the  usual  medical  attendant  of  the 
party.  Whether  you  consider  the  life  in  question  in  all  respects  safe 
and  proper  to  be  insured  by  the  company  upon  ordinary  terms,  and 
whether  you  recommend  the  same  to  the  Directors  as  such.  Ascer- 
tain if  the  life  has  been  proposed  in  any  other  office,  and  if  so, 
whether  declined  or  taken.  If  the  insurance  is  proposed  bv  one 
party  on  the  life  of  another,  endeavor  to  learn  and  state  the  object 
for  which  it  is  intended. 

No  one  can  blame  insurance  offices  for  acting  thus  rigorously. 
Frauds  of  the  worst  description  have  been  frequently  attempted  upon 
them,  and  it  is  only  by  the  adoption  of  a  system  of  this  kind  that 
they  can  protect  themselves. 

The  practice  with  some  offices  of  obtaining  a  certificate  gratui- 
tously from  the  medical  attendant  of  the  person  proposing  to  insure 
his  life  is  one  great  source  of  litigation.  The  responsibility  of  caus- 
ing the  life  to  be  accepted  or  rejected  is  thus  thrown  entirely  upon 
the  usual  medical  attendant  of  the  person;  for,  as  we  shall  see 
hereafter,  an  application  for  a  certificate  from  a  medical  practitioner 
who  is  a  stranger,  is  very  likely  to  be  treated  as  a  fraud,  and  to  lead 
to  the  disputing  of  the  policy.  The  medical  attendant  of  the  person, 
it  is  true,  is  the  only  individual  who  can  properly  certify  to  the  real 
state  of  health,  and  therefore  to  him  an  application  is  generally 
made.  He  is  sometimes  expected  to  furnish  an  important  certificate 
of  this  kind  gratuitously ;  and  should  it  happen  to  be  unfavorable, 
he  is  exposed  to  the  risk  of  losing  what  may  probably  be  a  lucrative 
portion  of  his  practice :  for  I  shall  not  suppose  that  any  member  of 
the  profession  would  certify  to  what  he  knew  to  be  untrue  in  order 
to  retain  a  patient.  The  question  is,  whether  an  insurance*  office  has 
a  right  to  place  a, medical  man  in  such  a  responsible  position  as  this. 
In  the  issuing  of  a  policy  the  insurers  and  insured  are  equally 
benefited,  for  the  contract  would  certainly  not  be  made  except  upon 
a  supposition  of  reciprocal  benefit.  The  medical  attendant,  without 
whose  sanction  the  policy  could  not  be  properly  effected,  not  only 
derives  no  benefit,  but  is  actually  exposed  to  the  risk  of  loss  for 
performing  in  an  honorable  and  conscientious  manner  an  invidious 
duty  thus  forced  upon  him.  Such  a  state  of  things  ought  not  to  be. 
Many  actions  for  the  recovery  of  disputed  policies  have  shown  most 
clearly  that  the  practice  leads  to  great  carelessness  and  indifference 
on  the  part  of  medical  men  in  drawing  up  these  certificates ;  and 
this  produces  in  the  end  a  more  serious  loss  to  the  representatives 
of  the  insured  than  if  the  life  had  not  been  accepted.     It  must  be 


MEDICAL    REFEREES.  731 

remembered  that  the  insurers  do  not  suffer  by  any  misconduct  on 
the  part  of  a  medical  man  who  signs  such  a  certificate,  but  the  repre- 
sentatives of  the  insured ;  hence  the  offices  show  no  disposition  to 
amend  this  vicious  system.  It  is  always  professed  that  such  com- 
munications are  confidential :  but  in  more  than  one  instance  medical 
men  have  found  that  the  contents  of  their  certificates  have  become 
known  to  their  patients,  and  have  even  been  publicly  used  as  evi- 
dence in  courts  of  law.  A  partial  remedy  would  be,  that  the  medical 
attendant  of  the  party  should  not  be  called  upon  to  sign  a  certificate 
at  all,  but  that  this  should  be  done  only  by  a  medical  referee  of  the 
office  after  a  regular  professional  consultation  with  the  medical 
attendant,  and  a  proper  examination  of  the  person.  If  the  life  were 
rejected,  the  onus  of  rejection  would  be  on  the  proper  person,  the 
appointed  referee ;  and  if  accepted,  he  would  be  properly  made 
responsible  to  the  office  for  any  gross  negligence  in  the  performance 
of  his  duties.  It  is  true  that  there  are  few  insurance  offices  which 
have  not  consulting  physicians  and  surgeons  attached  to  them ;  but 
the  weight  of  responsibility  in  contested  suits  does  not  rest  with 
these  officers  so  much  as  with  the  medical  attendants  of  the  insured. 
In  the  event  of  a  medical  practitioner  being  called  upon  to  sign  a 
certificate  of  this  kind,  it  appears  to  me  that  the  safe  plan  to  be 
adopted  would  be  that  he  should  decline  the  proposal,  except  upon 
a  professional  consultation  with  the  medical  officers  appointed  by 
the  insurers.  If,  however,  from  private  considerations,  he  is  com- 
pelled to  sign  the  certificate,  it  is  his  duty  to  use  the  greatest  caution, 
not  merely  in  returning  answers  to  the  formal  questions  on  the  paper, 
but  in  detailing  all  particulars  known  to  him  respect  in;/  the  state  of  health 
of  the  person.  In  acting  otherwise  he  would  be  doing  the  greatest 
possible  injury  to  the  representatives  of  the  insured,  and  probably 
damage  his  own  reputation.  There  is  no  intermediate  course;  the  duty 
must  either  be  performed  carefully,  conscientiously,  and  honorably, 
or  it  must  be  declined  altogether.  It  is  a  fallacy  to  suppose  that  any 
equivocation  or  concealment  in  the  declaration  can  escape  detection; 
and  yet,  from  the  evidence  which  has  been  given  on  some  trials,  it 
is  probable  that  such  an  idea  had  existed  in  the  mind  of  the  medical 
attendant  who  placed  his  name  to  the  certificate. 

Let  us  take  the  case,  however,  that  this  preliminary  duty  has  been 
properly  performed ;  important  medical  questions  may  arise  respect- 
ing the  alleged  infringement  of  the  conditions  of  the  policy.  The 
list  of  diseases  specified  comprises  a  great  variety — affections  of  the 
head,  apoplexy,  palsy,  epileptic  or  other  fits,  disease  of  the  brain, 
insanity,  disease  of  the  lungs,  spitting  of  blood,  asthma,  inflamma- 
tion, disease  of  the  heart,  dropsy,  diseases  of  the  bowels,  liver,  kid- 
neys, or  urinary  organs,  gout,  rheumatism,  hernia,  phthisis,  or  any 
hereditary  disease.  In  the  proposals  of  some  offices  the  mysterious 
word  "fits"  occupies  a  very  prominent  position,  but  it  is  difficult  to 
say  what  this  word  thus  isolated  actually  means.  It  appears  to  have 
been  borrowed  from  the  vocabulary  of  the  ancient  searchers  under 
the  bills  of  mortality  in  the  reign  of  Charles  II.  Thus  it  may  com- 
prise apoplexy,  epilepsy,  paralysis,  syncope,  convulsions  from  any 


732  DISEASES    TEXDIXG    TO    SHORTEN*    LIFE. 

cause,  and  even  asphyxia.  The  word  is  too  indefinite  for  a  certificate, 
and  should  be  expunged.  In  the  meantime,  a  court  of  law  will  not 
allow  insurers  to  benefit  by  the  use  of  ambiguous  terms  in  the  con- 
tract, and  it  has  therefore  commonly  restricted  the  meaning  of  the 
word  "fits"  to  attacks  of  epilepsy.  The  main  condition,  however,  is 
involved  in  the  terms — "any*  other  disease  or  disorder  tending  to  sho 
lift ."  Upon  the  meaning  of  these  words  litigation  commonly  turns, 
and  the  opinions  of  medical  experts  are  required. 

Diseases  Tending  to  Shorten  Lift-. — It  is  impossible  to  lay  down  any 
general  rules  for  determining  what  diseases  have  and  what  diseases 
have  not  a  tendency  to  shorten  life.  Any  deviation  from  health 
might  be  so  interpreted ;  but  the  law  puts  a  proper  limitation  here 
upon  the  meaning  of  the  words,  considering  them  to  apply  to  those 
diseases  only  which,  in  a  medical  view,  are  regarded  as  of  a  serious 
nature,  and,  as  a  general  rule,  are  likely  either  directly  or  indirectly 
to  affect  the  duration  of  life  of  any  person  laboring  under  them. 
This  question  was  brought  to  an  issue  in  the  case  of  Watson  v. 
Mainwaring,  in  which  payment  of  the  amount  of  a  policy  was  re- 
fused, because  the  insured  had  labored  at  the  time  under  what  was 
called  <<r 'ionic  dyspepsia;  and  this  fact  was  kept  concealed  from  the 
insurers.  It  was  left  as  a  question  of  fact  to  the  jury,  whether  the 
malady  with  which  the  deceased  was  afflicted,  and  of  which  he  ulti- 
mately died,  was  an  ordinary  or  organic  dyspepsia  at  the  time  of 
the  insurance.  The  judge  (Chambre)  in  charging  the  jury  said  : 
•■  All  disorders  have  more  or  less  a  tendency  to  shorten  life,  even 
the  most  trifling;  as,  for  instance,  corns  may  end  in  mortification; 
but  that  is  not  the  meaning  of  the  clause.  If  dyspepsia  were  a  dis- 
order tending  to  shorten  life  within  this  exception,  the  lives  of  half 
the  members  of  the  profession  of  the  law  would  be  uninsurable." 
We  learn  then,  from  this  case,  that  a  person  may  die  from  a  dis  - 
under  which  he  was  laboring  at  the  time  of  insurance :  and  yet  if  it 
be  not  the  common  course  of  that  disease  to  shorten  life,  the  repre- 
sentatives may  recover  the  amount  of  the  policy.  This  is  an  equi- 
table interpretation  of  the  terms;  for  the  insurers  have  no  right  to 
give  a  forced  meaning  to  the  words  of  the  policy,  and  to  take  advan- 
tage of  what  must  be  regarded  as  an  accidental  result.  From  other 
decisions  we  learn  that,  in  order  to  render  a  policy  valid,  these 
words  do  not  imply  that  the  insured  must  have  been  at  the  time 
entirely  free  from  all  the  seeds  of  disorder  or  latent  disease.  Such  a 
condition  is  impossible.  A  man  may  be  laboring  under  some  insi- 
dious disease — ulceration  of  the  stomach  or  intestines,  for  instance 
— leading  to  perforation ;  but  if  this  be,  as  it  commonly  is.  unknown 
both  to  himself  and  his  medical  attendant,  the  insurers  are  bound  to 
take  the  risk.  Lord  Mansfield,  in  the  case  of  Sir  James  Ross,  held 
that  the  warranty  was  sufficiently  true,  if  the  person  were  at  the 
time  in  a  reasonably  good  state  of  health.  A  life  may  be  a  g 
life,  although  the  person  may  be  at  the  time  laboring  under  some 
bodily  infirmity. 

[The  assured  who  effected  a  policy  on  his  life  in  February,  1855, 
signed  a  declaration  stating,  among  other  things,  that  he  was  then 


INFLUENCE    OF    GOUT.  i  66 

in  good  health,  and  did  ordinarily  enjoy  good  health:  and  that  he 
was  not  aware  of  any  disorder  or  circumstance  tending  to  shorten 
his  life,  or  to  render  an  insurance  on  his  life  more  than  usually  haz- 
ardous, unless  anything  stated  in  answer  to  certain  questions  which 
preceded  the  declaration  might  be  so  considered.  In  an  action  upon 
the  policy,  it  appeared  that  in  1853  and  1854,  the  deceased  bad  had 
two  severe  bilious  attacks.  Medical  men  had  expressed  different 
opinions  as  to  the  effect  of  these  attacks  upon  his  health ;  but  it  did 
not  appear  that  the  unfavorable  opinions  had  ever  been  communi- 
cated to  the  assured.  It  was  held  that  it  was  proper  to  instruct  the 
jury  that  "  if  the  assured  honestly  believed  at  the  time  he  made  the 
declaration,  that  the  bilious  attacks  had  no  effect  upon  his  health, 
and  did  not  tend  to  shorten  his  life,  or  to  render  an  insurance  upon 
it  more  hazardous,  the  fact  that  he  was  aware  that  he  had  had  these 
attacks,  even  though  (without  his  knowledge)  they  had  such  a  tend- 
ency, would  not  defeat  the  policy." — Jones  v.  Provincial  Ins.  Co.,  3 
C.  B.  (N.  S.)  65.— P.] 

On  the  other  hand,  a  disease  tending  to  shorten  life  must  not  be  taken 
to  signify  only  one  of  those  maladies  which  have  commonly  a  rapid 
and  fatal  course — as  phthisis  and  scirrhus :  it  may  apply  to  dropsy, 
gout,  asthma,  insanity,  and  many  diseases  of  a  chronic  character. 
When  the  existence  of  these  diseases,  or  even  a  well-marked  tendency 
to  them,  is  concealed  from  the  insurers,  or  omitted  to  be  stated 
through  mistake,  even  without  fraudulent  intention,  the  policy  in 
the  event  of  death  becomes  void,  because  the  risk  incurred  is  really 
different  from  the  risk  understood  and  intended  at  the  time  of  the 
agreement.  Such  diseases  are  not  necessarily  fatal,  but  this  is  not 
the  question :  their  tendency  is  to  diminish  the  expectation  of  life, 
and  if  medical  evidence  establish  this  with  regard  to  any  disorder 
intentionally  concealed,  whether  chronic  or  acute,  the  contract  is  at 
an  end. 

Gout. — In  December,  1862,  a  case  was  tried  in  which  it  was  alleged 
that  there  had  been  concealment  of  the  existence  of  gout.  (Uxors,  of 
FowkesY..  The  Manchester  and  London  Assurance  Company.)  Thecleceased 
Fowkes,  a  commercial  traveller,  aged  49,  in  the  year  1860  effected  a 
policy  on  his  life  for  1000Z.  He  died  in  June,  1861.  Payment  was 
refused  on  the  ground  that  the  answers  of  deceased  were  untrue,  and 
that  there  had  been  suppression  of  a  material  fact.  It  seems  he  was 
asked  whether  he  had  ever  been  afflicted  with  gout,  and  he  answered 
"No."  He  was  asked  whether  the  life  had  been  offered  at  any  other 
office,  and,  if  so,  whether  it  was  accepted ;  and  he  answered  that  it 
had  been  proposed,  and  had  been  accepted  at  the  ordinary  rate. 
These  were  the  answers  which  it  was  alleged  were  false.  On  the 
part  of  the  company,  a  surgeon  stated  that  in  May,  1858,  deceased 
was  suffering  from  suppressed  gout.  He  had  an  "extremely  slight 
attack,"  which  lasted  only  about  forty-eight  hours;  he  did  not  tell 
the  deceased  that  it  was  gout ;  he  believed  that  he  died  of  suppressed 
gout  in  an  aggravated  form.  A  proposal  of  the  deceased  to  another 
company,  which  had  been  declined,  was  put  in  evidence.  On  the 
part  of  the  plaintiffs  it  was  contended  that  there  was  no  evidence 


73-i  CONCEALMENT    OF    HABITS. 

that  deceased  had  ever  been  "  afflicted  with  gout."  The  Lord  Chief 
Justice  left  it  to  the  jury — first,  whether  the  answers  of  the  insured 
were  untrue;  and  next,  whether  they  were  false  to  his  knowledge. 
First,  had  he  been  "afflicted  with  gout?"  The  question  must  be 
considered  with  some  reasonable  latitude,  and  it  was  not  because  a 
person  had  some  passing  symptoms  which  a  far-seeing  medical  man 
might  ascribe  to  the  presence  of  suppressed  gout  in  the  system,  but 
whether  there  was  gout  in  a  sensible  appreciable  form  ?  This  cer- 
tainly was  stated  before  ths  proposal,  to  have  been  "the  slightest 
possible  case"  of  gout,  according  to  the  medical  evidence.  As  to 
the  other  question — whether  the  life  had  been  proposed  at  any  office 
and  accepted  or  declined — it  appeared  that  the  life  had  been  pro- 
posed at  two  offices,  and  accepted  by  one  but  declined  by  the  other. 
Had  the  assured  answered  truly  in  simply  saying  that  he  had  pro- 
posed and  been  accepted?  The  question  no  doubt  was  not  in  the 
most  comprehensive  form,  but  was  it  answered  fully  and  fairly,  and 
according  to  its  obvious  meaning  and  effect,  by  saying  nothing  of 
the  proposal  which  had  been  declined?  He  thought  not ;  but  left 
it  to  the  jury.  He,  however,  thought  further  that  it  was  not  strictly 
true  that  the  life  had  been  "accepted"  in  the  sense  in  which  the 
word  was  used — for  it  had  not  been  accepted  by  any  office  on  a 
proposal  for  assurance,  but  merely  approved  by  the  medical  man. 
It  was  for  the  jury  to  say  whether  either  of  the  answers  was  untrue, 
and,  if  so,  whether  either  was  untrue  to  the  knowledge  of  the  assured. 
The  jury  found  that  the  assured  had  not  been  afflicted  with  gout  at 
the  time  of  the  proposal ;  also  that  the  answer  to  the  other  question 
was  untrue,  but  not  to  his  knowledge.  The  Lord  Chief  Justice 
directed  a  verdict  for  the  plaintiff,  subject  to  a  point  reserved  for  the 
court  whether  the  knowledge  of  the  untruth  was  material. 

Habits. — Again,  a  person  may  be  laboring  under  no  actual  disease 
at  the  time  of  affecting  the  insurance,  but  his  1  tab  its  may  be  such  as 
to  produce  general  injury  to  health,  and  to  have  a  tendency  to 
shorten  life.  Concealment  of  habits,  the  effect  of  which  on  health 
must  or  ought  to  be  known  to  all  medical  men,  may  be  just  as  fatal 
to  a  policy  as  the  concealment  of  a  serious  disease.  Although  they 
may  not  always  be  included  in  the  questions  put  by  the  office,  yet 
the  law  will  equitably  hold  that  the  insurers  should  be  made  ac- 
quainted with  all  circumstances  which  might  reasonably  affect  the 
risk.  Concealed  habits  of  drunkenness  have  thus  given  rise  to 
medical  questions  of  considerable  importance;  and  in  one  remarkable 
instance  which  will  be  mentioned  hereafter,  a  question  arose  as  to 
whether  the  practice  of  opium-eating,  which  had  been  concealed 
from  the  insurers,  had  or  had  not  a  tendency  to  shorten  life. 

Some  recent  exposures,  partly  of  a  civil  and  partly  of  a  criminal 
nature,  have  rendered  insurance  offices  much  more  strict  in  their  in- 
quiries. In  the  rules  already  quoted,  special  information  is  de- 
manded upon  the  existence  of  material  circumstances  touching  health 
or  habits  of  life,  and  whether  the  person  is  or  is  not  of  temperate 
habits.     Any  facts  bearing  upon  these  questions,  if  known  to  the 


CONCEALMENT    OF    HABITS.  735 

medical  attendant,  must  of  course  be  stated.  The  existence  of  such 
habits  must  be  known  to  the  person  himself,  and  the  declaration 
which  he  signs  is  so  explicit  that,  if  intentionally  concealed  by  him, 
no  individual  can  reasonably  complain  of  the  voidance  of  the  policy 
and  the  forfeiture  of  the  premiums. 

The  case  of  Von  Lindenau  v.  Desborough,  tried  in  the  Court  of 
King's  Bench  before  Lord  Tenterden  in  October,  1828,  shows  that 
medical  men  are  bound,  at  the  risk  of  invalidating  the  policy,  to 
state  the  exact  bodily  condition,  so  far  as  it  can  be  obtained  by  ob- 
servation, of  the  person  whose  life  it  is  proposed  to  insure.  It 
appears  that  on  the  16th  June,  1824,  a  policy  for  3,208?.  was  effected, 
in  the  Atlas  office,  on  the  life  of  the  Duke  of  Saxe  Gotha,  at  the  time 
he  was  residing  abroad.  The  Duke  died  on  the  11th  February, 
1825,  within  nine  months  of  the  time  of  effecting  the  insurance  ;  and 
the  payment  of  the  amount  of  the  policy  was  refused  on  account  of 
a  material  concealment  of  the  exact  condition  of  the  insured  from 
the  insurers.  It  appeared  in  evidence  that  for  some  time  prior  to 
the  insurance,  the  Duke  had  been  an  invalid,  and  that  at  the  time  it 
was  effected  he  was  childish  and  had  not  spoken  for  two  years. 
He  had  labored  under  some  affection  of  the  brain,  did  not  improve 
in  health  after  the  insurance,  and  ultimately  died  from  an  attack  of 
paralysis.  The  certificate  upon  which  the  insurance  was  granted 
had  been  signed  by  two  German  physicians,  Drs.  Dorl  and  Ziegler. 
It  was  to  the  effect  that  the  general  health  of  the  Duke  was  good ; 
but  that  he  was  "hindered"  (gehindert,  had  an  impediment)  in  his 
speech,  and  had  an  affection  in  his  left  eye.  It  was  also  stated  that 
he  was  perfectly  free  from  disease  or  symptoms  of  disease.  On  in- 
spection of  the  head  a  tumor  of  large  size  connected  with  the  inner 
table  of  the  skull  was  found  pressing  upon  the  brain.  This  tumor 
was  evidently  of  long  standing,  and  had  probably  been  the  cause  of 
the  symptoms  and  death.  Ten  ounces  of  serum  were  found  effused 
in  the  brain. 

It  appears  that  before  the  insurance  was  effected  an  agent  in  Ger- 
many had  informed  the  insurers  that  the  Duke  had  led  a  dissolute 
life,  by  which  he  had  lost  the  use  of  his  speech,  and,  according  to 
some,  of  his  mental  faculties  also ;  and  on  this  the  Office  required  a 
payment  of  nearly  double  the  usual  premium.  The  case  of  the 
insurers  was  that  there  had  been  material  concealment  of  the  Duke's 
real  condition  at  the  time  of  effecting  the  insurance.  The  late  Mr. 
J.  H.  Green,  who  appeared  as  a  witness  for  the  plaintiff,  the  claim- 
ant under  the  policy,  considered,  from  the  history  of  the  case,  that 
there  were  no  symptoms  of  organic  disease,  although  the  symptoms 
mentioned  would  lead  to  a  suspicion  of  disease  in  the  head.  In  re- 
ply to  a  cpaestion  by  Lord  Tenterden,  he  said  if,  as  a  medical  man, 
he  had  been  asked  by  an  Insurance  Company  concerning  the  state 
of  a  man's  health,  who  was  unwilling  to  move,  who  was  subject  to 
control  and  influence,  and  who  had  lost  his  speech,  he  would  have 
considered  it  his  duty  to  mention  these  circumstances.  Lord  Ten- 
terden then  left  it  to  the  jury  whether  there  had  been  any  conceal- 


r36  MATERIAL    CONCEALMENT. 

nit 'lit  of  material  facts  relative  to  the  Duke's  health.     The  plaintiff 
was  nonsuited,  and  a  new  trial  subsequently  refused. 

There  can  be  no  doubt  that  the  answer  here  given  by  Mr.  Green 
was  such  as  every  conscientious  man  must  have  given  'under  the 
circumstances.  A  medical  expert  appears  in  court  to  speak  the 
whole  truth,  to  the  best  of  his  judgment,  and  not  to  make  out  rightly 
or  wrongly  the  particular  case  of  the  person  who  summons  him. 
On  the  other  hand,  it  is  obvious  that  Drs.  Dorl  and  Ziegler.gave  a 
most  improper  certificate.  They  might  not  have  been  able  to  ex- 
press any  opinion  respecting  the  existence  of  a  tumor  in  the  brain, 
but  they  were  wrong  in  suppressing  the  real  state  of  the  Duke.  If 
they  knew  his  actual  condition,  their  conduct  was  censurable ;  if 
they  did  not  know  it,  they  were  not  justified  in  signing  a  certificate 
at  all.  Because  a  man  may  enjoy  at  the  time  tolerable  bodily  health, 
facts  of  this  nature,  showing  great  disease  of  the  nervous  system, 
ought  not  to  be  kept  from  the  knowledge  of  the  insurers.  Imbe- 
cility depending  on  whatever  cause  should  always  be  mentioned. 

Material  Concealment. — Some  medical  practitioners  entertain  the 
opinion  that,  provided  they  can  certify  that  the  person  is  in  good 
health  at  or  about  the  time  of  the  insurance,  that  is  all  that  the 
insurers  need  know.  The  same  opinion  is  commonly  entertained 
by  the  insured  ;  and  the  latter,  after  having  been  attended  by  one 
medical  man  for  an  illness,  will  apply  to  another,  a  comparative 
stranger,  to  certify  to  his  condition  of  health  for  insurance.  We 
must  not  lend  ourselves  to  this  system,  which  is  based  sometimes 
upon  a  mistake,  at  others  upon  fraud.  If  medical  men  would  de- 
cline signing  the  papers  under  such  circumstances,  they  would  not 
only  save  themselves  from  censure,  but  be  actually  conferring  a 
benefit  upon  the  applicant,  by  preventing  him  from  obtaining  a 
policy  upon  terms  which  on  his  death  may  render  it  invalid,  and 
entail  a  forfeiture  of  the  premiums.  From  what  has  already  been 
said,  it  will  be  understood  that  the  exact  state  of  health  of  the  per- 
son at  the  time  of  the  insurance  does  not  represent  the  whole  of  the 
risk  incurred  by  the  Office.  The  restoration  to  health,  as  in  a  case 
of  diseased  lungs,  may  be  only  temporary :  it  may  be  speedily  fol- 
lowed by  phthisis,  and  the  insurers  therefore  ought  to  be  informed 
of  the  previous  condition  as  well  as  present  state  of  the  applicant. 
The  conditions  in  the  declarations  are  so  explicit  upon  this  point,  as 
to  render  it  scarcely  necessary  to  refer  to  the  propriety  of  making 
this  addition  to  the  certificate.  The  disease  under  which  the  insured 
had  labored  may  have  been  of  a  trivial  kind,  and  not  likely  to  affect 
the  risk  ;  nevertheless  the  safest  plan  is  to  state  it.  The  option  will 
then  lie  with  those  who  are  to  incur  the  risk.  When  facts  of  this 
kind  are  either  concealed  or  not  plainly  stated,  the  question  of  how 
far  they  were  or  were  not  material  to  be  laid  before  the  insurers  is 
always  left  to  the  jury,  who  are  guided  in  their  verdict  by  their  own 
common-sense  as  well  as  by  medical  opinions.  It  would  appear 
also,  from  a  decision  of  the  House  of  Lords  in  Anderson  v.  Fitzgeraldj 
that  the  truth  of  the  answers  given  and  not  their  materiality,  should 


MATERIAL    CONCEALMENT.  737 

govern  the  verdict  of  a  jury.  In  a  case  tried  in  December,  1856, 
Lord  Campbell  held  that  a  suppression  of  the  truth  on  the  part  of 
the  person  whose  life  was  insured  would  not  avoid  the  policy,  if  the 
party  effecting  the  insurance  was  innocent  and  ignorant  of  the  sup- 
pression. 

Some  medical  men  have  adopted  the  plan  of  signing  certificates, 
but  have  declined  to  make  any  written  reply  to  certain  queries : 
as,  for  instance,  the  general  query — Can  you  give  any  and  what 
information  respecting  the  habits  of  the  applicant  ?  If  nothing  be 
known  concerning  these,  it  should  be  so  stated;  if,  however,  the 
existence  of  any  habits  affecting  health  be  known  to  us,  we  shall  do 
an  injury  to  the  applicant  and  ourselves  by  withholding  information 
on  the  subject.  It  may  be  the  means  of  causing  a  heavier  premium 
to  be  demanded  for  insurance  than  if  the  facts  were  known;  and  if 
this  should  not  happen,  the  omission  is  very  likely  to  give  rise  to 
future  litigation.  Thus,  in  the  case  of  the  Earl  of  Mar,  the  payment 
of  the  policy  was  refused  on  the  ground  that  the  Earl  had  been  ad- 
dicted to  opium-eating.  His  medical  referee  replied  favorably  to 
the  special  questions  in  regard  to  habits,  whether  sedentary  or  active, 
temperate  or  intemperate ;  but  he  neglected  to  reply  to  the  general 
question  regarding  habits ;  and  on  the  Earl's  death  it  was  found 
that  he  had  been  an  opium-eater  for  many  years  before  effecting  the 
insurance.  This  fact  might  not  have  been  known  to  the  medical 
referee,  but  it  is  always  better  to  fill  in  the  reply  either  affirmatively 
or  negatively,  if  the  certificate  be  signed  at  all,  than  to  leave  the 
Office  to  draw  an  unfavorable  inference,  or  to  render  the  policy 
afterwards  open  to  dispute. 

In  the  case  of  a  Mrs.  Elgie  payment  of  the  amount  of  a  policy 
was  refused  under  the  following  circumstances :  The  insured  had 
been  for  some  time  prior  to  the  insurance  in  a  delicate  state  of 
health,  and  in  the  year  1821  it  was  thought  that  the  symptoms  were 
those  of  phthisis.  In  October,  1822,  she  was  twice  alarmingly  ill. 
In  December  of  that  year,  wishing  to  insure  her  life,  she  called  in 
a  medical  friend,  who  had  not  been  in  attendance  upon  her,  to  exa- 
mine her  and  certify  as  to  her  state  of  health.  It  appears  he  exa- 
mined particularly  the  state  of  her  lungs  and  liver,  and  finding  them, 
as  he  thought,  sound,  certified  that  the  ordinary  state  of  her  health 
was  good.  On  the  19th  March,  1823,  he  gave  another  certificate  to 
the  same  effect,  upon  which  the  insurance  was  effected  in  April, 
1823.  Mrs.  Elgie  died  of  disease  of  the  lungs  in  April,  1821.  Pay- 
ment was  refused,  on  the  ground  that  there  had  been  concealment 
of  material  facts  as  to  the  state  of  health  of  the  insured.  It  appears 
that,  unknown  to  the  medical  gentleman  who  had  given  the  certifi- 
cate, the  insured  had  been  attended  between  December,  1822,  and 
the  19th  March,  1823  (the  date  of  the  certificate),  by  a  medical 
practitioner  residing  in  her  neighborhood  for  a  cough,  and  that  she 
had  become  much  emaciated.  This  gentleman,  however,  thought 
that  ^here  was  no  structural  disease — an  opinion  confirmed  by  the 
examination  made  for  the  certificate  in  March.  The  fact  of  the  de- 
ceased  having  labored  under  this  illness  was,  however,  concealed 
47 


738      CONCEALMENT  OF  PHTHISIS  AND  HERNIA. 

from  the  insurers.  The  jury  thought  that,  although  there  had  been 
concealment,  it  was  not  material,  and  a  verdict  was  returned  against 
the  defendants.  A  new  trial  was  granted,  but  a  verdict  was  again 
returned  against  them.  The  truth  is,  it  is  not  the  concealment  of 
every  slight  attack  of  illness  that  will  vitiate  a  policy ;  although 
the  contract  being  one,  as  it  is  termed,  uherrimse  fidei,  it  is  in  the 
highest  degree  unwise  either  in  the  insured,  or,  if  it  be  known  to 
him,  in  the  medical  man  signing  the  certificate,  to  conceal  from  the 
insurers  any  previous  illness  or  medical  attendance  from  another 
quarter.  It  may  always  be  fairly  urged  that  a  knowledge  of  the 
facts  might  have  led  to  the  rejection  of  the  life,  or  have  made  a  dif- 
ference in  the  amount  of  the  annual  premiums.  One  part  of  our 
duty  therefore,  if  we  sign  a  certificate  upon  a  careful  examination,  is 
to  ascertain  whether  the  applicant  has  or  has  not  been  previously  at- 
tended by  another  medical  practitioner. 

A  case  was  tried  at  the  Warwick  Summer  Assizes,  1844  (Geach 
v.  Ingall),  in  which  it  was  alleged  that  the  existence  of  phthisis  (pul- 
monary consumption),  or  phthisical  symptoms,  had  been  concealed 
from  the  office.  On  the  side  of  the  plaintiff  the  medical  attendant  of 
the  insured  was  called,  and  he  certified  that  in  May,  1840,  when  the 
policy  was  issued,  he  considered  the  deceased  to  be  in  good  health, 
and  an  insurable  life.  A  physican  who  examined  the  deceased  in 
February  of  that  year  stated  his  belief  that  the  chest  of  the  deceased 
was  sound,  and  he  considered  him  to  be  a  very  good  life.  For  the 
defence  two  medical  men  were  called,  who  deposed  that  deceased  had 
had  spitting  of  blood  before  effecting  the  insurance,  and  that  he  had 
labored  under  decided  symptoms  of  consumption  in  1840,  which  it 
was  inferred  must  have  existed  at  the  time  of  the  insurance.  There 
was  evidence  of  a  general  consumptive  tendency  in  the  family  ;  the 
father  died  of  it,  and  there  was  no  doubt  whatever  that  the  insured 
had  died  of  it  in  December,  1843,  three  and-a-half  years  after  the 
policy  was  issued.  The  medical  evidence  was  conflicting,  but  the 
existence  of  the  disease  at  the  time  of  the  insurance  rested  upon  pre- 
sumption and  not  upon  proof;  hence  the  jury  returned  a  verdict  for 
the  plaintiff.  A  second  and  a  third  trial  were  had  upon  this  case,  on 
the  ground  of  misdirection  by  the  learned  judges ;  but  verdicts  were 
again  returned  on  both  these  occasions  in  the  plaintiff's  favor.  It 
is  most  probable  that  the  seeds  of  consumption  existed  in  the  in- 
sured; but,  unless  there  is  some  plain  and  certain  evidence  from 
symptoms,  proof  of  this  will  amount  to  nothing.  If  inferential  proof 
of  this  kind  were  sufficient  to  avoid  a  policy,  the  payment  of  most 
policies  might  be  easily  and  successfully  disputed.  Had  the  deceased 
died  soon  after  the  insurance,  there  might  have  been  greater  proba- 
bility in  favor  of  the  view  adopted  by  the  office  ;  but  he  lived  nearly 
four  years  afterwards ;  hence,  if  the  symptoms  had  existed  in  a  con- 
firmed state  at  the  time  of  the  insurance,  of  which  there  was  no 
direct  evidence,  as  the  medical  officer  of  the  company  had  certified  in 
favor  of  the  life,  the  case  must  have  been  of  an  unusually  protracted 
kind. 

In  a  case  in  which  strangulated  hernia  was  the  cause  of  death,  the 


CONCEALMENT    OF    DISEASE.  739 

deceased  had  insured  his  life  upon  his  own  declaration  and  a  medi- 
cal certificate.  In  about  thirteen  months  afterwards  he  died  from 
the  effects  of  an  operation  for  strangulated  hernia.  The  medical 
witness  who  signed  the  certificate  stated  at  the  trial  that  the  deceased 
had  never  had  hernia,  and  that  he  had  not  attended  him  for  that  dis- 
ease. A  letter  was  produced,  however,  in  which  he  (the  witness)  had 
admitted  the  existence  of  hernia  in  the  deceased  four  months  before 
his  death.  He  denied  the  truth  of  this  statement,  and  said  the  tumor 
which  he  had  reduced  by  manipulation  was  varicocele.  The  ques- 
tion was,  whether  hernia  had  or  had  not  existed,  and  had  been  con- 
cealed from  the  insurers  at  the  time  when  the  insurance  was  effected. 
The  admission  in  the  letter  carried  the  period  of  the  alleged  exist- 
ence of  hernia  to  five  months  after  the  certificate  was  granted,  whilst 
the  deceased  had  positively  stated  in  his  declaration,  that  he  was  not 
and  had  never  been  affected  with  rupture,  and  the  medical  certificate 
was  to  the  same  effect.  One  medical  witness  deposed  that  he  had  been 
consulted  by  the  deceased,  and  had  found  him  laboring  under  irredu- 
cible hernia  five  months  before  he  proposed  to  insure  his  life !  This 
gentleman  stated  that  he  then  informed  the  deceased  he  had  inguinal 
hernia ;  he  tried  to  reduce  it,  but  could  not  succeed.  These  facts,  it 
was  alleged,  were  not  stated  to  the  insurers  at  the  time  of  the  insur- 
ance, as  they  certainly  ought  to  have  been.  On  the  other  side,  two 
medical  witnessess,  including  the  operator,  thought  that  the  hernia 
was  quite  recent.  The  operator  found  no  adhesions,  and  there  was  no- 
thing to  induce  him  to  suppose  that  the  hernia  was  of  fourteen  months' 
standing.  Evidence  was  also  given  to  show  that  the  witness  who 
deposed  to  the  existence  of  inguinal  hernia  before  the  insurance 
might  have  been  mistaken  in  his  diagnosis,  and  have  confounded  a 
hydrocele  or  a  varicocele  with  a  hernia ;  but  admitting  this  to  be 
true,  the  existence  of  a  tumor  of  any  kind  in  such  a  situation  should 
not  have  been  kept  concealed  from  the  company  or  their  medical 
referee.  The  jury  returned  a  verdict  that  there  was  no  fraud,  but 
that  the  deceased  had  had  hernia  at  the  time  of  effecting  the  insur- 
ance. A  second  trial  was  granted,  and  a  verdict  was  then  returned 
in  favor  of  the  plaintiffs. 

If,  under  any  circumstances,  a  jury  should  find  that  the  conceal- 
ment is  material,  the  legal  consequence  is  that  the  policy  is  void. 
It  is  not  at  all  necessary  that  the  person  should  die  of  the  disease 
concealed.  This  rule  was  laid  down  by  the  late  Lord  Tenterden  in 
the  case  of  a  Colonel  Lyon.  The  Colonel  insured  his  life  by  two  poli- 
cies in  May  and  June,  1823,  and  died  of  a  bilious  remittent  fever  in 
( >ctober  of  that  year.  Payment  was  refused  on  the  ground  of  mis- 
representation and  concealment.  Colonel  Lyon  referred  the  office 
for  a  certificate  of  his  health  to  a  gentleman  who  had  not  attended 
him  for  three  years  previously.  His  answers  to  the  printed  ques- 
tions were  that  he  had  had  no  other  medical  attendant,  and  that  he 
had  never  had  "  a  serious  illness."  The  medical  gentleman  to  whom 
he  referred  certified  that  his  life  was  insurable,  and  the  policy  was 
issued.  It  appeared  in  evidence,  however,  that  the  deceased  had 
been  attended  by  two  other  medical  practitioners  from  February  to 


740  CONCEALMENT    OF    DISEASE. 

April,  1823,  for  hepatitis,  fever,  and  a  determination  of  blood  to  the 
head.  One  of  these  employed  very  active  treatment :  he  considered 
him  to  be  in  a  dangerous  state,  and  would  not  have  certified  him  to 
be  in  health  until  the  end  of  May,  1823.  All  agreed  that  the  deceased 
did  not  die  of  the  disease  for  which  he  had  been  thus  attended.  Lord 
Tenterden  stated  it  to  be  his  opinion,  that  if  a  man  referred  to  one 
practitioner,  because  he  could  speak  well  of  his  health,  and  thought 
that  if  he  referred  to  other  medical  men  because  they  would  not  so 
certify,  although  the  insured  did  not  die  of  the  disease  with  which  he 
was  then  afflicted,  the  policy  would  be  void.  A  verdict  was  accord- 
ingly given  for  the  defendants.  The  practice  of  referring  to  medi- 
cal men  who  have  been  only  recently  consulted  is  not  unfrequent. 
The  opinion  of  the  usual  medical  attendant  might  be  unfavorable, 
or  he  might  report  on  the  existence  of  habits  which  would  render 
the  life  uninsurable,  or  insurable  only  at  a  high  premium.  This 
want  of  fair-dealing,  however,  commonly  defeats  its  object.  There 
is  expensive  litigation,  and  the  policy  is  pronounced  to  be  void. 
The  case  of  Wilshere  v.  Brown,  tried  before  Lord  Abinger  in  the 
Exchequer  in  December,  1842,  and  of  Palmer  and  Fish  v.  Irving, 
tried  at  the  Norwich  Summer  Asssizes,  furnish  illustrations  of  this. 
In  the  latter  case  the  deceased  had  returned  that  he  had  never  had 
a  medical  attendant.  His  life  was  insured  for  a  large  sum  on  the 
21st  November,  1842,  and  he  died  on  the  5th  December  following. 
There  was  reason  to  believe  that  he  had  died  from  inflammation  of 
the  lungs ;  but  it  was  proved  that  he  had  labored  under  symptoms 
of  pulmonary  consumption,  and  had  been  attended  by  three  medical 
men  shortly  before  he  effected  the  insurance.  This  was  concealed, 
and  the  policy  was  set  aside  on  the  ground  of  fraud. 

A  singular  case  was  tried  at  Glasgow  in  1837,  in  which  the  pro- 
ceedings were  inverted,  compared  with  the  usual  English  practice  in 
such  cases.  An  Insurance  Company  brought  an  action  against  the 
representatives  of  the  insured,  on  the  issue  whether  the  policy  had 
not  been  obtained  by  misrepresentation  and  undue  concealment.  An 
insurance  was  effected  on  the  life  of  a  Mrs.  Ralston,  on  the  10th  De- 
cember, 1833.  Her  own  declaration  was  that  she  was  in  good  health 
and  that  she  was  not  afflicted  with  any  disease  or  disorder  tending  to 
shorten  life.  She  referred  to  her  usual  medical  attendant,  who  cer- 
tified that  he  had  known  her  for  ten  years,  and  had  been  in  the  habit 
of  attending  her  professionally  ;  that  she  was  last  ill  in  the  month 
of  September,  1833  ;  "that  her  indisposition  was  acidity  of  the 
stomach;"  that  she  had  not,  to  his  knowledge,  been  affected  with  any 
illness  of  such  a  nature  as  to  influence  her  general  health;  that  she 
was  then  (30th  November,  1833)  in  perfect  health,  and  was  not  sub- 
ject to  fits  or  any  affection  of  the  head,  but  occasionally  to  slight 
headache  from  acidity  in  the  stomach.  He  knew  of  no  circumstance 
in  her  business  or  habits  of  living  tending  to  impair  her  health  or 
shorten  her  life.  The  deceased  died  of  apoplexy  on  the  3d  Septem- 
ber, 1834,  within  nine  months  from  the  issuing  of  the  policy.  The 
Insurance  Company  were  about  to  pay  the  amount,  when  an  action 
was  brought  by  the  medical  attendant  against  the  executors  of  the 


INTEMPERATE    HABITS.  741 

deceased  for  payment  of  162?.  for  medical  attendance,  &c,  on  Mrs. 
Ralston,  from  the  15th  September,  1833  (two  months  prior  to  the 
date  of  the  policy)  to  the  4th  June,  1834.  The  referees  awarded 
145/.  to  the  plaintiff.  His  books  were  given  in  evidence,  and  it  then 
appeared  that  between  the  19th  September  and  3d  December,  1833, 
(the  date  of  the  proposal  for  insurance)  he  had  paid  her  thirty-five 
professional  visits,  most  of  these  of  long  duration.  It  further  ap- 
peared from  the  diary  that  she  had  been  frequently  bled ;  her  head 
had  been  shaved  and  blistered,  and  leeches  had  been  applied  to  her 
temples.  She  had  also  had  constant  attendance  after  the  insurance, 
and  in  the  early  part  of  1834  had  had  several  fits  of  epilepsy.  Three 
medical  witnesses  deposed  that  the  declaration  of  deceased  and  the 
certificates  given  by  her  medical  attendant  did  not  set  forth  her  true 
condition ;  and  that  there  had  been  misrepresentation  and  conceal- 
ment of  material  facts.  This  was  also  the  opinion  of  the  judge,  and 
a  verdict  was  returned  for  the  office.  Although  the  illness,  prior  to 
the  insurance,  might  have  had  no  connection  with  the  death  from 
apoplexy,  it  was  held  that  the  insurers  ought  to  have  been  made 
acquainted  with  it. 

Among  the  diseases  upon  the  concealment  of  which  policies  have 
been  most  frequently  disputed,  may  be  enumerated  gout,  dropsy, 
paralysis,  epilepsy,  haemoptysis,  incipient  phthisis,  delirium  tremens  ; 
and  to  this  list  may  be  added  drunkenness,  intemperance,  and  irregu- 
lar habits. 

Intemperate  Habits. — In  a  large  number  of  cases  the  payment  of 
policies  is  resisted  on  the  ground  of  concealed  drunkenness  and  gene- 
ral habits  of  intemperance.  There  is  some  difficulty  in  these  cases, 
because  medical  men  may  entertain  different  opinions  respecting  the 
effect  of  such  habits  upon  the  general  health,  and  the  degree  to  which 
they  may  be  safely  carried.  There  is  one  thing  however  certain — 
whatever  may  be  our  opinion  of  their  effect  on  health,  we  are  bound 
to  state,  if  known  to  us,  that  they  exist,  and  thus  put  it  out  of  the 
power  of  a  company  to  dispute  a  policy  upon  such  a  ground.  From 
the  frequent  concealment  of  habits  of  this  kind,  some  offices  now 
adopt  the  practice  of  making  it  a  special  question,  to  which  a  plain 
negative  or  affirmative  answer  should  always  be  given:  "  Are  you 
now  and  have  you  always  been  of  temperate  habits  of  life  ?" 

When  intemperance  is  alleged,  we  find  not  only  conflicting  medi- 
cal evidence  but  much  cross-swearing  among  the  witnesses.  It  be- 
comes a  question :  What  is  intemperance  ?  and  this  is  answered 
according  to  the  peculiar  views  of  a  witness.  A  case  was  tried  at 
the  Exeter  Spring  Assizes  in  1842  (tSouthcomb  v.  Merrimaii),  which 
will  show  the  difficulty  of  getting  at  the  truth.  Payment  of  a  policy 
was  disputed  by  the  office  on  the  ground  of  concealed  intemperate 
habits.  At  the  trial  the  representatives  of  the  insured  called  twelve 
witnesses  to  prove  that  the  deceased  was  a  very  temperate  man,  while 
the  office  called  twenty-one  to  show  that  he  was  habitually  intem- 
perate !  One  of  the  temperance  witnesses  (for  the  plaintiff)  defined 
drunkenness  to  be  "when  a  man  lost  his  reason,  could  not  give  a 


712       CONCEALED  HABITS  OF  INTEMPERANCE . 

proper  answer,  was  not  able  to  do  business,  bad  lost  bis  legs,  and  was 
obliged  to  be  carried  bome."  He  admitted  that  tbe  deceased  bad 
occasionally  continued  drinking  for  three  or  four  days  together,  but 
that  was  a  very  rare  occurrence.  Tbe  medical  attendant  who  gave 
the  certificate  said  that  the  deceased's  was  a  perfectly  good  life,  and 
be  considered  him  to  be  a  person  of  sober  and  temperate  habits  :  be 
had  not  thought  it  requisite  to  inform  tbe  office  of  occasional  out- 
breaks, because  be  did  not  think  that  drinking  had  any  effect  upon 
his  health.  Several  witnesses  proved  that  deceased  was  in  the  habit 
of  drinking  enormous  quantities  of  beer,  and  that  it  required  a  great 
deal  to  make  him  ramble.  Tbe  insurance  was  effected  in  October, 
1839,  and  tbe  deceased  died  in  April,  1841,  from  inflammation  of 
the  lungs  ;  but,  in  tbe  opinion  of  the  medical  witnesses,  this  had  not 
arisen  from  excessive  drinking.  Notwithstanding  the  concealment 
of  these  facts,  the  jury  returned  a  verdict  for  the  full  amount 
claimed ;  but  a  rule  for  a  new  trial  was  afterwards  obtained.  This 
case  shows  what  fallacious  views  are  entertained  on  the  medical 
questions  of  life-insurance.  In  a  case  like  this  it  was  clearly  the 
duty  of  a  medical  man  to  describe  tbe  habits  of  the  deceased.  He 
might,  if  he  pleased,  have  appended  to  the  certificate  that  in  his 
judgment  they  had  not  affected  tbe  health  of  the  person,  but  the  de- 
fendants who  were  to  take  the  risk  should  have  been  placed  in  a 
position  to  form  a  judgment  for  themselves. 

In  the  case  of  the  Hon.  H.  G.  Talbot  (Craig  v.  Fenn,  December, 
1811),  where  no  answer  was  returned  to  the  question  whether  the 
deceased  was  of  temperate  and  moderate  habits  of  life,  and  the  com- 
pany actually  charged  a  higher  premium  in  consequence,  the  jury 
returned  a  verdict  in  their  favor,  the  real  condition  of  the  insured 
not  having  been  made  known  to  them  at  the  time  the  insurance  was 
effected 

[Where  the  representation  was  made  that  the  insured  was  of  sober 
and  temperate  habits  and  in  good  health;  if  tbe  representation  was 
true  at  the  time  it  was  made,  the  subsequent  habits  of  the  insured 
would  be  no  bar  to  a  recovery  upon  tbe  policy;  (Rekhardv.  Man- 
hattan Life  Insurance  Company,  31  Missouri  R.  515.)  And  if  the  party 
insuring  is  not  called  upon  by  any  general  or  special  question,  he 
need  make  no  statement  as  to  any  particular  habit,  as  intemperance, 
though  such  habit  may  be  prejudicial  to  his  health.  Bawls  v.  Life 
Ins.  Co.,  36  Barb.  (N.  Y.)  357.  Where  the  insurance  is  by  a  creditor 
upon  tbe  life  of  his  debtor,  declarations  of  the  latter  as  to  his  habits, 
or  as  to  the  fact  of  suppression  of  information  are  mere  hearsay  and 
inadmissible  as  evidence.     lb. — P.] 

Delirium  Tremens.  Concealed  Habits  of  Intemperance. — In  Hutton 
v.  Waterloo  Life  Association  (Q.  B.  December,  1859),  an  action  was 
brought  by  a  widow  for  tbe  recovery  of  2,500/.  upon  a  policy  effected 
in  April,  1851,  on  the  life  of  her  husband.  Payment  was  refused  on 
the  ground  that  tbe  written  answers  made  by  deceased  to  questions 
proposed  by  the  company  were  false,  and  therefore  that  the  contract 
which  was  based  uj)on  them  was  void.     One  question  was  whether 


CONCEALED  HABITS  OF  INTEMPERANCE.       743 

he  was  subject  to  delirium  tremens  or  any  disease  calculated  to  shorten 
life,  which  he  answered  in  the  negative ;  a  second  was,  whether  he 
was  of  temperate  and  sober  habits,  which  he  answered  in  the  affir- 
mative ;  and  a  third  was  as  to  the  name  and  residence  of  his  "  ordi- 
nary medical  attendant,  to  be  referred  to  as  to  present  and  general 
state  of  health,"  to  which  he  answered,  "  Dr.  Cobb."  The  inquiry 
now  was  whether  these  answers  were  true.  The  action  had  already 
been  once  tried,  when  the  plaintiff  obtained  a  verdict ;  but  the  court 
granted  a  new  trial  upon  the  ground  that  there  was  no  finding  by 
the  jury. 

The  evidence  in  the  case,  medical  and  general,  showed  that  the 
deceased  was  of  intemperate  habits,  and  that  in  May,  1854,  he  had 
suffered  from  delirium  tremens,  of  which  disease  he  died  in  1856 ; 
further,  that  Dr.  Cobb,  to  whom  he  referred  as  his  usual  medical 
attendant,  had  not  attended  him  since  1851,  and  that  from  this  date 
until  the  date  of  the  insurance  he  had  been  attended  by  another 
medical  man,  to  whom  he  had  given  no  reference,  although  he  was 
his  usual  medical  attendant.  The  jury  found  for  the  defendants  on 
the  main  issues.  This  case  presented  two  curious  features :  1st, 
the  medical  evidence  proved  that  the  first  attack  of  delirium  tremens 
came  on  on  May  11,  after  the  insurance  had  been  effected ;  and  2dly, 
the  medical  attendant  of  the  deceased  and  the  medical  officer  of  the 
company  differed  greatly  about  the  deceased's  state  of  health  at  or 
about  the  time  the  insurance  was  effected.  The  medical  attendant 
of  the  deceased,  who  was  a  witness  for  the  company,  deposed  that 
he  attended  him  for  an  attack  of  delirium  tremens  on  May  11,  and 
again  on  May  28,  1854 — both  attacks  being  the  results  of  excessive 
drinking.  The  report  to  the  company,  made  by  their  own  medical 
officer,  dated  May  22,  1854,  gave,  however,  a  most  flattering  account 
of  deceased's  health,  and  described  him  as  a  "first-class  life."  In 
his  evidence  at  the  trial  this  gentleman  said  that  he  then  observed 
no  indication  of  delirium  tremens  nor  of  drunken  habits ;  the  de- 
ceased was  the  picture  of  health.  This  serious  discrepancy  could 
not  be  reconciled  by  a  re-examination  of  the  witnesses.  The  con- 
cealment of  intemperate  habits  was  clearly  proved,  and  on  this  pro- 
bably the  verdict  of  the  jury  chiefly  turned. 

Questions  of  a  similar  kind  were  raised  in  Wheelton  v.  Ilurdisty 
(Q.  B.  Dec.  1856).  An  insurance  had  been  effected  to  a  large  amount 
on  the  life  of  a  Mr.  Jodrell,  and  the  payment  of  the  policy  was  dis- 
puted on  the  ground  that  there  had  been  concealment  of  intemper- 
ate habits,  and  of  the  existence  of  delirium  tremens  at  the  time  the 
insurance  was  effected.  The  jury  found  that  there  had  been  mis- 
representation and  concealment. 

One  of  the  most  singular  cases  of  this  description,  in  reference  to 
conflicting  medical  evidence,  was  that  of  Raivlings  v.  Desborough, 
tried  by  Lord  Denman  in  December,  1837.  The  main  question  was, 
whether  a  Mr.  John  Cochrane,  whose  life  had  been  insured,  was  or 
was  not  a  person  of  intemperate  habits  at  or  before  the  time  of  in- 
surance. A  medical  certificate  had  been  given  to  the  effect  that 
his  habits  were  not  intemperate.     The  weight  of  the  evidence,  how- 


744  LIFE    INSURANCE. 

ever,  general  and  medical,  tended  to  snow  that  he  was  a  thorough 
drunkard.  One  of  the  Witnesses  for  the  plaintiff*  said,  the  deceased 
"never  appeared  to  me  to  take  anything  to  hurt  a  man;  I  never 
saw  him  drink  more  than  the  rest  of  the  company ;  I  only  saw  him 
intoxicated  fifty  or  sixty  times  in  four  years !  His  health  did  not 
seem  to  be  impaired  by  what  he  drank."  His  groom  stated  that  he 
had  seen  his  master  "  tipsy  a  hundred  times,  perhaps,  but  not  beastly 
drunk."  The  late  Mr.  Travers  examined  the  deceased  for  one  office, 
and,  from  what  he  saw,  advised  that  his  life  should  not  be  accepted. 
He  considered  the  man  to  be  laboring  under  delirium  tremens.  One 
observation  made  by  this  witness  is  worthy  of  remembrance  when  a 
medical  practitioner  is  engaged  in  examining  a  person  for  a  life-in- 
surance— i.  e.,  a  man  may  have  pursued  an  intemperate  course  for 
some  time,  and  yet  his  appearance  at  the  time  may  be  such  as  to 
lead  a  common  observer  to  imagine  he  was  in  the  plenitude  of  health 
when  he  is  liable  to  become  the  subject  of  an  immediate  attack. 
Notwithstanding  the  strong  evidence  of  habits  of  intemperance  from 
a  period  anterior  to  the  date  of  the  insurance,  the  jury  returned  a 
verdict  for  the  plaintiffs,  but  a  motion  for  a  new  trial  was  soon  af- 
terwards made.  Lord  Denman  observed  upon  this  occasion,  in  re- 
spect to  what  was  material  concealment,  that  he  did  not  conceive  the 
true  meaning  to  be,  that  the  party  whose  life  was  to  be  insured  was 
bound  to  volunteer  a  statement  of  every  circumstance  that  anybody 
might  afterwards  think  was  likely  to  affect  the  risk  of  his  life.  The 
reaJ  intention  was,  that  he  should  submit  himself  to  a  full  examina- 
tion and  inquiry,  that  he  is  bound  to  state  nothing  untruly,  and  that 
he  is  bound  to  answer  all  questions  truly.  If  he  decline  to  answer, 
the  office  may  act  upon  his  refusal,  and  if  he  answer  untruly,  he 
shall  gain  no  benefit  from  such  false  statement. 

In  February,  1840,  a  trial  took  place  before  Tindal,  C.  J.  (Pole  v. 
Rogers)  relative  to  a  policy  on  the  life  of  Mr.  Peter  Cochrane,  brother 
of  this  Mr.  John  Cochrane.  The  insurance  was  effected  in  1834. 
The  insured  died  the  following  year  of  hydrothorax,  brought  on,  as 
it  was  alleged  by  defendants,  by  very  intemperate  habits,  the  exist- 
ence of  which  was  concealed  from  them.  The  evidence,  both  medi- 
cal and  general,  was  just  as  conflicting  as  in  the  former  case,  and  it 
became  rather  a  question  of  credibility.  The  jury  returned  a  verdict 
for  the  plaintiffs,  thereby  either  denying  the  existence  of  intemper- 
ance, or  considering  that  the  concealment  of  it,  if  it  existed,  was  not 
material. 

This  case  is  worthy  of  note  in  one  point  of  view,  as  it  involved  a 
new  question  in  medical  jurisprudence — namely,  whether,  we  are  to 
regard  the  immediate  or  remote  effects  on  the  body  produced  by  in- 
temperate habits?  The  Solicitor-General,  who  appeared  for  the 
plaintiffs  (the  representatives  of  the  insured),  argued  that  the  terms 
"  habits  prejudicial  to  health"  were  too  indefinite.  Was  it  to  be 
regarded  as  an  abstract  or  relative  proposition  ?  He  appeared  to  rest 
his  case  upon  an  admission  that  there  was  intemperance  to  a  certain 
degree,  but  he  contended  that  habits  which  were  not  at  all  prejudi- 
cial to  the  health  of  one  man  might  absolutely  kill  another.     There 


CONCEALED    HABITS    OF    INTEMPERANCE.  745 

was  a  very  common  habit  of  keeping  late  hours ;  this  might  be  ut- 
terly destructive  to  the  health  of  some  persons,  but  not  to  that  of 
others.  This  sort  of  condition  was  so  vague  that  it  left  it  open  to 
an  insurance  office  to  resist  the  payment  of  any  policy,  unless  the 
meaning  of  the  words  was  brought  within  some  reasonable  and  well- 
defined  limits.  The  jury  were  bound  to  see  whether  the  alleged  in- 
temperate habits  had  been  indulged  in  for  a  long  time  without  in- 
jury ;  they  must  look  to  all  the  habits  of  the  person  taken  together, 
and  see  whether  one  habit  was  not  counteracted  in  its  effects  by  an- 
other. The  insured  was  a  man  of  very  active  habits,  and  therefore 
excessive  drinking  would  not  affect  him  as  it  would  others  who  led 
a  sedentary  life. 

This  ingenious  but  sophistical  reasoning  involves  an  important 
medical  question.  It  is  well  known  that  intemperance  is  a  relative 
term,  and  may  be  differently  construed  by  different  medical  wit- 
nesses. The  real  question,  however,  divested  of  its  sophistry,  is 
this :  Can  any  person  indulge  in  an  excessive  use  of  alcoholic 
liquids  without  this  practice  sooner  or  later  leading  to  an  impair- 
ment of  health,  by  producing  disorder  of  the  stomach  and  liver,  and 
remotely  affecting  different  organs  ?  The  effects  of  such  habits  may 
not  show  themselves  immediately,  but  the  office  requires  to  be  in- 
formed of  their  existence  or  non-existence,  and  not  of  the  period 
when  they  are  likely  to  affect  health  visibly  or  to  engender  a  fatal 
disease.  To  assert  that  a  man  can  be  addicted  to  excessive  drink- 
ing without  impairing  his  health  is  contrary  to  all  experience. 
There  is  no  such  compensation  or  balance  of  habits  as  that  which 
the  Solicitor-General  supposed  to  exist  in  this  case.  Habit  may  ac- 
custom a  man  to  intemperance — it  may  enable  him  to  drink  a  large 
quantity  of  alcoholic  liquid  without  being  apparently  injuriously 
influenced  by  it  at  the  time  ;  but  a  deranged  state  of  system  will 
sooner  or  later  follow,  and  delirium  tremens  or  dropsy  will  proba- 
bly supervene.  A  good  natural  constitution  may  enable  a  man  to 
resist  the  pernicious  effects  for  a  certain  period,  but  ultimately  they 
will  show  themselves  in  some  form  of  disease ;  and  in  the  case  of 
these  two  brothers,  the  result  of  their  intemperance  was  made  ap- 
parent in  the  very  early  deaths  of  both.  It  is  unfortunate  that  no 
light  is  permitted  to  be  thrown  on  such  cases  by  pathology.  Post- 
mortem examinations  are  not  always  made  in  these  cases ;  for  the 
death  being,  as  it  is  called,  natural,  it  is  not  commonly  thought  ne- 
cessary to  inspect  the  body,  although  as  in  the  above  instances,  the 
condition  of  the  liver  and  other  organs  might  at  once  have  removed 
a  difficulty  which  arose  from  the  conflicting  evidence  on  the  habits 
of  the  deceased. 

In  all  cases  of  a  contested  policy,  one  important  principle  is  uni- 
formly acted  upon ;  those  who  resist  the  payment  are  bound  to  prove 
what  they  allege  by  conclusive  and  satisfactory  evidence.  A  court 
will  not  receive  probability  or  conjecture — the  evidence  must  be 
certain.  Hence  many  suits  fail  from  the  medical  evidence  going  no 
further  than  to  show  that  a  particular  disease  or  habit  had  probably 
existed  at  the  time  of  insurance.     If  the  disease  or  habits  be  shown 


746  EFFECTS    OF    ABSTINENCE. 

to  have  certainly  existed,  the  evidence  may  still  fail  to  prove  satis- 
factorily that  the  concealment  was  either  wilful  or  material. 

Contested  cases  of  life-insurance  are  very  instructive:  they  often 
show  the  imperfect  manner  in  which  medical  observations  respecting 
health  or  disease  are  made,  and  that  the  medical  treatment  of  persons 
whose  lives  are  insured  may  become  a  material  question  in  the  event 
of  a  policy  being  disputed.  In  the  case  of  Chattock  v.  Shaive,  in 
reference  to  an  insurance  on  the  life  of  a  Colonel  Greswold,  a  ques- 
tion arose  not  only  respecting  the  concealment  of  intemperate  habits, 
but  as  to  the  concealed  existence  of  delirium  tremens,  from  the  exa- 
mination of  handwriting,  as  well  as  from  the  description  given  by 
nou -professional  witnesses.  It  was  here  even  doubtful  what  had 
caused  the  death  of  the  deceased.  According  to  one  medical  wit- 
ness, it  was  a  curious  combination  of  Asiatic  cholera,  phrenitis,  and 
epilepsy !  It  was  proved  that,  more  than  three  years  before  the 
insurance  was  effected,  this  gentleman  had  met  with  a  fall,  and  he 
was  afterwards  seized  with  a  fit,  described  by  some  witnesses  as 
epileptic,  by  others  as  arising  from  concussion  of  the  brain.  The 
existence  of  intemperance  and  epilepsy  prior  to  the  insurance  was 
not  made  out  to  the  satisfaction  of  the  jury,  and  they  returned  a 
verdict  for  the  representatives  of  the  insured. 

In  Walters  v.  Barker,  tried  at  the  Monmouth  Summer  Assizes, 
1844,  the  deceased,  at  the  age  of  sixty,  insured  his  life  on  the  4th 
May,  1841,  and  he  died  in  the  August  following.  It  was  alleged  by 
the  office  that  the  cause  of  death  was  an  attack  of  paralysis,  which  it 
was  pretended  had  existed  from  a  very  early  period  of  his  life.  No 
medical  evidence  was  given  on  either  side;  there  was  merely  a 
presumption  that  death  might  have  taken  place  from  paralysis; 
hence  the  verdict  was  for  the  plaintiffs. 

Abstinence.  The  Vegetarian  System.. — ~We  have  already  considered 
the  effects  of  habits  of  intemperance,  and  the  necessity  for  stating  in 
a  certificate  the  existence  of  them  when  known;  but  other  habits 
may  exist  which  have  a  tendency  to  shorten  life,  although  in  a  less 
obvious  manner.  What  are  called  temperance  principles  are  or  were 
very  prevalent.  There  are  many  persons  who  have  been  full  livers, 
and  have  afterwards  taken  up  the  notion  that  water  and  a  vegetable 
diet  were  all  that  was  necessary  to  support  life.  This  sudden  change, 
especially  in  persons  advanced  in  life,  is  very  likely  to  affect  the 
constitution  seriously,  and,  if  not  to  create  disease,  so  to  weaken  the 
vital  powers  as  to  render  any  slight  illness  or  accident  serious.  I 
knew  one  instance  in  which  a  gentleman  who  had  been  in  the  habit 
of  living  on  a  full  diet,  with  a  moderate  use  of  alcoholic  liquids, 
suddenly  adopted  the  plan  of  living  on  water  and  vegetable  food; 
he  obviously  fell  off  in  strength,  and  lost  his  previously  healthy 
condition.  About  a  year  afterwards  he  met  with  a  slight  sprain  to 
the  ankle-joint;  inflammation  ensued,  which,  in  spite  of  the  best 
treatment,  assumed  an  unhealthy  character;  suppuration  of  the  joint 
followed;  amputation  of  the  leg  was  performed,  but,  in  spite  of  an 
improved  diet,  the  powers  of  life  never  rallied.     There  was  no  at- 


OPIUM-EATING.  747 

tempt  at  union  in  the  flap,  and  he  finally  died  exhausted.  There 
can  be  no  doubt  that  these  sudden  changes  in  the  mode  of  living  are 
liable  to  lead  to  impairment  of  health,  and  to  affect  materially  the 
expectation  of  life.  Hence  it  is  our  duty  to  inquire  and  report  upon 
facts  of  this  kind  when  they  become  known  to  us. 

In  Huntley  v.  The  St.  George  Insurance  Company  (Newcastle  Au- 
tumn Assizes,  1858),  a  medical  man  insured  his  life  for  2,000Z. ;  and 
although  certified  to  be  in  good  health,  and  to  all  appearance  he  was 
so,  he  died  from  Bright's  disease  within  three  months  after  he  had 
effected  the  insurance.  There  was  also  disease  of  the  heart.  The 
questions  whether  he  had  either  of  these  diseases  at  the  time  of  the 
insurance  were  answered  by  him  in  the  negative.  It  was  contended 
that,  as  a  medical  man,  he  must  have  known  that  he  was  suffering 
from  these  diseases,  and  had  wilfully  concealed  them.  It  appeared 
from  the  evidence  that  the  deceased  had  taken  to  a  vegetable  diet, 
and  it  was  considered  that  this  was  the  cause  of  the  rapid  failing  of 
his  health.  The  jury  returned  a  verdict  for  the  plaintiffs,  and  the 
Chief  Baron  suggested  that  in  future  Insurance  Companies  should 
put  among  their  questions  to  insurers,  "Are  you  a  vegetarian?" 

Opium-Eating. — There  is  another  habit  said  to  be  common,  the 
concealment  of  which  gave  rise  to  an  important  trial  some  years 
since:  I  allude  to  the  practice  of  opium-eating.  In  1826  the  Earl  of 
Mar  effected  an  insurance  on  his  life,  and  two  years  afterwards,  i.  e., 
in  1828,  he  died  of  jaundice  and  dropsy  at  the  age  of  fifty-seven. 
The  Insurance  Company  declined  paying  the  amount  of  the  policy, 
on  the  ground  that  the  Earl  was,  at  the  time  of  the  insurance,  and 
had  been  for  some  time  previously,  an  opium-eater.  This  practice 
was  concealed  from  the  insurers ;  and  it  was  further  alleged  that  it 
had  a  tendency  to  shorten  life.  It  was  clearly  proved  in  evidence 
that  the  Earl  had  been  a  confirmed  opium -opium  eater  up  to  the 
time  of  his  death.  According  to  Dr.  Christison,  the  deceased  had 
taken  laudanum  for  thirty  years,  at  times  to  the  amount  of  two  or 
three  ounces  daily — a  tablespoonful  for  a  dose.  He  was  a  martyr  to 
rheumatism,  and,  besides,  lived  rather  freely.  Many  persons  who 
were  constantly  about  him,  and  many  intimate  friends,  deposed  that 
until  1826  (the  year  of  the  insurance)  he  was  of  a  cheerful  disposi- 
tion, and  clear  in  his  intellects.  Some  of  them  admitted  that  they 
then  perceived  a  change  in  his  habits,  which  they  attributed  to  the 
adverse  circumstances  in  which  he  was  compelled  to  live.  In  1825, 
Dr.  Abercrombie  found  him  enfeebled  and  broken-down  in  constitu- 
tion, but  without  any  definite  complaint.  The  main  question  at  the 
trial  was,  whether  opium-eating  had  a  tendency  to  shorten  life — for 
on  this  the  issue  turned — whether  the  concealment  from  or  the  non- 
communication of  this  practice  to  the  office  was  or  was  not  material. 

Drs.  Christison,  Alison,  Abercrombie,  and  Duncan  were  examined 
on  the  part  of  the  insurers;  and  although  they  entertained  the 
opinion  that  the  habit  had  a  tendency  to  shorten  life,  they  were 
unable  to  adduce  any  cases  in  support  of  it.  Their  opinion  was 
based  not  on  personal  experience,  but  on  the  general  effects  of  opium 


748  EFFECTS    OF    OPIUM- EATING    ON    HEALTH. 

as  manifested  by  its  action  on  the  brain — by  its  producing  disorder 
of  the  digestive  organs,  and  giving  to  the  person  a  worn  and  emaci- 
ated appearance.  In  most  of  the  instances  collected,  there  was  no 
evidence  that  life  had  been  shortened  by  the  practice.  On  the  con- 
trary, some  of  the  individuals  had  carried  it  on  for  years,  and  had 
attained  a  good  old  age.  The  jury  returned  a  verdict  for  the  plain- 
tiffs, not  on  the  ground  that  the  practice  was  innoxious  and  its  con- 
cealment immaterial,  so  much  as  on  the  technical  point  that  the 
insurers  had  not  made  the  usual  and  careful  inquiries  into  the  habits 
of  the  deceased ;  and  they  were  therefore  considered  as  having  taken 
upon  themselves  the  risk  from  their  own  laches.  It  appears  that  the 
general  question  with  respect  to  habits  was  not  answered  by  the 
medical  referee,  and  it  was  therefore  considered  that  the  office  had 
waived  the  knowledge  of  them.  A  new  trial  was  granted,  on  the 
ground  of  misdirection,  but  the  suit  was  compromised. 

Hence  it  will  be  seen  that  no  decision  was  come  to  in  this  case  on 
an  important  question,  which  is  very  likely  to  arise  again.  It  will 
be  desirable  therefore  to  examine  some  of  the  facts  connected  with 
opium-eating,  in  order  if  possible  to  see  how  far  it  really  tends  to 
shorten  life.  In  the  case  of  the  Earl  of  Mar,  it  appeared  to  be  a 
fair  inference  that  the  habit  did  not  shorten  his  life,  for  he  is  repre- 
sented to  have  indulged  in  it  for  thirty  years ;  and  for  twenty-eight 
}^ears,  according  to  the  statements  of  his  friends,  no  injurious  effects 
had  followed.  Dr.  Christison  subsequently  collected  from  numerous 
sources  no  fewer  than  twenty-five  cases,  from  which  Ave  learn  that 
opium  has  been  taken  in  large  quantities  for  forty  years  together 
without  producing  any  marked  injury  to  health.  At  the  London 
Medical  Society,  the  late  Dr.  Clutterbuck  related  the  case  of  a  woman 
who  for  seven  years  had  taken  two  scruples  (forty  grains)  of  solid 
opium  daily.  She  was  fifty-four,  had  led  an  irregular  life,  and  had 
first  taken  opium  to  relieve  the  pains  of  rheumatism.  The  dose 
was  not  increased,  and  the  usual  ill-effecxs  of  opium  were  absent — 
such  as  constipation,  nausea,  and  loss  of  appetite.  Although  she 
did  not  increase  the  dose,  the  effects  of  the  diminution  of  a  single 
grain  of  her  usual  quantity  were  most  marked,  and  she  felt  them 
immediately.  Many  cases  of  this  description  are  recorded  by  medi- 
cal authorities ;  they  appear  to  show  that  opium-eating  has  not 
necessarily  that  tendency  to  shorten  life  which  it  has  hitherto  been 
supposed  to  have.  There  is,  however,  sufficient  evidence  to  prove 
that  the  practice  gives  rise  to  prejudicial  effects  on  the  system  and 
tends  to  impair  health.  It  may  not  have  this  effect  in  all  cases,  ex- 
cept on  the  withdrawal  of  the  stimulus ;  but  this  is  not  the  question. 
It  might  be  on  this  principle  argued  that  the  drinking  of  alcoholic 
liquids  has  no  tendency  to  shorten  life,  because  some  hundreds  of 
cases  may  be  adduced  in  which  the  persons  have  been  addicted  to 
intemperate  habits  for  years,  and  have  still  appeared  to  suffer  but 
little  in  bodily  health.  They  who  have  witnessed  the  effects  of 
opium-eating  in  Turkey  and  China  agree  that  the  practice  leads  to 
the  speedy  destruction  of  health.  Dr.  Oppenheim,  in  writing  on 
the  state  of  medicine  in  Turkey,  says;    "The  habitual  opium-eater 


EFFECTS    OF    OPIUM-EATING    OX    HEALTH.  749 

is  readily  recognized  by  his  appearance.  A  total  attenuation  of 
body,  a  withered  yellow  countenance,  a  lame  gait,  a  bending  of  the 
spine  (frequently  to  such  a  degree  as  to  cause  the  body  to  assume  a 
semicircular  form),  and  glassy  deep  sunken  eyes,  betray  him  at  the 
first  glance.  The  digestive  organs  are  much  deranged  ;  the  sufferer 
eats  scarcely  anything,  and  has  hardly  one  evacuation  in  a  week ; 
his  mental  and  bodily  powers  are  destroyed.  As  the  habit  becomes 
more  confirmed,  his  strength  continues  decreasing,  the  craving  for 
the  stimulus  becomes  greater,  and  in  order  to  produce  the  desired 
effect  the  dose  must  be  constantly  augmented.  After  long  indul- 
gence, the  opium-eater  suffers  from  neuralgic  pains,  to  which  opium 
itself  brings  no  relief.  These  persons  seldom  attain  the  age  of  fortv 
if  they  have  begun  to  take  opium  early."  This  description  of  the 
effects  is  exactly  what  we  should  expect  from  physiological  and 
pathological  reasoning.  Dr.  Christison  states  he  has  ascertained  that 
constipation  is  by  no  means  a  general  consequence  of  the  continued 
use  of  opium ;  but  this  may  be  simply  an  exception  to  the  rule.  It 
is  believed  by  some  that  the  action  of  the  drug  may  be  different  in 
different  countries,  and  that  the  description  of  the  effects  produced 
by  the  use  of  opium  in  Turkey  cannot  be  applied  to  the  English 
opium-eater.  The  following  case,  however,  which  occurred  to  Dr. 
A.  T.  Thomson  at  University  College  Hospital,  shows  that  climate 
has  little  influence  on  the  effects  of  this  drug : — 

E.  M.,  aged  35,  was  admitted  May  26,  1835.  About  seventeen 
years  ago  she  began  to  suffer  from  a  pain  in  the  right  iliac  region, 
for  which  a  medical  gentleman  ordered  her  to  take  ten  drops  of 
laudanum  night  and  morning.  This  was  gradually  increased,  the 
pain  continuing,  until  at  last  she  took  three  teaspoonfuls  every  four 
hours,  night  and  day.  At  first  the  ten  drops  relieved  the  pain,  but 
it  was  found  necessary  to  increase  the  dose  to  produce  the  same 
effect,  so  that  the  three  teaspoonfuls  at  last  did  not  produce  so  much 
relief  as  the  ten  drops  at  first.  The  effect  of  the  small  doses  was 
simply  to  produce  a  relief  from  pain,  without  otherwise  affectin<>- 
the  body  or  mind.  As  the  dose  was  increased,  however,  she  found 
it  to  produce  a  comfortable  condition  of  the  mind :  she  felt  lively 
and  cheerful,  and  was  capable  of  doing  any  amount  of  work  ;  it  also 
caused  a  sense  of  warmth  over  the  whole  body.  She  had  severe 
family  afflictions,  but  while  under  the  influence  of  opium  was  not 
at  all  distressed  by  them,  although  she  felt  them  severely  at  other 
times.  If  she  passed  over  the  usual  time  for  taking  a  dose,  she  had 
the  most  distressing  sensations  about  the  joints,  not  of  pain,  but 
such  as  she  was  unable  to  describe.  She  suffered  from  involuntary 
motions  of  the  arms,  fingers,  and  toes ;  numbness  in  the  limbs  and 
body  generally ;  profuse  perspiration,  nausea,  vomiting,  and  loss  of 
appetite ;  a  saline  taste  in  the  saliva,  and  a  bad  taste  in  the  mouth  ; 
trembling  of  the  limbs,  great  debility,  and  a  feeling  of  lassitude. 
The  memory  and  mental  powers  generally  became  impaired,  and 
there  was  a  great  depression  of  the  spirits.  These  symptoms  were 
all  relieved  by  a  repetition  of  the  dose.  The  opium  also  produced 
constipation — not  more  than  one  motion  occurring  in  a  week:  and 


750  NOXIOUS    EFFECTS    OF    OPIUM. 

she  does  not  recollect  whether  that  was  produced  by  medicine  or 
not.  If  the  dose  was  deferred,  she  had  always  suffered  from  severe 
headache.  Her  sense  of  smell  was  so  much  impaired  that  she  could 
perceive  no  pungency  in  snuff;  her  taste  was  so  much  lost  that  she 
could  not  distinguish  pepper  or  mustard ;  and  her  hearing  was  so 
defective  that  she  could  hardly  detect  the  voice  of  any  one  who 
spoke ;  yet  her  own  voice  sounded  most  disagreeably  loud  to  her. 
Her  touch  was  so  much  affected  that  she  could  not  execute  any 
needlework.  The  acuteness  of  all  her  senses  was,  however,  restored 
by  the  usual  dose,  the  want  of  which  was  indicated  by  flushing  and 
heat  of  the  face.  During  the  period  of  taking  the  opium  she  had 
very  little  sleep,  and  in  the  intervals  she  did  not  attempt  to  sleep 
from  want  of  the  desire,  so  that  she  generally  worked  all  night. 
What  sleep  she  had  was,  generally,  during  the  day,  but  this  was 
much  confused  and  easily  broken.  About  five  or  six  years  ago,  her 
resources  being  exhausted,  she  obtained  admission  into  the  hospital. 
The  laudanum  was  here  discontinued  for  the  first  three  days,  and 
all  the  above  symptoms  were  present ;  she  now  for  the  first  time 
appeared  to  see  the  most  frightful  spectres  of  animals  and  other  ob- 
jects in  the  ward.  The  symptoms  were  again  relieved  by  the  usual 
doses.  The  doses  of  laudanum  were  decreased  during  the  whole 
time ;  and  when  she  left  the  hospital,  she  took  a  teaspoonful  only  in 
the  course  of  the  day.  On  returning  home,  as  she  was  dependent 
on  her  friends,  she  was  obliged  to  discontinue  the  laudanum  and 
wine,  and  was  unable  to  get  beer ;  she  was  now  more  miserable  than 
before,  all  the  symptoms  returning  with  increased  severity,  and  for 
the  first  six  months  she  was  almost  entirely  helpless.  There  was 
pain  in  the  chest  with  a  cough,  which  had  continued  ever  since.  She 
was  twelve  months  at  home  before  the  above  distressing  symptoms 
disappeared.  The  consequences  of  her  opium-eating  then  observed 
were  a  much-impaired  taste,  numbness  of  the  limbs,  coldness  of  the 
feet,  inability  to  walk  far  without  aching  pains  in  the  limbs,  and  a 
general  sense  of  lassitude. 

There  is  abundant  evidence  that  this  drug,  as  it  has  been  admin- 
istered to  children  in  the  factory-districts,  has  produced  serious  in- 
jury to  health  and  great  mortality.  In  the  late  Mr.  Grainger's  report 
on  the  Children's  Employment  Commission,  it  is  stated  that  lauda- 
num and  other  preparations  of  opium  are  given  to  young  children 
in  gradually-increased  doses,  until  the  child  will  bear  from  fifteen  to 
twenty  drops  of  laudanum  at  a  time.  The  child  becomes  pale  and 
wan,  with  a  peculiar  sharpness  of  features,  and  rapidly  wastes  away, 
The  majority  of  these  children  die  by  the  time  they  are  two  years 
old.  These  facts  appear  to  show  that  climate  does  not  at  all  affect 
the  action  of  the  drug  in  the  early  periods  of  life,  and  the  observa- 
tions yet  made  are  not  sufficiently  numerous  to  justify  us  in  affirm- 
ing the  existence  of  this  influence  with  respect  to  adults.  Dr.  Chris- 
tison  has  remarked  that  many  persons  probably  die  young  from  the 
effects  of  this  habit  without  the  secret  being  discovered ;  for  even 
the  medical  attendant  as  well  as  intimate  friends  may  be  kept  in 
complete  ignorance  of  the  person  indulging  in  it.     On  the  whole, 


TOBACCO-SMOKING.  751 

we  are  bound  to  conclude  that  the  habit  of  opium-eating  is  injurious 
to  health,  and  is  therefore  calculated  to  shorten  life.  In  any  pro- 
posal for  life-insurance  the  insurers  ought  to  be  informed  of  this 
habit  where  it  exists,  and  no  medical  man  should  sanction  its  con- 
cealment merely  because  many  persons  addicted  to  it  have  lived  for 
years  in  apparently  tolerable  health.  One  of  the  questions  put  to 
a  medical  man  is,  whether  he  knows  any  material  circumstance 
touching  the  health  or  habits  of  the  person  to  which  the  other  in- 
quiries in  the  certificate  do  not  extend ;  and  if  so,  he  is  required  to 
state  them.  Now,  without  going  the  length  of  saying  that  the  life 
of  an  opium-eater  is  uninsurable  upon  a  common  risk,  the  habit  is 
itself  sufficiently  material  to  require  that  it  should  be  declared  in 
reply  to  such  a  question  as  this.  The  practice  may  be,  and  often  is, 
concealed  from  a  medical  attendant ;  then  the  insured,  if  not  candid 
in  avowing  its  existence,  must  expose  his  representatives  to  the  risk 
of  losing  all  benefit  under  the  policy.  Independently  of  medical 
facts,  which  appear  to  favor  both  sides  of  this  question,  a  jury  would 
probably  be  guided  to  a  verdict  by  the  effect  actually  produced  on 
the  constitution  of  a  person  who  has  been  addicted  to  the  practice. 
If  it  has  continued  many  years,  and  there  is  no  proof  of  his  health. 
having  in  consequence  undergone  any  remarkable  change,  this  might 
be  regarded  by  the  jury  as  the  best  possible  evidence  in  favor  of 
the  concealment  not  being  in  such  a  case  material.  The  insurers 
could  not  equitably  complain  of  the  verdict  in  the  Earl  of  Mar's 
case;  for  as  he  began  opium-eating  at  twenty-seven,  and  died  at 
fifty-seven  without  any  obviously  injurious  effects  being  produced 
by  the  use  of  the  drug,  it  could  not  be  said  that  in  his  case  at  least 
the  practice  had  shortened  life.  It  is  rarely  in  our  power  to  apply 
any  better  or  more  practical  test  than  this,  under  circumstanees  in 
which  medical  facts  appear  to  bear  both  ways.  The  case  is  very 
different  from  intemperance  in  the  use  of  alcoholic  liquids  :  no  one 
can  doubt  that  in  this  form  the  results  must  be  inevitably  to  impair 
health  and  to  shorten  life.  The  facts  here  bear  one  way ;  and  if  in- 
stances of  longevity  can  be  adduced  among  spirit-drinkers,  they  are 
well  known  and  generally  admitted  to  be  exceptions  to  the  rule. 
The  queries  put  by  Insurance  Offices  are  now  so  explicit,  that  they 
must  be  considered  as  including  the  habit  of  opium-eating ;  and 
there  does  not  appear  to  be  any  just  pretence  for  evading  the  ad- 
mission of  the  practice,  either  on  the  part  of  the  insured  or  (if 
known  to  him)  of  his  medical  attendant. 

Tobacco- Smoking. — I  am  not  aware  that  the  prevalent  habit  of 
smoking  tobacco  has  ever  been  regarded  in  relation  to  life-insurance. 
Although  inveterate  smokers  are  liable  to  attacks  of  dyspepsia,  loss 
of  muscular  and  nervous  power,  weakness,  and  other  derangements 
of  the  system,  there  is  not,  so  far  as  I  know,  any  evidence  to  show 
that  the  practice  has  a  tendency  to  shorten  life.  Should  the  habit 
be  stated  in  a  certificate?  I  think  it  should,  if  known  to  the  medi- 
cal referee  and  where  it  is  of  a  most  inveterate  kind.  This  would 
at  least  prevent  objections  on  the  part  of  a  captious  company.  There 
is  no  rule  of  law  on  this  point,  if  we  except  a  dictum  of  Lord  Mans- 


752  INFLUENCE    OF    INSANITY. 

field :  "  The  insured  need  not  mention  what  the  insurer  ought  to 
know,  what  he  takes  upon  himself  the  knowledge  of,  or  what  he 
waives  being  informed  of:  the  insurer  need  not  be  told  general 
topics  of  speculation." 

Insanity. — When  we  are  called  upon  to  say  what  diseases  have  a 
tendency  to  shorten  life,  there  is  commonly  no  difficulty  in  giving 
a  reply,  since  the  name  of  the  disease — its  known  effects  upon  the 
body — the  degree  of  mortality  produced  by  it,  and  its  intractable- 
ness,  are  data  upon  which  a  medical  opinion  may  be  easily  expressed. 
There  are  some  diseases,  however,  respecting  which  it  is  not  so  easy 
to  return  an  answer;  and  among  these  may  be  mentioned  insanity, 
which  has  already  given  rise  to  discussion  in  a  court  of  law.  The 
treatment  of  this  malady  falls  out  of  the  usual  line  of  practice ;  and 
there  are  comparatively  few  in  the  profession  who  have  made  them- 
selves acquainted  with  statistical  details  respecting  it.  This  may 
account  for  the  decision  in  the  following  case  : — 

In  1835,  a  trial  took  place  at  the  York  Assizes,  in  which  the  ques- 
tion was,  whether  insanity  had  or  had  not  a  tendency  to  shorten  life. 
The  representatives  of  a  clergyman  brought  an  action  against  the 
Providence  Insurance  Company,  to  recover  the  amount  of  a  policy 
effected  on  the  life  of  a  gentleman :  but  the  office  refused  to  pay  on 
account  of  the  person  having  been  insane,  and  this  fact  having  been 
kept  from  their  knowledge  when  the  insurance  was  effected.  Several 
medical  witnesses  gave  evidence  on  the  occasion.  One  considered 
that  insanity  had  a  tendency  to  shorten  life ;  another,  that  it  had 
not ;  a  third,  who  admitted  that  the  deceased  was  laboring  under  in- 
sanity, did  not  consider  that  his  mental  state  was  such  as  had  a  tend- 
ency to  shorten  life.  The  judge  charged  the  jury  that  the  question 
for  them  to  consider  was,  whether  insanity  had  a  tendency  to  shorten 
life,  as,  if  so,  this  would  make  the  concealment  of  it  material.  If 
insanity  had  such  a  tendency,  they  must  find  for  the  defendant ;  if 
not,  for  the  plaintiff.  The  jury  found  for  the  plaintiff,  on  the  ground 
that  insanity  had  no  tendency  to  shorten  life,  and  that  therefore  the 
concealment  was  not  material. 

There  is  probably  no  case  which  more  strongly  shows  the  neces- 
sity for  proper  medical  evidence  on  these  occasions.  The  finding  of 
the  jury  was  contrary  to  all  good  medical  experience,  and  was 
founded  on  a  complete  mistake.  The  researches  of  Esquirol,  Farre, 
and  others,  show  that  insanity  has  a  decided  tendency  to  shorten  life. 
So  well  aware  are  the  insurance  offices  of  this,  that  the  existence  or 
non-existence  of  insanity  or  mental  derangement  is  now  made  a 
special  question,  to  which  an  answer  must  be  given  in  the  declaration. 
The  contrary  opinion  appears  to  have  arisen  from  the  hypothesis 
that  insanity  is  not  a  bodily  disease,  and  in  no  way  connected  with 
physical  changes  in  the  structure  of  the  brain.  Admitting  this  state- 
ment to  be  true,  experience  is  decidedly  against  the  inference  based 
on  it,  when  we  look  at  insanity  in  the  aggregate  of  cases. 

There  was  formerly  an  erroneous  notion  that  insanity  had  a  tend- 
ency to  prolong  life ;  but  more  correct  statistical  researches  have 
shown  that  the  insane  are  more  liable  than  the  sane  to  various  dis- 


ACCIDENTAL    CAUSES    OF    DEATH.  753 

eases,  and  that  when  attacked  they  sink  more  easily  under  them : 
hence  the  mortality  of  the  insane  is,  cseteris  paribus,  much  above  the 
average  of  that  of  the  sane  population.  Among  other  fatal  diseases, 
the  insane  are  especially  liable  to  attacks  of  paralysis  and  epilepsy  : 
and  paralysis,  however  slight,  is  commonly  the  forerunner  of  death 
in  these  cases.  In  private  asylums,  the  mortality  is  always  less  than 
in  public  hospitals  ;  but  recent  researches  have  shown  that  the  mor- 
tality of  the  insane  has  been  much  reduced  by  the  introduction  of 
an  improved  system  of  management  and  treatment. 

Accurate  observations  have  shown  that  the  mortality  among  male 
is  greater  than  among  female  lunatics,  and  the  more  advanced  the 
age  the  greater  the  proportionate  rate  of  mortality.  The  conceal- 
ment of  insanity  in  any  of  its  forms,  or  even  of  a  known  hereditary 
tendency  to  this  malady,  would  be  considered  material,  inasmuch  as 
either  condition  forms  a  special  question  to  which  an  answer  should 
be  returned. 

Accidental  Causes  of  Death.  Death  from  Sunstroke. — There  are 
several  Offices  which  now  insure  persons  against  accidents  occurring 
on  sea  or  land,  and  it  would  seem  at  first  sight  that  there  would  be 
less  room  for  litigation  under  such  circumstances.  The  proof  of  the 
accident  and  the  amount  of  injury  done,  or  (if  fatal)  the  cause  of 
death,  would  appear  to  be  a  simple  matter.  But  the  question  arises — - 
What  is  an  accidental  as  distinguished  from  a  natural  cause  of  death  ? 
AVith  our  ideas  of  an  accident,  we  generally  associate  physical  in- 
jury or  violence  done  to  the  person ;  and  if  a  man  dies  from  any 
other  cause,  his  death  cannot  be  said  to  be  accidental.  This  ques- 
tion came  before  the  Court  of  Queen's  Bench,  in  January,  1861 
(Sinclair  v.  The  Maritime  Insurance  Company),  and  the  Lord  Chief 
Justice  delivered  the  judgment  of  the  court.  The  action  was 
brought  by  the  administratrix  of  a  person  named  Laurence,  who, 
being  about  to  proceed  on  a  voyage  as  a  master  of  a  vessel,  insured 
himself  against  any  personal  injury  from  any  "accident"  which 
might  happen  to  him  upon  any  ocean,  sea,  river,  or  lake.  The 
assured  being  with  his  ship  in  the  Cochin  Eiver,  on  the  southwest 
coast  of  India,  and  being  on  duty  on  board  his  ship,  was,  in  the 
language  of  the  special  case,  "struck  down  by  sunstroke,"  from  the 
effects  of  which  he  died  in  the  course  of  the  same  clay.  The  ques- 
tion was,  whether  the  death  arose  from  "accident"  within  the  mean- 
ing of  the  policy,  and  the  opinion  of  the  court  was  that  it  did  not. 
It  was  difficult  to  draw  a  line  between  a  death  from  "accident"  in  a 
policy  of  this  nature  and  a  death  from  natural  causes,  such  as  should 
be  of  universal  application.  But  the  court  might  safely  assume 
that  in  an  "accident"  some  violence,  casualty,  or  vis  major  was  neces- 
sarily involved,  and  that  a  death  from  a  known  natural  cause  could 
not  be  considered  as  accidental.  Disease  or  death  engendered  by 
exposure  to  heat,  cold,  damp,  and  the  vicissitudes  of  climate  or  at- 
mospheric influences,  could  not  properly  be  said  to  be  accidental  ; 
at  all  events,  not  unless  the  exposure  was  brought  about  by  circum- 
stances of  an  accidental  character.  Thus,  if  a  mariner  in  the  ordi- 
48 


754  LIFE    INSURANCE.      ALLEGED    SUICIDE. 

nary  discharge  of  his  duty  caught  cold  and  died,  his  death  would 
not  be  accidental,  though  it  might  be  so  if  by  reason  of  shipwreck 
he  was  compelled  to  take  to  the  boat,  and  died  from  exposure  to  wet 
and  cold.  In  one  sense  the  death  was  accidental,  for  the  effect  was 
uncertain  beforehand ;  but  it  must  be  considered  as  the  effect  of 
natural  causes,  and  not  accidental.  Sunstroke,  so  far  as  the  court 
was  informed  of  it,  was  an  inflammatory  disease  of  the  brain, 
brought  on  by  exposure  to  the  intense  heat  of  the  sun's  rays.  To 
that  disease  persons  exposing  themselves  to  the  sun  in  tropical  cli- 
mates were  more  or  less  liable,  just  as  persons  exposing  themselves 
to  natural  causes  of  a  different  kind  were  liable  to  diseases  conse- 
quent therefrom.  Death  from  "sunstroke"  must  therefere  be  con- 
sidered as  arising  from  natural  causes  and  not  from  accident,  and 
judgment  will  be  given  in  favor  of  the  defendants. 

In  the  case  of  a  person  being  killed  by  lightning  whose  life  was 
insured  against  accidental  death,  the  question  might  arise  whether 
such  a  mode  of  death  was  accidental  or  not.  Death  by  lightning  is 
certainly  not  a  natural  cause  of  death,  and  in  common  language  any 
person  killed  by  lightning  is  said  to  have  died  accidentally. 

[Where  a  death  takes  place  in  such  manner  that  it  may  have  hap- 
pened from  natural  causes,  the  assured  are  not  liable  unless  it  is 
proved  to  have  been  caused  by  accident.  Trew  v.  Ins.  Co.,  5  Hurls. 
&  Norm.  211. 

A  clause  in  a  life-insurance  policy  provided  in  case  "of  a  bodily 
injury  to  the  insured  of  so  serious  a  nature  as  to  wholly  disable 
him  from  following  his  usual  business,  occupation,  or  pursuits,"  for 
the  payment  of  £5  per  week  during  the  continuance  of  such  dis- 
ability. The  insured,  a  solicitor  and  registrar  of  a  county  court, 
was  confined  to  his  bedroom  for  several  weeks  by  a  sprained  ankle, 
and  was  consequently  unable  to  attend  to  his  business.  It  was  held 
that  he  was  "wholly  disabled"  within  the  meaning  of  the  policy, 
and  therefore  entitled  to  recover.  Hooper  v.  Accidental  Ins.  Co.,  5 
Hurls.  &  Norm.  516.— P.] 

Suicide. — Among  the  conditions  in  policies  of  insurance,  there  is 
generally  a  stipulation  in  the  contract  that  the  policy  shall  be  void 
if  the  person  who  insures  his  life  commits  suicide.  Thus,  a  medi- 
cal question  may  arise  as  to  whether  suicide  was  or  was  not  com- 
mitted in  a  particular  case.  A  person  may  die  from  poison,  wounds, 
drowning,  or  other  forms  of  asphyxia ;  and  it  may  be  difficult  to 
say  in  certain  cases  whether  the  death  arose  from  accident,  suicide, 
or  from  violence  inflicted  by  another.  Such  cases  are  often  left  in 
great  uncertainty  at  coroner's  inquests — the  evidence  received  being 
imperfect  or  insufficient;  because  in  cases  of  sudden  death,  provided 
there  be  no  suspicion  of  murder,  it  is  considered  of  little  moment 
to  make  a  strict  inquiry.  If  the  life  of  the  deceased  should  happen 
to  be  insured  under  a  policy  containing  this  condition  respecting 
suicide,  the  question  may  become  of  great  moment  to  the  interest 
of  the  insurers,  and  they  will  require  clear  evidence  that  the  death 
was  natural  or  accidental,  and  not  suicidal,  before  paying  the  amount 


BY    POISON".      DIFFICULTY    OF    PROOF.  755 

of  the  policy.  The  cause  of  death  should  in  all  cases  of  violence 
be  determined  by  a  medical  man:  this  will  put  an  end  to  any  dis- 
pute concerning  the  payment  of  the  policy,  and  relieve  the  repre- 
sentatives from  the  trouble  and  expense  of  litigation.  If  the  death 
be  sudden,  and  any  suspicious  circumstances  are  left  unexplained, 
it  is  certain  that  a  civil  action  will  follow.  We  are  not  therefore 
safe  if,  at  a  coroner's  inquest,  we  suppose  that  we  have  only  to  satisfy 
a  common  jury  by  a  hasty  opinion  expressed  from  an  external  view 
of  the  body  or  an  ill-conducted  inspection,  merely  because  it  may 
appear  to  us  quite  certain  that  the  deceased  could  not  have  been 
murdered.  Should  the  deceased  happen  to  be  one  of  that  class  of 
persons  on  whose  lives  insurances  are  commonly  effected,  the  whole 
of  the  circumstances  connected  with  the  examination  of  the  body, 
and  the  medical  opinion  of  the  cause  of  death,  must  come  to  light, 
and  if  carelessly  performed  will  probably  be  made  the  subject  of  a 
severe  cross-examination.  I  have  known  several  instances  in  which 
there  have  been  painful  exposures  of  this  kind,  because  the  medical 
witness  thought  any  kind  of  evidence  would  serve  the  purpose  of  a 
coroner's  jury.  The  verdict  of  a  jury  at  an  inquest  is  not  binding 
on  a  Company :  they  have  not  only  a  right  but  often  good  reason  to 
dispute  it,  and  they  frequently  exercise  this  privilege.  The  In- 
surance Companies  are  exposed  to  all  kinds  of  frauds,  some  of  them 
of  a  most  fearful  kind,  actually  leading,  as  in  the  case  of  burial- 
clubs  (a  kind  of  life-insurance),  to  the  perpetration  of  murder  for 
the  sake  of  the  small  amount  insured. 

A  case  of  some  interest  in  reference  to  the  question  of  suicide  by 
poison,  on  the  part  of  a  person  whose  life  had  been  only  recentlv 
insured  for  a  very  large  sum,  was  tried  before  Lord  Tenterden  in 
1832  (Kinnear  v.  The  Bock  Insurance  Company) ;  the  late  Mr.  J.  H. 
Green,  Mr.  Key,  and  myself  were  called  upon  to  give  evidence  on 
the  part  of  the  defendants.  This  trial  would  not  have  occurred  but 
that  the  medical  inspection  of  the  body  for  the  inquest  two  years 
previously  had  been  most  improperly  conducted,  and  no  satisfactory 
evidence  of  the  cause  of  death  assigned.  As  a  sum  of  10,000/. 
rested  upon  the  issue,  the  insurers  felt  that  they  had  a  right  to  de- 
mand a  full  and  perfect  inquiry.  The  depositions  taken  at  the  in- 
quest on  deceased  were  sent  to  me  for  examination,  and  from  these 
it  appeared  that  the  person  whose  life  was  insured  died  two  years 
before  the  action  was  brought ;  the  body  was  carelessly  inspected 
for  a  coroner's  inquest,  and  the  contents  of  the  stomach,  without 
being  subjected  to  any  chemical  analysis,  had  been  thrown  away. 
These  circumstances  placed  great  difficulty  in  the  way  of  producing 
proof,  and  in  fact  so  far  as  medical  evidence  was  concerned  they 
left  the  question  almost  a  mere  matter  of  opinion.  An  application 
was  made  to  me  on  the  part  of  the  Insurance  Company,  to  know 
whether  the  exhumation  of  the  body  and  any  further  processes  of 
analysis  would  be  attended  with  any  benefit,  but  an  answer  was  re- 
turned in  the  negative.  From  the  manner  in  which  the  first  exami- 
nation had  been  conducted — also  from  the  fact  that,  as  the  symptoms 
under  which  the  deceased  had  died  could  only  have  been  presump- 


756  ALLEGED    SUICIDE    BY    POISON. 

tively  those  of  narcotic  poisoning,  it  was  altogether  improbable  that, 
two  years'   interment,  any  trace  of  narcotic   poison  would  be 
discovered  in  the  remains. 

The  deceased — who,  according  to  the  evidence  given  at  the  trial, 
had  been  for  some  time  in  a  low  state  of  mind — returned  to  his 
house,  in  the  Regent's  Park,  on  the  evening  of  the  19th  October, 
1830.  The  house  was  then  undergoing  repair;  his  family  were  in 
the  country,  and  the  only  person  residing  with  him  at  the  time  was 
a  man-servant.  The  account  given  by  this  person  was  that  the 
deceased  returned  home  about  ten  o'clock  in  the  evening,  apparently 
in  his  usual  health :  he  ordered  him  to  place  a  decanter  of  wine,  a 
tumbler,  and  a  wineglass  on  the  library  table  adjoining  his  bedroom; 
told  him  that  he  was  going  to  take  a  composing  draught,  and  desired 
that  he  might  not  be  called  on  the  following  morning,  saying  that 
he  would  ring  his  bell  if  he  wanted  anything.  The  deceased  went 
to  bed,  but  about  twelve  o'clock  the  servant  was  awakened  by  a 
noise,  as  if  the  bar  of  the  library- shutters  had  fallen.  On  getting  up, 
he  saw  his  master,  without  a  light,  in  the  act  of  returning  from  the 
library  to  his  bedroom,  which  adjoined  it;  he  took  a  light  from 
witness,  and  again  went  to  bed.  On  going  up  stairs  ten  minutes 
afterwards,  witness  found  the  light  extinguished,  and  the  door  of 
the  deceased's  bedroom  fastened.  On  the  next  morning,  at  9.30, 
witness  went  to  deceased's  bedroom,  and  knocked  at  the  door  as 
usual,  but  received  no  answer ;  he  went  again  at  ten  o'clock,  but 
the  door  was  still  fastened,  and  the  deceased  did  not  answer  when 
he  knocked.  The  workmen  who  were  employed  in  the  house 
alarmed  witness,  about  twelve  o'clock,  by  telling  him  that  they  had 
heard  his  master  moaning  or  groaning.  A  ladder  was  then  pro- 
cured, and  the  room  was  entered  b}r  the  window.  The  deceased  was 
in  bed,  and  appeared  to  have  just  died  as  the  witnesses  entered.  A 
surgeon  was  immediately  sent  for,  who  on  his  arrival  examined  and 
tasted  some  liquid  which  was  found  in  a  tumbler  on  the  table. 
Search  was  made  lor  a  phial,  but  none  could  be  found;  however,  it 
was  proved  that  there  were  on  the  library -table  a  piece  of  blue  and 
a  piece  of  red  paper,  evidently  the  cover  and  wrapper  of  a  phial, 
which  were  not  there  previously.  It  was  also  deposed  that  a  cork 
and  string  were  found  in  the  fireplace.  The  window  of  the  library 
was  open,  the  shutters  having  been  unfastened. 

The  surgeon,  who  was  called,  stated  that  the  body  was  lying  in  a 
composed  state,  the  countenance  being  somewhat  pale.  There  was 
perspiration  on  the  skin,  with  patches  of  a  livid  color  here  and  there 
distributed  over  it.  The  body  was  inspected  for  the  coroner's  in- 
quest by  two  physicians  and  two  surgeons.  An  accumulation  of 
putrid  blood  is  said  to  have  been  found  in  the  stomach,  with  an 
effusion  on  either  side  of  the  chest.  The  vessels  of  the  brain  were 
somewhat  turgid,  but  there  was  no  extravasation.  The  contents  of 
the  stomach  were  thrown  away  without  any  chemical  analysis  hav- 
ing been  made.  It  appears  that  the  only  approach  to  analysis  was 
the  drawing  of  a  stick  of  nitrate  of  silver  across  the  mucous  mem- 
brane of  the  stomach  at  the  time  of  the  inspection.     The  cause  of 


VITIATION    OF    POLICIES    BY    SUICIDE.  757 

death  assigned  by  these  witnesses  was  the  rupture  of  a  bloodvessel 
in  the  stomach.  A  verdict  of  "Death  from  natural  causes"  was 
returned;  the  body  was  buried,  and  it  was  supposed  that  all  inquiry 
had  ceased. 

The  cause  of  death  assigned  by  the  witnesses  being  considered  al- 
together inadequate  to  account  for  this  event  under  the  circumstances 
— the  suddenness  of  death  in  a  person  who  was  in  perfect  health  the 
evening  before — the  absence  of  any  sign  of  effusion  of  blood  in  the 
brain,  so  frequently  met  with  in  sudden  death  from  apoplexy — to- 
gether with  the  circumstantial  evidence  that  some  liquid  had  been 
taken  by  deceased  and  the  phial  disposed  of,  afforded  a  strong  ground 
for  suspicion.  The  insurers  refused  payment  of  the  amount  of  the 
policy  and  demanded  an  inquiry. 

The  circumstantial  evidence  not  being  of  itself  sufficient  to  esta- 
blish the  fact  of  poisoning,  additional  evidence  was  required  to 
determine — 1.  Whether  the  cause  of  death  assigned  by  the  witnesses 
at  the  inquest  was  adequate  to  account  for  it ;  and  2.  Whether,  if  not, 
the  facts  proved  relative  to  the  death  of  the  deceased  were  consistent 
with  narcotic  poisoning — whether,  in  short,  death  b}?"  poison  was  or 
was  not  probable. 

Mr.  Green,  Mr.  Key,  and  myself  were  requested  to  give  an  opinion 
on  these  points.  With  regard  to  the  first,  we  said  the  cause  of  death 
assigned  by  the  witnesses  was  inadequate  and  unsatisfactory.  The 
blood  found  in  the  stomach  was  loosely  described  as  half-putrid  and 
not  coagulated :  so  far  from  its  being  proved  that  it  had  been  effused 
during  life,  it  was  not  improbable,  from  the  careless  manner  in  which 
the  inspection  was  made,  that  it  had  proceeded  from  some  vessels 
divided  by  the  examiners.  Admitting  that  it  had  been  effused  dur- 
ing life,  it  did  not  furnish  a  satisfactory  explanation  of  the  cause  of 
death,  since  the  quantity  was  small.  That  it  was  not  satisfactory  to 
the  inspectors  themselves  appeared  certain  from  the  fact  that  they 
examined  the  stomach  for  some  land  of  poison  by  the  rough  experi- 
ment of  drawing  a  stick  of  nitrate  of  silver  over  the  mucous  mem- 
brane !  Further,  gastric  hemorrhage  rarely  destroys  life  on  a  first 
attack,  and  is  generally  accompanied  by  vomiting  of  blood;  but  the 
deceased  had  never  been  subject  to  haematemesis,  and  there  had  been 
no  bloody  vomiting. 

With  regard  to  the  second  question,  the  facts  proved  might  be 
explained  by  supposing  that  the  deceased  had  taken  a  poisonous 
dose  of  laudanum  or  of  some  preparation  of  opium:  it  might  be 
contended  that  no  opiate  was  present  in  the  stomach,  but  it  did  not 
appear  that  any  analysis  had  been  made.  The  deceased  had  died  in 
about  the  period  at  which  this  poison  operates  fatally,  and  it  was  for 
the  jury  to  determine  from  the  circumstantial  evidence,  as  the  medi- 
cal evidence  wholly  failed  to  throw  light  upon  the  subject,  how  far 
this  was  likely.  We  all  agreed  that  narcotic  poisoning  in  the  de- 
ceased's case  was,  so  far  as  we  could  speak  in  the  absence  of  an  ana- 
lysis, probable,  inasmuch  as  the  facts  proved  respecting  his  death 
agreed  with  this  view,  and  the  results  of  the  medical  inspection  so 
far  as  they  went  were  quite  consistent  with  it.     On  the  other  hand, 


758  VITIATION    OF    POLICIES    BY    SUICIDE. 

the  question  might  arise  whether  there  were  no  natural  causes  which 
would  have  destroyed  life  within  twelve  hours  in  the  same  tranquil 
manner  in  which  the  deceased  was  supposed  to  have  died.  To  this 
it  may  be  replied,  that  apoplexy  and  other  diseases  might  also  have 
accounted  for  death ;  but  there  was  no  evidence  from  the  inspection 
to  establish  the  existence  of  these,  and  death  from  a  narcotic  poison 
was,  medically  speaking,  just  as  probable.  It  short,  as  the  evidence 
was  essentially  of  a  negative  kind,  and  there  were  two  ways  of 
accounting  for  death,  either  of  them  consistent  with  the  medical  facts, 
it  remained  for  the  jury  to  decide  from  the  whole  of  the  circum- 
stances which  was  the  more  probable.  The  cause  of  death  was  en- 
tirely a  matter  of  medical  presumption.  It  was  impossible  to  swear 
that  the  deceased  could  not  have  died  from  apoplexy  or  from  the 
effects  of  a  large  dose  of  an  opiate.  As  the  case  was  only  one  of 
suspicion,  and  not  of  actual  proof,  a  verdict  was  returned  for  the 
plaintiff. 

There  can  be  no  doubt  of  the  propriety  of  the  verdict,  since  the 
law  always  justly  insists  upon  what  the  circumstantial  evidence 
combined  with  medical  opinions  was  here  incapable  of  affording — 
namely,  direct  and  not  inferential  proof  of  death  from  poison.  The 
insurers  had  alleged  suicide  by  poison — this  they  were  bound  to 
prove  by  clear  and  distinct  evidence ;  the  plaintiff  was  not  required 
to  show  that  the  death  was  natural.  If,  besides  the  paper- wrappers, 
string,  and  cork,  a  phial  which  had  evidently  contained  laudanum 
had  been  found,  or  the  liquid  in  the  tumbler,  instead  of  being  merely 
tasted  or  smelt  by  the  medical  gentleman  and  then  thrown  away, 
had  been  carefully  analyzed,  or  had  the  same  cautious  proceedings 
been  adopted  with  regard  to  the  contents  of  the  stomach,  clear  evi- 
dence might  have  been  adduced  which  would  have  satisfied  the  jury 
that  the  deceased  had  died  from  narcotic  poison.  In  supposing  that 
the  deceased  took  a  fatal  dose  of  an  opiate,  it  was  assumed  that  he 
had  disposed  of  the  bottle  by  throwing  it  out  of  the  library-window, 
which  was  found  open  after  the  shutters  had  been  fastened:  no  traces 
of  the  composing  draught  which  he  had  told  his  servant  he  should 
take  were  found — not  even  the  phial — and  the  colored  wrappers  of 
paper,  cork,  and  string  found  in  the  bedroom  were  not  accounted 
for. 

The  only  point  that  went  against  the  presumption  of  narcotic 
poisoning  was  this:  the  servant  swore  on  the  trial  that  his  master's 
bell  rang  about  nine  o'clock.  If  this  were  true,  the  deceased  could 
not  then  have  been  under  the  influence  of  a  narcotic  poison,  as  he 
must  have  walked  across  the  room  to  have  rung  the  bell.  This 
would  have  given  but  three  hours  for  the  fatal  operation  of  the  poison, 
while  most  cases  of  poisoning  by  opium  have  not  proved  latal  in 
less  than  from  six  to  twelve  hours.  Still,  opium  has  been  known 
to  cause  death  within  a  short  period.  Dr.  Christison  met  with  a 
case  where  the  person  died  in  three  hours,  and  Dr.  Beck  another 
where  death  occurred  in  two  hours  and  a  half.  But  on  comparing 
the  evidence  of  this  witness  at  the  inquest  and  the  trial  there  was  a 
great  discrepancy.     He  said  nothing  of  a  bell  ringing  when  exam- 


VITIATION    OF    POLICIES    BY    SUICIDE.  759 

hied  at  the  inquest  recently  after  his  master's  death  ({.  e.  two  years 
before  the  trial),  when  it  might  be  supposed  that  the  whole  of  the 
circumstances  were  fresh  in  his  mind.  He  had  also  stated  that  just 
before  the  alleged  ringing  of  the  bell,  when  he  knocked  at  his  mas- 
ter's door,  on  going  up  to  his  room  about  nine  o'clock,  he  received 
no  answer.  There  was  only  one  bell  in  the  house,  and  the  four 
workmen  employed  about  the  house  did  not  hear  it  ring  during  the 
whole  of  the  morning.  These  four  witnesses  also  deposed  to  an- 
other important  fact :  they  swore  that  between  eleven  and  twelve, 
hearing  a  groaning  or  a  snoring  in  the  deceased's  bedroom,  they 
proposed  to  the  servant  to  break  open  the  door  and  enter ;  but  he 
objected  because,  he  said,  his  master  was  poorly — that  he  had  taken 
a  composing  draught,  and  had  desired  him  not  to  go  near  the  room 
until  he  heard  his  bell  ring.  This  he  said  two  hours  after  the  time 
at  which  he  swore  on  the  trial  that  he  had  heard  the  bell  ring  and 
went  up  to  answer  it !  This  part  of  the  evidence,  which  appeared 
to  militate  against  the  presumption  of  narcotic  poisoning,  was  there- 
fore inconsistent  and  unworthy  of  belief ;  but  by  a  strange  omission 
the  discrepancies  in  the  evidence  of  this  witness  escaped  notice  at 
the  time.  This  case  shows  the  importance,  nay  the  absolute  neces- 
sity, of  performing  post-mortem  inspections  and  chemical  analyses 
for  inquests  in  a  careful  and  proper  manner.  It  also  illustrates  the 
principle  that,  although  suicide  may  be  a  ground  for  vitiating  a 
contract  of  this  description,  the  allegation  must  not  rest  upon  mere 
medical  presumptions  or  inferences,  but  upon  direct  and  positive 
proofs. 

Among  the  medico-legal  questions  connected  with  this  subject  is 
the  following :  Does  the  proviso  in  the  policy  respecting  suicide  in- 
clude all  acts  of  self-destruction,  or  is  it  restricted  only  to  those  cases 
in  which  either  a  sane  or  a  partially  insane  person  consciously  de- 
stroys himself?  This  question  has  been  elsewhere  considered  (chap. 
64).  The  act  of  suicide  does  not  necessarily  indicate  insanity  ;  but 
even  if  it  did,  the  rule  of  law,  as  settled  by  a  majority  of  the  judges 
in  reference  to  this  proviso  in  cases  of  life-insurance,  is  that  whenever 
an  insured  person  destroys  himself  intentionally,  whatever  may  be 
the  state  of  his  mind,  the  policy  is  void.  If  a  person,  whether  sane 
or  insane,  kills  himself  unintentionally,  then  the  insurers  are  liable ; 
but  the  onus  of  proof  in  this  case  lies  upon  the  plaintiffs,  i.  e.  those 
who  would  benefit  by  the  policy.  According  to  the  practice  of 
some  offices,  the  act  of  suicide  does  not  render  a  policy  void. 

[The  leading  English  cases  on  this  subject  are  Borradale  v.  Hun- 
/■',■,  5  Mann.  &  Grang.  R.  639,  and  Cleft  v.  Schwaibe,  3  Mann., 
Grang.  &  Scott  R.  437.  In  the  former  case  the  provision  was,  that 
the  policy  should  be  void  if  the  assured  "  should  die  by  his  own 
] muds."  The  assured  threw  himself  into  the  Thames  and  was 
drowned.  The  jury  found,  however,  that  though  this  was  done 
voluntarily,  and  with  intent  to  destroy  life,  that  the  assured  "  was 
not  capable  of  judging  between  right  and  wrong."  The  majority  of 
the  court  held  the  policy  to  be  avoided.  Chief  Justice  Tindal  dis- 
sented, delivering  a  very  able  opinion  sustaining  his  views. 


760  PERPETRATION    OF    MURDER 

In  the  other  case  the  policy  provided  that  it  should  become  void  if 
the  assured  "committed  suicide."  He  did,  in  a  fit  of  insanity,  com- 
mit suicide  by  taking  sulphuric  acid.  Creswell,  J.,  directed  the 
jury  that  they  must  find  for  the  plaintiff,  unless  the  assured,  when 
he  died  by  his  own  voluntary  act,  "  was  able  to  distinguish  between 
right  and  wrong,  and  to  appreciate  the  nature  and  quality  of  the  act 
that  he  was  doing,  so  as  to  be  a  responsible  moral  agent."  Upon 
a  bill  of  exceptions  this  instruction  was  held  to  be  erroneous,  the 
majority  of  the  court  being  of  opinion  that  it  was  immaterial  under 
the  terms  of  the  policy,  whether  the  assured  was  or  was  not  at  the  time 
a  responsible,  moral  agent.  Chief  Baron  Pollock  and  Justice  Wight- 
man  dissented,  on  the  ground  that  as  "  soon  as  it  is  ascertained  that 
a  person  has  lost  his  sense  of  right  and  wrong,  it  matters  not  what 
else  of  the  human  faculties  or  capacities  remain,  and  that  he  can  no 
more  commit  suicide  than  he  can  commit  murder." 

The  same  question  arose  in  Breasted  v.  Farmers'  Loan  and  Trust 
Co.,  1  Hill  (N.  Y.)  R.  73;  affirmed  in  1  Seld.  299.  The  policy  in 
that  cases  provided  that  it  should  become  void  in  case  the  assured 
should  "  die  by  his  own  hand."  He  committed  suicide  by  drown- 
ing himself  in  the  Hudson  River,  being  at  the  time  of  "  unsound 
mind,  and  wholly  unconscious  of  the  act."  The  case  came  before 
the  court  upon  a  demurrer.  Nelson,  C.  J.,  delivered  the  opinion  of 
the  court,  giving  judgment  for  plaintiff. 

A  similar  decision  has  recently  been  made  by  the  Supreme  Court 
of  Maine  upon  an  insurance  effected  by  Joseph  Esterbrook,  Avho 
afterwards  became  deranged,  and  committed  suicide  by  shooting 
himself.     (Legal  and  Insurance  Reporter,  Sept.  1866,  p.  281.) 

As  to  the  construction  of  the  words  "  die  by  his  own  hand,"  see 
Harlman  v.  Keystone  Ins.  Co.,  9  Harris  (Penna.)  466. — P.] 

It  is  naturallv  supposed  that  a  man  has  a  direct  interest  in  pre- 
serving his  own  life,  but  this  of  course  will  not  prevent  him  from 
falling  a  victim  to  the  criminal  designs  of  another.  The  insurable 
interest  of  a  person  in  the  life  of  another  became  an  important  ques- 
tion in  January,  1863,  in  LTebdon  v.  West.  The  plaintiff,  a  clerk  in 
a  banking-firm,  had  effected  an  insurance  on  the  life  of  one  Pedder, 
who  was  a  member  of  the  firm.  Plaintiff  became  indebted  to  the 
firm  for  a  sum  of  5,000?.,  and  Pedder  having  informed  the  plaintiff 
that  he  should  not  be  troubled  with  any  demand  for  repayment  dur- 
ing his  (Pedder's)  life,  the  plaintiff  insured  Pedder's  life  in  the  de- 
fendant's company  for  the  sum  of  2,500/.  It  was  the  payment  of 
this  sum  to  the  plaintiff  that  was  now  in  dispute,  the  defendant  con- 
tending that  plaintiff  had  no  insurable  interest  in  the  life  of  Pedder. 
The  case  was  argued,  and  the  court  put  to  counsel  the  cases  which 
had  been  already  decided,  of  a  father  insuring  his  son's  life  or  a  hus- 
band his  wife's.  It  had  been  held  that  in  these  cases  there  was  no 
insurable  interest.  Hence,  when  a  husband  desired  to  make  a  pro- 
vision tor  his  wife,  he  insured  his  own  life — she  did  not  insure  his. 
Further,  they  instanced  the  remarkable  case  of  Wainwright  (p.  762), 
in  which  that  person  induced  his  sister-in-law  to  insure  her  life,  and 
then  poisoned  her,  in  order,  as  next  of  kin,  to  get  hold  of  the  sum 


FOE    THE    AMOUNT    OF    THE    POLICY.  761 

assured.  That  case  showed  the  immense  importance  of  the  law  requir- 
ing a  real  interest  in  the  life  of  a  person  whose  life  was  insured.  The 
result  of  the  argument  was  that  the  court  reserved  its  judgment; 
but  there  appeared  to  be  no  agreement  concerning  what  was  a  legal 
insurable  interest  in  the  life  of  another.  [See  Reese  v.  Mutual  Ins. 
Co.,  23  N.  Y.  (9  Smith)  516;  Raids  v.  Insurance  Co.,  36  Barb.  (N. 
Y.)  357.  In  the  latter  case  it  was  held  that  a  creditor's  insurance 
upon  the  life  of  his  debtor  was  not  invalidated  by  the  running  of 
the  statute  of  limitations  against  the  debt  before  death. — P.] 

The  insurance  of  lives  has  been  considered  to  be  objectionable, 
on  the  ground  that  it  tends  to  create  an  interest  in  the  death  of  an- 
other, and  thus  to  lead  to  secret  acts  of  murder.  The  14th  George 
III.  c.  48,  expressly  enacts  that  no  insurance  on  life  shall  be  valid 
unless  the  person  insuring  has  a  direct  legitimate  interest  in  the 
person  whose  life  is  insured.  This  statute  was  enacted  for  the  pur- 
pose of  preventing  gambling  in  policies,  and  to  guard  society  against 
the  risk  of  persons  insuring  contriving  the  death  of  the  insured  for 
the  sake  of  the  payments  to  be  made  under  the  policy  ;  but  its  effect 
is  simply  to  render  the  policy  void ;  it  does  not  require  that  the 
premiums  shall  be  refunded,  nor  does  it  award  any  penalty  on  the 
offenders.  As  policies  of  life-insurance  may  be  bought  and  sold 
like  other  property,  they  may  fall  into  the  hands  of  persons  who 
have  no  other  interest  in  them  than  the  desire  that  such  policies 
should  speedily  become  claims  by  the  death  of  the  insured.  The 
interest  of  such  holders,  it  has  been  justly  observed,  lies  in  the  death 
and  not  in  the  life  of  the  insured. 

[In  a  recent  case  in  Pennsylvania,  Elliotts  Executor's  Ap.  14 
Wright,  75,  it  was  decided  that  the  assignment  of  policies  of  life  in- 
surance by  a  debtor  who  was  insolvent  when  insured,  in  trust  for 
the  benefit  of  his  wife,  is  fraudulent  and  void  as  against  creditors. 
But  that  policies  effected  without  fraud  directly  and  on  their  face  for 
the  benefit  of  the  wife  and  payable  to  her,  are  not  fraudulent  as  to 
creditors. — P.] 

A  case  is  related '  in  which  a  man  was  found  dead  at  St.  Fergus, 
in  Scotland,  from  a  pistol-shot  wound  under  very  suspicious  circum- 
stances. The  medical  and  moral  facts  were  not  consistent  with  the 
theory  of  suicide  ;  on  the  contrary,  they  all  pointed  to  a  cool  and 
deliberate  act  of  murder.  A  medical  man  was  placed  on  his  trial 
for  this  alleged  crime,  and  the  motive  assigned  for  the  act  was  that 
the  prisoner  had  recently  effected  insurances  in  three  different 
offices  to  the  amount  of  about  2,000/.,  upon  the  life  of  the  deceased 
— a  poor  man,  in  whose  life  it  was  proved  he  could  have  had  no 
lawful  pecuniary  interest.  The  insurances  were  only  for  short 
periods,  and  as  in  the  Scotch  Offices  the  policies  are  not  rendered 
void  by  suicide,  the  amounts  could  be  claimed  even  assuming  that 
the  deceased  had  destroyed  himself.  The  body,  weapon,  and  other 
objects  had,  it  was  supposed,  been  arranged  with  a  view  to  make  it 
appear  that  the  act  was  suicidal.     It  is  a  significant  fact,  however, 

1  [Taylor's  Piinc.  and  Prac.  of  Med.  Jurisp.,  p.  537.] 


762  PERPETRATION    OF    MURDER 

as  a  key  to  explain  the  death  of  the  deceased  and  the  motive  of  the 
accused,  that  the  risk  connected  with  the  largest  insurance  (1,000/.) 
commenced  on  the  24th  November,  1852,  and  terminated  on  the  21th 
November,  1853.  Only  one  premium  to  the  amount  of  about  eleven 
pounds  had  been  paid,  and  tins  payment  was  proved  to  have  been 
made  by  the  prisoner.  The  deceased  was  found  dead  on  the  20th 
November,  1853 ;  i.  e.  only  four  days  before  the  date  at  which  the 
policy  of  insurance  on  his  life  would  have  lapsed.  The  evidence 
went  to  show  that  the  accused  had  the  motive,  means,  and  oppor- 
tunhVy  of  committing  this  crime;  but  as  there  were  no  circumstances 
which  could  directly  fix  it  upon  him,  he  was  acquitted  of  the 
charge. 

A  remarkable  case  was  tried  in  this  country  in  1835  {Wainwright 
v.  Bland,  Exchequer,  29th  June,  1835),  in  which  the  amount  of  a 
policy  of  insurance  effected  for  two  years  on  the  life  of  a  Miss 
Abercromby  was  sought  to  be  recovered.  The  action  was  brought 
against  the  Directors  of  the  Imperial  Assurance  Company,  and  was 
resisted  by  them  on  the  grounds  that  the  lady  had  been  destroyed 
by  poison,  and  that  the  plaintiff  Wainwright  had  no  lawful  pecuni- 
ary interest  in  her  life.  As  there  is  strong  reason  to  believe  that 
this  was  one  of  the  first  murders  brought  about  by  the  use  of  strych- 
nia in  this  country,  it  may  be  considered  as  the  type  of  those  which 
twenty-one  years  afterwards  were  for  a  time  successfully  perpetrated 
by  the  criminal  William  Palmer.  Strychnia  had  been  discovered 
only  twelve  years  previously,  and  it  was  then  but  little  known  as  a 
poison  either  in  England  or  France.  The  history  of  the  case  is  re- 
markable, as  the  .real  cause  of  death  was  completely  overlooked. 
Two  fine-looking  young  women  of  the  name  of  Abercromby,  the 
daughters  of  a  deceased  officer,  with  no  other  property  than  pen- 
sions of  ten  pounds  a  year  from  government,  lived  a  few  miles  out 
of  town  with  a  man  of  the  name  of  Wainwright  and  his  wife,  who 
were  also  in  reduced  circumstances.  They  came  to  London  in  1830, 
as  the  winter  was  setting  in,  and  took  lodgings.  The  elder  girl, 
having  just  attained  her  twenty-first  year,  was  sent,  sometimes  alone 
and  sometimes  with  her  sister,  to  no  fewer  than  eight  or  ten  insurance 
offices,  to  effect  insurances  at  each  on  her  own  life.  Being  in  full  and 
vigorous  health,  she  met  with  a  favorable  reception  from  several 
offices,  although  she  could  assign  no  other  reason  for  wishing  to  in- 
sure her  life  than  that  she  was  told  it  was  right  for  her  to  do  so. 
Five  offices  granted  policies  in  her  own  name,  some  for  two,  others 
for  three  years,  for  no  less  a  sum  than  16,000?.  Among  them  the 
Imperial,  in  October,  1830,  accepted  an  insurance  on  her  life  for  two 
years  for  3,0007.  On  the  13th  of  the  following  December,  when  in 
perfectly  good  health,  she  made  her  will,  and  assigned  this  and  other 
policies  to  the  plaintiff  Wainwright  and  his  wife.  On  the  evening 
of  this  day  the  whole  party  went  to  a  public  theatre,  and  on  their 
return  had  a  supper  of  oysters  and  porter.  On  this  occasion  Miss 
Abercromby  was  first  taken  ill;  it  was  said  she  suffered  from  an 
hysterical  attack,  but  there  is  no  clear  account  of  her  illness  at  this 
time.     It  was  not  until  the   16th  that  she  was  seen  by  a  physician, 


FOR    THE    AMOUNT    OF    THE    POLICY.  763 

but  her  illness  was  not  such  as  to  excite  alarm  ;  it  was  supposed  to 
be  hysterical.  On  the  21st  this  physician  was  called  suddenly  to 
her,  and  he  then  found  her  in  violent  tetanic  convulsions,  resembling 
those  which  are  sometimes  the  effects  of  a  wound,  i.  e.,  tetanus.  She 
said  she  was  sure  she  should  die,  and  she  suddenly  went  off  into  a 
fit  of  convulsions.  The  physician  left  the  house,  returned  in  about 
an  hour,  and  she  was  then  just  dead.  The  appearances  presented 
by  the  body  are  imperfectly  reported ;  there  was  an  effusion  of  serum 
at  the  base  of  the  brain,  and  to  this  death  was  referred.  There 
was  no  analysis  of  the  contents  of  the  stomach ;  it  is  said  they  were 
minutely  examined,  and  that  there  was  no  appearance  of  anything 
sufficient  to  account  for  death  ;  but  the  person  to  whom  this  examina- 
tion was  intrusted  was  not  called  to  the  trial. 

Wainwright,  as  executor  and  trustee,  applied  for  payment  of  two 
of  the  policies  which  had  been  assigned  to  him,  but  this  was  refused. 
He  then  went  to  France  with  his  family,  and  five  years  afterwards 
(in  1885),  through  an  agent,  brought  an  action  against  the  Imperial 
Assurance  Company.  On  this  occasion  the  jury  could  not  agree  in 
a  verdict.  ("  Med.  Gaz.,"  vol.  16,  p.  606.)  Another  action  was  after- 
wards brought  against  the  company,  and  the  facts  above  stated  came 
out  at  the  trial.  The  Attorney-General  said  that  the  plaintiff  had 
left  the  country,  and  there  was  good  reason  to  believe  that  he  would 
never  again  return  to  it.  The  judge  charged  the  jury  that,  whether 
murder  had  been  committed  or  not,  the  executors  could  recover, 
provided  the  insurance  had  been  effected  hand  fide  on  behalf  of  the 
deceased.  His  lordship  directed  their  attention  to  the  extraordinary 
fact  of  this  young  lady,  the  deceased,  having  effected  these  large 
insurances  for  only  two  years ;  of  her  sudden  illness  and  death  in 
convulsions  soon  after  the  assignment  of  the  policy  ;  and  reminded 
them  that  no  proof  had  been  adduced  to  substantiate  the  reasons  she 
had  given  to  the  various  offices  for  effecting  the  insurances  on  her 
life.  By  the  will  and  assignment  made  to  the  plaintiff  and  his  wife, 
these  persons  were  placed  in  a  situation  in  which  the  law  would  not 
allow  any  one  to  stand — namely,  that  of  having  a  strong  interest  in 
procuring  the  death  of  a  fellow-creature  by  unlawful  means.  The 
jury  returned  a  verdict  for  the  insurers,  on  the  ground  of  misrepre- 
sentation and  want  of  interest. 

There  can  be  no  doubt  that  this  young  woman  died  from  the  ef- 
fects of  a  dose  of  strychnia,  administered  to  her  shortly  before  she 
was  seen  by  the  physician  on  the  afternoon  of  the  21st  December. 
Tetanus  as  it  is  produced  by  this  poison  is  rapidly  fatal ;  but  as  it 
arises  from  wounds  it  comes  on  slowly,  and  is  only  fatal  after  some 
•lays,  and  there  was  no  wound  or  other  natural  cause  to  account  fur 
its  occurrence.  Wainwright  was  subsequently  tried,  convicted  of 
forgery,  and  transported.  He  died  many  years  afterwards  in  one  of 
our  penal  settlements,  and,  before  his  death,  it  is  reported  that  he 
substantially  admitted  that  he  destroyed  Miss  Abercromby  and 
several  other  persons  by  strychnia. 

Some  of  the  poisonings  which  took  place  at  Rugeley  in  1855-6, 
and  which  culminated  in  the  conviction  and  execution  of  the  noto- 


764  PERPETRATION    OF    MURDER 

rious  William  Palmer  for  the  murder  of  J.  P.  Cook,  originated  in  the 
easy  system  of  raising  money  by  the  insurance  of  lives.  The  body 
of  Ann  Palmer,  the  wife  of  the  prisoner,  had  been  lying  fifteen 
months  in  the  grave,  under  a  professional  burial-certificate  of  death 
from  bilious  cholera,  when  the  sudden  death  of  Cook  and  the  detec- 
tion of  antimony  in  his  body  led  to  the  exhumation  of  the  body  of 
this  lady.  It  was  then  found  that  she  had  died  from  the  effects  of 
antimony,  which  was  detected  by  Dr.  Keesand  myself  in  all  parts  of 
the  body,  even  in  the  ovaries.  When  the  history  of  the  illness 
which  preceded  death  was  gone  into,  it  was  found  that  the  symptoms 
were  consistent  with  the  effects  of  tartarized  antimony,  but  not  with 
those  of  bilious  cholera  or  any  other  disease.  Antimony  had  not 
been  prescribed  for  the  deceased  during  her  illness,  and  it  was  there- 
fore clear  that  it  must  have  been  administered  to  her  by  some  one 
up  to  within  a  short  period  of  her  death.  With  an  actual  life-inter- 
est in  his  wife's  property  to  the  extent  of  only  3,000/.,  and  within 
the  short  period  of  nine  months  of  her  death,  William  Palmer  made, 
or  caused  to  be  made,  proposals  for  insuring  her  life  in  eight  different 
offices  for  an  aggregate  sum  of  33,000/.  Three  of  these  proposals  made 
by  himself — to  the  Norwich  Union  in  December,  1853,  for  3,000/.; 
to  the  Scottish  Equitable  in  January,  1854,  for  5,000/. ;  and  to  the 
Sun  in  February,  1854,  also  for  5,000/. — were  accepted  by  these 
offices.  He  thus  contrived  in  less  than  three  months  to  effect  a  total 
insurance  of  13,000/.,  to  cover  a  life-interest  of  3,000/.  on  his  wile's 
property  !  The  other  proposals,  to  the  amount  of  about  20,000/., 
were  declined  by  the  offices  to  which  he  applied.  The  total  premi- 
ums paid  by  Palmer  on  the  three  policies  amounted  to  388/. ;  and  he 
was  at  the  time  so  pressed  for  money,  that  he  drew  a  bill  which  was 
actually  discounted  on  the  security  of  the  policies,  so  that  he  con- 
trived to  make  the  policies  pay  for  themselves.  As  he  was  in  em- 
barrassed circumstances,  and  unable  to  meet  bills  of  this  kind  without 
becoming  still  more  deeply  involved  in  debt,  the  realization  of  the 
policies  by  the  death  of  his  wife  became  to  him  a  matter  of  neces- 
sity. Within  little  more  than  six  months  after  effecting  the  insur- 
ances on  her  life,  the  wife  died  from  poison  under  his  immediate 
superintendence.  On  her  death  these  large  sums  were  claimed  by 
Palmer,  and  were  paid  to  him  by  the  offices.  Although  there  was 
at  the  time  some  suspicion  that  the  wife  had  died  from  poison,  there 
was  no  inquest  or  inspection,  and  the  body  was  hastily  buried.  These 
facts  only  came  to  light  more  than  a  year  afterwards,  during  the  in- 
vestigation of  another  murder  in  1855.  It  seems  that  the  general 
respectability  of  Palmer,  his  social  and  professional  position,  together 
with  the  two  medical  certificates  of  the  cause  of  the  death  of  the 
wife,  checked  any  intention  which  might  have  existed  on  the  part  of 
the  offices  to  resist  the  payment  of  the  policies.  William  Palmer, 
however,  carried  his  life-insurance  speculations  much  further  than 
this.  Having  no  pecuniary  interest  whatever  in  the  life  of  his  brother 
Walter  Palmer,  he  either  made  or  induced  him  to  make  proposals 
for  the  insurance  of  his  life,  in  various  offices,  to  the  amount  of 
82,000/..   The  Prince  of  Wales  office  accepted  the  proposals  to  the 


FOR    THE    AMOUNT    OF    THE    POLICY.  765 

extent  of  13,000/.,  under  certain  limitations.  On  the  16th  August, 
1855,  Walter  Palmer  died  suddenly,  in  the  presence  of  his  brother 
and  another  man  of  doubtful  character,  with  whom  he  had  recently 
placed  him  as  a  lodger,  and  it  was  rendered  highly  probable,  if  not 
proved,  that  the  prisoner  William  had  shortly  before  purchased  at  a 
druggist's  a  bottle  of  prussic  acid.  The  policy  had  been  previously 
assigned  by  Walter  to  William,  for  a  nominal  consideration;  but 
when  William  Palmer  made  application  for  the  amount  after  the 
death  of  his  brother,  the  office  refused  payment ;  and,  for  very  good 
reasons,  Palmer  failed  to  enforce  it.  He  subsequently  tried,  but  in- 
effectually, to  insure,  to  the  extent  of  25,000/.,  the  life  of  his  groom, 
George  Bates,  described  by  him  in  his  proposal  as  a  "gentleman"  of 
independent  means  ;  and  he  advised  a  man  named  Cheshire,  the  post- 
master of  Rugeley,  also  to  make  proposals  on  his  life  to  the  extent 
of  5,000/.  and  assign  the  policies  to  him.  But  for  the  revelation  of 
facts  connected  with  the  death  of  Cook,  these  two  persons,  on  whose 
heads  a  heavy  life-insurance  value  had  thus  been  set,  would  have 
been  the  next  victims.  Thuggism,  as  formerly  perpetrated  in  India 
by  a  certain  class  of  Hindoos,  might  be  regarded  as  a  venial  offence 
compared  with  this  professional  mode  of  raising  large  sums  of  money 
upon  human  life. 

It  is  now  the  custom  of  Offices  to  require  a  statement  whether  the 
life  has  been  already  proposed  to  other  Offiees,  and  whether  the 
proposal  has  or  has  not  been  accepted.  But  this  is  only  a  partial 
method  of  checking  such  nefarious  speculations.  In  France  and 
most  Continental  States  insurances  of  this  kind  are  said  to  be  strictly 
forbidden,  not  for  the  prevention  of  gambling  (which  is  rather  en- 
couraged), but  in  order  to  guard  society  against  the  risk  of  the  persons 
insuring  contriving  the  death  of  the  insured.  That  these  regulations 
are  not  sufficient  to  guard  against  secret  murder  and  speculation  in 
human  life  is,  however,  clearly  established  by  the  case  of  Dr.  De  la 
Pommerais,  who,  in  May,  186-1,  was  convicted  in  Paris  of  the  murder 
of  a  woman  name  Pauw.  The  reader  will  find  an  aecount  of  the 
medical  circumstances  connected  with  this  act  of  murder,  which 
equals,  if  it  does  not  surpass  in  atrocity,  the  murders  perpetrated  by 
William  Palmer  on  his  wife  and  brother,  on  p.  361:  of  "  The  Princi- 
ples and  Practice  of  Medical  Jurisprudence." 

De  la  Pommerais  had  first  eohabited  with  the  deceased.  Having 
thrown  her  off,  he  married,  in  August,  1861,  a  lady  of  some  fortune, 
Madlle.  Dubizy.  Some  time  after  the  marriage,  the  mother  of  this 
lady  died  under  very  suspicious  circumstances,  as  it  was  supposed, 
from  poison  administered  by  the  prisoner.  In  June,  1863,  he  sud- 
denly and  without  any  apparent  cause  renewed  his  intimacy  with 
the  deceased  Pauw,  who  was  living  in  great  poverty  with  several  of 
her  children.  Having  advanced  to  her  small  sums  of  money, 
amounting  on  the  whole  to  about  27/.,  he  induced  her  to  insure  her 
liir  in  various  Insurance  Offices  for  the  sum  of  22,000/.,  and  after- 
wards to  assign  the  policies  to  him.  The  reasons  which  he  gave  for 
effecting  these  insurances  were — partly  that  he  had  advanced  to  the 
deceased  large  sums  of  money  (4,000/.),  and  partly  that,  in  the  event 


766  INSURANCE    MURDERS. 

of  her  death,  he  wished  to  provide  for  his  illegitimate  children. 
The  first  statement  was  proved  to  be  untrue,  and  the  second  was 
inconsistent  with  the  claims  which  he  subsequently  made  on  the 
Offices.  The  woman  was  examined,  found  to  be  in  good  health,  and 
insurances  on  her  life  were  effected  for  two  or  three  years  to  the 
large  amount  above  stated.  La  Pommerais  paid  the  first  premiums, 
amounting  to  600Z.  He  had  thus  entered  into  engagements  for  three 
years  to  pay  in  premiums  a  sum  of  about  800?.  per  annum,  when 
his  practice  did  not  bring  in  more  than  400?.  per  annum,  and  he  had 
no  other  resources.  He  induced  the  deceased  to  feign  that  she  was 
ill  and  had  met  with  an  accident ;  but  the  surgeons  and  physicians 
whom  she  consulted  found,  on  examination,  that  there  was  nothing 
the  matter  with  her,  with  the  exception  of  a  few  attacks  of  vomit- 
ing. She  continued  well  up  to  the  16th  of  November,  when  the 
prisoner  visited  her  and  passed  the  evening  with  her.  She  was 
taken  very  ill  that  night,  and  after  violent  vomiting  and  convul- 
sions, with  fainting,  she  died  on  the  morning  of  the  17th,  as  it  was 
proved,  from  the  effects  of  digitaline,  a  large  quantity  of*  which  the 
prisoner  had  purchased  some  time  before,  and  of  the  disposal  of 
which  he  could  give  no  satisfactory  account.  He  found  no  diffi- 
culty, however,  in  procuring  a  medical  certificate  to  the  effect  that 
deceased  had  died  from  gastritis  and  perforation  of  the  stomach. 
The  policies  of  assurance  had  been  assigned  to  him  by  the  deceased 
shortly  before  her  death,  and  it  was  the  early  claim  which  he  put  in 
for  the  payment  of  them  that  first  led  to  suspicion.  There  was  no 
answer  to  the  charge  of  murder  by  the  administration  of  digitaline, 
and  the  prisoner  was  convicted  and  executed. 

The  proper  method  to  stop  this-  secret  system  of  murder  would 
be  by  placing  severe  legal  restrictions  on  the  sale  or  assignment  of 
policies,  and  by  preventing  the  purchase  of  them  by  strangers,  who 
can  only  have  an  interest  in  the  death  of  the  insured  at  the  earliest 
possible  period.  The  burial-club  murders  are  said  to  have  been 
much  checked  by  a  regulation  which  prohibited  a  person  from  re- 
covering under  this  species  of  insurance  more  than  the  amount 
proved  to  have  been  actually  paid  for  the  funeral. 


INDEX. 


Abdomen,  wounds  of  the,  294 
Abortion,  444 

causes  of,  445 

from  drugs,  448 

from  injections,  456 

signs  of  in  the  living  and  dead,  456 

feigned,  458 

law  relative  to,  458 

medical  responsibility  in  cases  of,  464 

proofs  required,  465 
Abortives,  specific,  449 
Abstinence,  effects  of,  414 
Accidental  wounds,  217,  228 
Acetate  of  lead,  135 

of  copper,  138 

of  morphia,  167 
Acetic  acid,  103 
Acid,  sulphuric,  90 

nitric,  93 

hydrochloric,  97 

oxalic,  98 

tartaric  and  acetic,  102 

arsenious,  112 

arsenic,  126 

prussic,  170 

carbonic,  381 

sulphurous,  390 

tartaric,  102 

hydrosulphuric,  395 
Acid  poisons,  90 
Aconitina,  200 
Aconite,  poisoning  with,  197 

root  mistaken  for  horseradish,  199 

leaves  and  seeds  of,  199 
Aconitum  napellus,  197 
jEthusa  cynapium,  196 
Affiliation,  evidence  in  cases  of,  563,  581 
Age,  medical  questions  concerning,  539 

for  procreative  power,  579,  589 

impotency  depending  on,  581 

ofthe  new-born  child,  rules  for  determin- 
ing, 467 
Air,  in  veins,  a  cause  of  death,  292 

confined,  suffocation  from,  392 

of  drains  and  sewers,  composition  of,  401 
Alcohol,  poisoning  with,  178 
Algaroth,  powder  of,  143 
Alienation,  mental  (see  Insanity),  629 
Alkalies,  poisoning  with,  104 
Allotropic  phosphorus,  action  of,  111 
Almond-flavor,  175 
Almonds,  bitter,  essential  oil  of,  175 
Aloes,  noxious  effects  of,  147 
Ambidextrous  persons,  wounds  by,  229 
Amenorrhea,  424 

a  cause  of  insanity,  590 


Amentia,  637 

Ammonia,  poisoning  by,  105 
Ammoniated  mercury,  133 
Ammonio-chloride  of  mercury,  134 
Amnii,  liquor,  stains  of,  465 
Amorphous  phosphorus,  112 
Analysis,  articles  preserved  for,  26 

fallacies  connected  with,  27 
Anamirta  cocculus,  182 
Androgyni  and  androgynae,  569 
Animal  irritants,  151 
Antimony,  tartarized,  poisoning  by,  141 

chronic  poisoning  by,  141 

chloride  of,  145 
Apnoea,  death  from,  319 
Aqua-fortis,  93 
Areolae  of  the  breasts,  state  of,  in  pregnancy, 

420 
Arrowroot,  detection  of,  498 
Arsenates,  alkaline,  poisoning  by  the,  126 
Arsenic,  112 

eating,  66 

symptoms  caused  by,  112 

post-mortem  appearances,  113 

death  from  external  application  of,  114 

analysis  as  a  solid,  115 

in  solution,  117 

Marsh's  process  for,  118 

Reinsch's  process  for,  118,  123 

detection  of,  in  organic  mixtures,  119 

sulphides  of,  127 

acid,  126 
Arsenious  acid  (see  Arsenic),  112 
Arsenites,  alkaline,  poisoning  by,  125 
Arsenite  of  copper,  125 

in  paper-hangings,  126 
Arsenuretted  hydrogen,  fatal  effects  of,  127 

tests  for,  118 
Arteries,  wounds  of,  291 
Arterial  and  venous  blood,  243 
Artificial  inflation  ofthe  lungs,  485 
Asphyxia,  death  from,  55 

various  forms  of,  319 

from  mechanical  causes,  370 

from  gases,  380 
Assizes,  trial  at  the,  38 
Atelectasis  ofthe  lungs,  480 
Atelectasis  a  cause  of  still-birth,  509 
Atropa  belladonna,  201 
Atropia,  203 
Attesting  witnesses,  678 

Bacon,  155 

Ballottement  in  pregnancy,  424 
Balls,  apertures  produced  by,  305 
deflection  of,  306 


768 


INDEX, 


Barber's  poisoned  wheat,  183 
Barium,  chloride  of,  107 
Baryta,  poisoning  by,  107 
Bastardy,  adulterine,  543 
Battle's  vermin  killer,  187 
Bearsfoot  (Hellebore),  149 
Belladonna,  201 
Bestiality,  625 
Bichloride  of  mercury,  128 
Binoxalate  of  potash,  102 
Birth,  concealment  of,  442 

proofs  of,  in  criminal  law,  492 

date  of,  531 

partial  and  entire,  532 

proof  of,  in  civil  law,  533 

plural,  541 

monstrous,  541 
Births,  premature,  551 

protracted,  554 

posthumous,  565 
Bitter  almonds,  essential  oil  of,  175 
Black  hellebore,  149 
Bladder,  rupture  of  the,  287 
Blistering-fly,  poisoning  by,  151 
Blood  on  weapons,  233 

on  clothing  and  furniture,  235 

marks  of,  in  death  from  wounds,  236 

tests  for,  238 

arterial  and  venous,  243 

corpuscles  of,  244 

on  linen,  24(1 

human  and  animal,  247 

optical  examination  of,  250 

loss  of,  a  cause  of  death,  252 

extravasation  of,  on  the  brain,  279 

in  cases  of  abortion,  465 

in  stomachs  of  new-born  children,  500 

menstrual,  623 
Blood-crystals,  249 
Blood-stains,  examination  of,  238 

on  linen,  239 

date  of,  239,  251 

distinguished  from  rust  and  fruit  stains, 
241 

microscopical  examination  of,  244 

spectral  examination  of,  250 

in  cases  of  abortion,  465 

of  rape,  623 
Blows  or  falls,  injuries  produced  by,  218 
Blue  vitriol,  139 

rocket,  197 
Body,  cooling  of  the,  in  death,  5S 

destruction  of  the,  by  fire,  315 

specific  gravity  of  the,  331 

inspection   of  the,  in  cases  of  poisoning, 
22 

position  of  the,  in  death    from  wounds, 
232 

position  of  the,  in  death  from  hanging, 
351 
Bones,  fractures  of  the,  300 
Books,  quotations  from,  46 
Born  alive,  signification  of,   in  criminal  and 

civil  law,  492,  533 
Brain,  wounds  of  the,  285 
Breasts,  changes  in  pregnancy,  420 
Brick-kilns,  vapor  of,  391 
Broom-tops  as  an  abortive,  448 
Brucia,  effects  of,  191 

Buoyancy  of  the  body,  living  and  dead,  331 
Burnett's  fluid,  poisoning  with,  145 
Burning,  homicidal,  315 


Burns  and  scalds,  311 

on  the  living  and  dead  body,  "13 

the  result  of  accident,   homicide  or  sui- 
cide, 315 

by  corrosive  liquids,  317 

from  lightning,  404 
Butler's  vermin  killer,  187 
Butter  of  antimony,  145 

Cadaveric  rigidity,  58 
Cesarean  extraction,  536 
Camphor,  poisoning  with,  181 
Canalis  venosus,  closure  of  the,  496 
Cantharides,  effects  of,  151 

detection  of,  152 
Cantharidine,  152 
Capacity,  testamentary,  672 

test  of,  672 
Carbonates  of  potash  and  soda,  104 

of  ammonia,  105 

of  baryta,  108 

of  lead,  137 
Carbonic  Acid,  suffocation  by,  331 

symptoms  caused  by,  383 

appearances  in  death  from,  384 

analysis,  384 

combustion  in  mixtures  of,  385 

of  lime  and  brick-kilns,  391 
Carbonic  oxide,  386 

Carburetted  hydrogen,  suffocation  by,  393 
Carnal  knowledge,  597 
Carotid  arteries,  wounds  of  the,  292 
Catamenia  (see  Menstruation),  418 
Caustic  alkalies,  poisoning  with,  104 
Cement-kilns,  vapors  of,  391 
Cephalamiatoma  in  infanticide,  51S 
Cerebral  or  narcotic  poisons,  70,  165 
Cerebro-spinal  poisons,  70 
Certificates  of  insanity,  rules  regarding,  650 
Ceruse,  poisoning  by,  13S 
Cesspools,  effluvia  of,  400 
Charcoal  vapor,  effects  of,  386 
Chest,  wounds  of  the,  287,  294 

changes  produced  in  the,  by  respiration, 

i:;. 

Child-murder,  466.      (See  Infanticide.) 
Child,  legal  definition  of  a,  443 

new-born,  age  and  maturity  of,  from  the 
sixth  to  the  ninth  month,  46S 

evidence  from  development  of,  54S 

inspection  of  the  body  of,  470 

changes  in  the  body  of  the,  after  birth, 
496 
Children,  supposititious,  474 
Chloride  of  barium,  107 

of  mercury,  128 

of  antimony,  145 

of  zinc,   145 

of  iron,  145 
Chloroform,  poisoning  with,  179 
Cholera  mistaken  for  poisoniug,  75 
Cholesterine,  503 
Chronic  poisoning,  SO 

by  phosphorus,  109 

by  arsenic,  113 

by  mercury,  129 

by  lead,  138 

by  antimony,  142 
Chronic  insanity,  638,  646 
Cicuta  virosa,   194 
Cider  poisoned  with  lead,  138 
Circulation,  cessation  of  the,  in  death,  57 


INDEX. 


769 


Circulation,  foetal  changes  in  the,  497 
Circumstantial  evidence,  in  wounds,  231, 
Citrate  of  iron  mistaken  for  blood,  243 
Classification  of  poisons,  68 
Coal-vapor,  effects  of,  390 

gas,  suffocation  by,  393 
Cocculus  indicus,  poisoning  with,  182 
Coke-vapor,  effects  of,  390 
Colchicina,  145 

Colchicum,  poisoning  with,  148 
Cold,  death  from,  410 

infanticide  by,  515 
Coldness  of  the  body  in  death,  58 
Colic,  painter's,  138 
Colica  pictonum,  138 
Colocynth,  effects  of,  147 
Color-test,  influence  of  morphia  in  disguising, 

190 
Colostrum  of  milk,  499 
Coma,  or  death  by  the  brain,  56 
Combustion,  human,  alleged,  315 

in  carbonic  acid  and  air,  385 
Commissions  of  lunacy,  658,  667 
Compression  of  the  brain,  280 
Concealment  of  pregnancy,  425 

of  delivery,  430 

of  birth,  442 
Conception,  date  of,  544 
Concussion  of  the  brain,  277 

and  intoxication,  278 
Concussion  of  the  spinal  marrow,  286 
Confessions  in  drunkenness,  709 
Confined  air,  effects  of,  392 
Congenital  diseases  in  new-born  children,  509 
Conia,  194 

Conium  maculatum,  poisoning  with,  193 
Contracts  of  lunatics,  669 
Contused  wounds,  218 
Contusions  on  the  living  and  dead,  214 
Cooling  of  the  body  after  death,  58 
Copper,  arsenite  of,  125 

poisoning  by  salts  of,  139 

in  articles  of  food,  141 
Copperas,  poisoning  with,  145 
Cord,  umbilical,  death  from  laceration  of,  50,7 

length  of  the,  526 

strangulation  by  the.  522 
Cord,  mark  of  the,  in  hanging,  344 

in  strangulation,  355 
Coroner's  inquests,  36 
Corpora  lutea,  439 

Corrosion  distinguished  from  ulceration,  83 
Corrosive  liquids,  burns  from,  317 
Corrosive  poisons,  68 

Coiirosive  Sublimate,  symptoms  of  poison- 
ing with,  128 

post-mortem  appearances,  130 

tests  for,  131 

in  organic  liquids,  131 
Counsel,  license  of,  40 

privileges  of,  45 
Courtesy,  tenancy  by,  535 
Cranium,  fractures  of  the,  284 

accidental  in  the  new-born  child,  518 
Cretins,  641 

Criminal  abortion,  444.      (See  Abortion.) 
Criminal  responsibility  in  insanity,  678 

in  drunkenness,  709 

somnambulism,  716 

in  deafness  and  dumbness,  719 
Croton  oil,  poisoning  with,  148 
Crying  evidence  of  live  birth,  535 

41) 


Crypsorchides,  virility  of,  583 
Cuts  and  stabs,  220 
Cyanide  of  silver.  172 
of  potassium,  174 

Dalby's  carminative,  167 
Date  of  birth,  531 

of  conception,  546 
Datura  stramonium,  207 
Daturia,  207 

Dead,  wounds  and  contusions  on  the,  212 
Dead  body,  examination  of  the,  22 

burning  of  the,  315 
Deadly  nightshade,  201 
Deaf  and  dumb,  718 
Deafness  and  dumbness,  feigned,  719 
Death,  signs  of,  57 

causes  of  sudden,  56 

muscular  irritability  after,  58 

reality  of,  59 

apparent  in  new-born  children,  481 

acceleration  of,  in  personal  injuries,  259 

from  surgical  operations  on  wounded  per- 
son, 270 

proof  of  in  cases  of  life  insurance,  722 

presumption  of,  724 
Debility,  death  of  a  new-born  child  from,  506 
Decay,  food  rendered  poisonous  by,  153 
Declarations  of  dying  person,  21,  32 
Defloration,  signs  of,  608 
Deformities,  evidence  from,  562 
Deformity,  sexual,  569 

of  the  face  from  wounds,  285 
Delirium  mistaken  for  insanity,  638 
Delirium  tremens,  following  wounds,  270 

in  reference  to  insanity,  650 

in  drunkards,  711 
Delivery,  430 

in  the  living,  431 

at  a  remote  period,  433 

feigned  and  unconscious,  434 

during  sleep,  436 
Delivery,  signs  of,  in  the  dead,  457 

protracted  death  of  the  child  from,  507 

sudden,  in  the  erect  posture,  519 

violence   inflicted  on    the    child    during, 
511,  521 

locomotion  and  exertion  after,  521 
Delusion  in  insanity,  635 

in    reference    to   testamentary  capacity, 
672 
De  lunatico  inquirendo,  658 
Dementia,  640 

senile,  643 
Dementia  naturalis,  accidentalis,  633 
Derangement,  mental,  629 
Destructive  things,  63 
Development  of  child,  evidence  from,  548 
De  ventre  inspiciendo,  writ  of,  428 
Diaphragm,  wounds  of  the,  293 
Digitalis,  poisoning  with,  205 
Digitaline,  206 
Dipsomania,  708 
Direction  of  wounds,  227 
Discharge  of  lunatics,  657 
Diseased  flesh,  poisonous,  152 
Disease,  influence  of,  on  poisons,  71 
Dislocations,  303 

Divorce,  medical  evidence  in  suits  of,  594 
Docimasia  pulmonaris,  479 

circulationis,  496 
Doubtful  sex,  569 


770 


IXDEX. 


Drains  and  sewers,  noxious  gases  of,  398 
Dress,   examination  of  the,  in  wounds,   221, 

223 
Dripping  poisoned  with  lead,  138 
Drowning,  cause  of  death  from,  321 

death  from  secondary  causes  in,  322 
appearances  in,  322 
medical  proofs  of,  326 
buoyancy  of  the  body  in,  331 
marks  of  violence  in  cases  of,  333 
homicidal  or  suicidal,  335 
from  partial  immersion,  335,  514 
a  cause   of  death  in  new-born  children, 
514 
Drugs  used  as  abortives,  458 
Drunkards,  restraint  of,  711 
Drunkenness,  responsibility  in  cases  of,  708 
interdiction  in  cases  of  habitual,  667,  711 
as  affecting  degree  of  guilt  in  homicide, 
712 
Ductus  arteriosus,  closure  of,  497 
Dumb,  responsibility  of  the,  718 
Dyes,  red,  mistaken  for  blood,  241 
Dying  declarations,  rules  respecting,  21,  32 

Earthenware,  wounds  from,  218 
Eccentricity  mistaken  for  insanity,  639 

in  wills,  673 
Ecchymosis,  from  violence,  213 

changes  of  color  in,  214 

production  of,  after  death,  215 

not  always  a  result  of  violence,  215 

in  hanging,  344 

in  strangulation  by  the   umbilical  cord, 
523 

natural  marks  resembling,  527 

caused  by  lightning,  407 
Eclampsia,  435 
Eczema  from  arsenic,  113 
Effusion  of  blood  (see  Extravasation),  279 
Effluvia  of  drains  and  sewers,  398 
Electric  fluid,  action   of,  402.      (See  Light- 
ning.) 
Embryo,  examination  of  the,  440 
Emerald  green,  poisoning  with,  125 
Emetic,  tartar,  poisoning  with,  141 
Epispadias,  586 
Epithelial  scales,  500 
Ergotin,  451 

Ergot  of  rye  as  an  abortive,  449 
Erysipelas  following  wounds,  269 
Essence  of  mirbane,  177 
Essential  oil  of  almonds,  175 
Ether,  poisoning  with,  179 
Evidence  and  testimony,  51 
Evidence,  medical,  40 

rules  for  the  delivery  of,  50 
Evidence  of  poisoning  in  the  living,  70 

in  the  dead,  78 

notes,  when  and  how  used  in,  27 

circumstantial,  in  wounds,  231 
Examination  in  chief,  44 

cross,  45,  48 
Examination  of  wounds,  211 

of  weapons,  216,  220 

of  fire-arms,  310 

the  female  in  child-murder,  530 

of  lunatics,  660 
Excitement  a  cause  of  extravasation,  2S2 
Exhaustion,  death  from,  256 
Exhumation  of  bodies,  24 
Extent  of  wounds,  226 


Extract,  Goulard's,  poisoning  with.  I'm 
Extravasation  of  blood  on  the  brain,  279 
date  of,  283 

Face,  wounds  of  the,  285 

Facts,  specification  of,  in  insanity,  654 

Family  likeness,  evidence  from,  561 

Fasting,  long,  effects  of,  414 

Fatuity,  643 

Fat  poisoned  by  lead  glaze,  138 

Features,  evidence  from  the,  561 

Fecundity  in  women,  592 

Feigned  poisoning,  76 

wounds,  222 

strangulation,  367 

pregnancy,  425 

menstruation,  419 

delivery,  434 

abortion,  458 

insanity,  645 

deafness  and  dumbness,  719 
Fern,  decoction  of,  as  an  abortive,  448 
Fever,  death  from,  after  wounds  and  opera- 
tions, 262 
Fire-arms,  examination  of,  310 
Fish,  poisonous,  153 
Flagellation,  death  from,  256 
Fleming's  tincture  of  aconite,  198 
Flesh,  diseased,  poisoning  by,  152 
Flogging,  military,  death  from,  256 
Fly  paper,  125 
Fly  water,  death  from,  125 
Foetal  circulation,  changes  in  the,  caused  by 

respiration,  496 
Foetal  stomach,  contents  of  the,  502 
Foetal  heart,  sounds  of  the,  423 

changes  in  the,  after  breathing,  496 
Foeticide,  444.     (See  Abortion.) 
Foetus,  characters   of  the,  from  conception  to 
the  sixth  month,  4  4ii 

from  the  sixth  to  the  ninth  month,  46S 
Food,  poisonous,  152 

putrescent,  163 

death  from  privation  of,  413 
Fool's  parsley,  poisoning  with,  196 
Foramen  ovale,  closure  of  the,  4'.' 7 
Fowler's  mineral  solution,  125 
Foxglove,  poisoning  with,  205 
Fractures,  300 

accidental,  in  the  drowned,  334 

in  new-born  children,  518 
Fragilitas  ossium,  301 
Fruit-stains  resembling  blood,  241 
Fungi,  poisoning  with,  183 

Gallbladder,  wounds  of  the,  297 

Gamboge,  effects  of,  147 

Game,  poisoned,  163 

Garotte  robberies,  363 

Gas,  suffocation  by,  393 

Gaseous  poisons,  380 

Gelatinized  perforation  of  the  stomach,  86 

Genitals,  wounds  of  the,  299 

Gestation,  natural  period  of,  544 

duration  of,  from  one  intercourse,  545 

short  periods  of,  547 

protracted,  554 

mistakes  in  the  mode  of  computation  ■  >{ 
557 

period  of,  not  fixed  bylaw,  559 
Glass,  wounds  caused  by,  2 IS 

powdered,  effects  of,  65 


INDEX. 


771 


Godfrey's  cordial,  167 
Gonorrhoea,  in  rape,  606 
Goulard's  extract,  137 
Goulard -water,  136 
Green  vitriol,  145 
Green  hellebore,  149 
Grievous  bodily  harm,  210 
Gunpowder,  wounds  from,  309 
Gunshot  wounds,  nature  of,  305 

near  or  distant,  305 

accidental,  homicidal,  or  suicidal,  307 

Habit,  its  influence  on  poisons,  65 

intemperate,  in  eases  of  life  insurance,  741 
Hasinatin,  properties  of,  238 

crystals  of,  249 
Hasmatoidin,  250 
Hasmin,  crystals  of,  250 
Hair,  evidence  from,  on  weapons,  234 

the  color  of,  in  paternity,  562 
Hallucinations  in  insanity,  634 

in  drunkenness,  710 

in  sleep,  717 
Hanging,  death  from,  337 

appearances  in  death  from,  339 

evidence  of,  from  mark  of  the  cord,  341,  344 

of  the  dead  body,  345 

marks  of  violence  on  the  body  in,  347 

homicidal,  348 

circumstantial  evidence  in  cases  of,  350 

evidence  from  position  of  the  body  in,  351 

fracture  of  crystalline  lens,  a  result  of,  352 
Hartshorn,  poisoning  with,  105 
Head,  wounds  of  the,  276 

injuries  to  the,  in  new-born  children,  517 
Heart,  wounds  of  the,  288 
Heat,  excessive,  death  from,  412 
Hellebore,  poisoning  with,  149 
Hemlock,  poisoning  with,  193    . 

water-dropwort,  195 
Hemorrhage,  death  from,  253 

internal,  death  from,  254 

death  of  the  new-born  child  from,  507 
Henbane,  poisoning  with,  184 
Hepatization  of  the  lungs,  480 
Hereditary  transmission  of  insanity,  644,  706 
Hermaphrodites,  legal  rights  of,  573 
Hermaphroditism,  569 
Hernia,  phrenic,  293 
Hierapicra,  147 

in  abortion,  448 
Homicidal  Monomania,  681 

symptoms  of,  683 

legal  tests,  686 

varieties  of,  684 

medical  tests  of,  690 

medical  evidence  in  cases  of,  695 
Homicidal  wounds,  characters  of,  226 

burning,  mistaken  for  spontaneous,  315 
Horseradish  mistaken  for  aconite,  198 
Hunger,  death  from,  413.   (See  Starvation.) 
Hydrochloric  acid,  97 

Hydrocyanic  acid,  170.    (See  Prussic  Acid.) 
Hydrogen,  test  for  arsenic,  118 
Hydrostatic  Test,  479 

objections   to  the,    from   sinking  of   the 
lungs,  480 

erroneous  inferences  from,  487 

effects  of  putrefaction  on  the,  484 

artificial  inflation,  485 

general  conclusions    respecting  the    em 
ployment  of,  490 


Hydrosulphate  of  ammonia,  401 
Hydrosulphuric  acid,  poisoning  with,  395 
Hymen,  evidence  derived  from  the,  in  rape,  599 

as  a  sign  of  virginity,  608 
Hyoscyamus,  poisoning  with,  184 
Hypospadias,  586 

Identity  of  substances,  25 
Idiocy,  633.  641 
Idiosyncrasy  in  poisoning,  67 
Idiots,  rape  on,  615 
Illusions  in  insanity,  634 

in  drunkenness,  710 
Imbecility,  641 

senile,  643 
Immaturity  of  the  foetus,  or  venter,  440 

of  the  partus,  in  cases  of  legitimacy,  548 

death  of  the  child  from,  516 
Impediments,  canonical,  to  marriage,  594 
Impotency,  causes  of,  578 

from  age,  581 

from  local  disease  and  malformation,  583 

from  general  disease,  587 

as  a  ground  for  divorce,  594 

Impulse  to  crime,  697 
Imputed  poisoning,  76 

wounds,  222 

strangulation,  367 
Inanition,  death  from,  413 
Incapacity,  sexual,  578.    (See  Impotency.) 
Incendiarism,  propensity  to,  708 
Incised  wounds,  217 
Incoherency,  643 

Incompetency,  mental,  medical  tests  of,  661 
Indian  tobacco,  204 
Indigo,  sulphate  of,  91 
Infanticide,  466 

inspection  of  the  body  in,  470 

proofs  of  life  before  respiration  in,  471 

after  respiration,  474 

static  test  in,  476 

Ploucquet's  test  in,  478 

legal  proofs  of,  493 

proofs  of  live  birth  in,  505 

natural  causes  of  death  in,  506 

violent  causes  of  death  in,  510 

summary  of  medical  proofs  in,  522,  531 

proposed  changes  in  the  law  of,  493 
Tiifaiis  in  law,  539 
Infantile  leucorrhoea,  603 
Infants,  action  of  opium  on,  167 
Inflation,  artificial,  of  the  lungs,  485 
Influence  of  morphia  in   disguising  the  color 

test,  190 
Inheritance,  questions  relating  to,  531 
Inquests,  coroners',  36 
Insane,  responsibility  of  the,  678,  669 
Insanity,  medical  definitions  of,  629 

moral,  631,  681 

legal  definitions  of,  633 

early  symptoms  of,  6S4 

hallucinations  and  illusions  in,  634 

lucid  intervals  in,  635 

various  forms  of,  637 

hereditary  transmission  of,  644,  706 

feigned,  645 

post-mortem  appearances  in,  646 

rules  for  applying  restraint  in,  647 

signing  certificates  of,  650 

interdiction  in  cases  of,  658 

evidence  of  from  written  documents,  664 

plea  of,  in  criminal  cases,  678 


772 


IXDEX. 


Insanity,  homicidal,  CS1 

puerperal,    706 
Insect-powders,  1»7 
Insemination,  546 
Inspection  of  the  body,  in  poisoning,  22 

in  wounds,  211 

in  child-murder,  470 

for  coroners'  inquests,  24 
Insurance,  life,  721 
Intellectual  insanity,  631 
Intemperate  habits  as  affecting  life  insurance, 

741 
Intercourse,  duration  of  gestation  after,  544 

carnal,  legal  proofs  of,  598 
Interdiction  in  insanity,  658,  667 
Intervals,  lucid,  in  insanity,  635 

validity  of  acts  performed  during,  636 
Intestines,  ruptures  of  the,  297 
Intoxication  mistaken  for  concussion,  278 
Iron,  salts  of,  poisoning  with,  145 
Iron  moulds  mistaken  for  blood  stains,  241 
Iron  filings,  65 
Iron,  muriate  of,  146,  455 
Irritant  poisons,  general  effects  of,  68 
Irritants,  mechanical,  65 

mineral,  90 

vegetable,  147 

animal,  151 

Jalap,  effects  of,  147 

Juniperus  Sabina,  poisoning  with,  147 

Jury  of  matrons,  429 

Kidneys,  ruptures  of  the,  297 
King's  yellow,  127 
Kleptomania,  708 

Labor,  premature,   induction  of,  464 

Laburnum,  poisoning  with,  208 

Lacerated  wounds,  218 

Lactation  a  cause  of  puerperal  insanity,  707 

Latent  disease,  death  from,  in  wounds,  259 

Laudanum,  poisoning  by,  166 

Lead,  poisoning  by  acetate  of,  135 

tests  for  the  salts  of,  136 

chronic  poisoning  by,  137 
Lead-glaze,  poisonous  effects  of,  137 
Lead  palsy,  137 
Legal  tests  of  insanity,  686 
Legitimacy,  legal  presumption  of,  543 

period  of  gestation  in  reference  to,  544 

disputed,  from  shortness  of  gestation,  547 

viability  in  reference  to,  551 

proofs  of,  from  the  state  of  the  offspring, 
548 

disputed  from  long  periods  of  gestation, 
556 

in  what  cases  admitted,  559 

inferred  from  paternal  likeness,  561 
Leucorrhoea,  infantile,  603 
Levant-nut,  1S2 
License  of  counsel,  40 
Life,  legal  and  medical,  494,  532 
Life  Insurance, 

principles  of,  721 

proof  of  death,  722 

suicide  in  relation  to,  703,  754 

questions  connected  with  proposals  for,  728 

policies  vitiated  by  fraud,  734 

acts  of  murder  in  connection  with,  760 
Lightning,  death  from,  402 

post-mortem  appearances,  440 


Lightning,  action  for  damage  from,  409 
Likeness,  parental,  evidence  from,  001 
Limekilns,  vapors  of,  391 
Liquids,  corrosive,  burns  by,  317 
Liquor  amnii,  465 
Liquor  arsenicalis,  125 
Litharge,  poisoning  with,  138 
Live  birth  in  civil  suits,  532 

proofs  of,  in  child-murder,  494 

summary  regarding,  504 
Liver,  ruptures  and  wounds  of  the,  296 
Lobelia,  poisoning  with,  204 
Lochia,  evidence  of  delivery  from  the,  432 
Lockjaw,  death  from,  in  wounds,  263 
Long  fasting,  effects  of,  413 
Lucid  intervals,  635 
Lucifer-matches,  poisoning  with,  109 
Lunacy,  633 

commissions  of,  658,  667 
Lunacy-acts,  legal  provisions  of  the  650 

breaches  of  the,  655 
Lunatics,  wounds  inflicted  by,  226 

restraint  applied  to,  647 

discharge  of,  657 

civil  responsibility  of,  669 

contracts  of,  669 

marriage  of,  669 

testamentary  capacity  of,  672 

interdiction  of,  658,  667 

examination  of  alleged,  660 

•wills  by,  672 
Lungs,  wounds  and  ruptures  of  the,  288 

examination  of  the,  in  new-born  children, 
474 

specific  gravity  of,  478 

atelectasis  of  the,  480 

variably  affected  by  respiration,  482 

putrefaction  of,  484 

artificial  inflation  of,  485 
Lung-tests,  477 
Lypemania,  640 

Magnetic  sleep,  rape  during,  619 
Majority,  questions  relative  to,  539 

when  attained,  540 
Malapraxis,  274,  304 

Malformation,  death  of  the  child  from.  507, 
541 

sexual,  569 
Mania.  637 

suicidal,  640 

homicidal,  681 

puerperal,   706 
Mania  sine  delirio,  631 
Marriage,  impediments  to,  594 

of  lunatics,  void,  669 
Marsh's  process  for  arsenic,  118 
Matrons,  jury  of,  429 

Maturity  of  the  new-born  child,  signs  of,  467 
Meadow  saffron  (see  Colchicum) ,  148 
Meat,  unwholesome,  152 
Meconic  acid,  tests  for,  168 
Meconium,  502 

microscopical  characters  of,  503 
Mechanical  injury,  death  from,  255 
Mechanical  irritants,  65 
Medical  evidence,  17 
Medical  witnesses,  40 
Medical  jurisprudence  defined,  17 
Medical  jurists,  duties  of,  IS 
Medical  witnesses  act,  37 
Medical  privilege,  41 


INDEX. 


773 


Medical  etiquette,  44 

Medical  responsibility,  in  wounds,  274 

in  cases  of  insanity,  656 

in  delivery,  464 
Medico-legal  reports,  28 

for  coroners'  inquests,  31 
Melted  metals,  burns  from,  311 
Melancholia,  640 

Menses,  suppression  of,  in  pregnancy,  418 
Menses  (see  Menstruation),  418 
Menstrual  blood,  character  of,  623 
Menstrual  climacteric,  592 
Menstruation,  suppression  of,  a  sign  of  preg- 
nancy, 418 

feigned,  419 

appearances  of,  after  death,  456 

relation  of  gestation  to,  547 

fallacies  in  calculating  pregnancy,  555 

age  at  which  it  appears,  589 

pregnancy  before,  418,  590 

appearance  of,  in  infants,  591. 

age  at  which  it  ceases,  592 

absence  of,  a  cause  of  sterility,  589 

in  hermaphrodites,  570 
Mental  alienation,  629 
Mercurius  Vitae,  144 
Mercuric  methide,  134 
Mercury,  poisoning  by  the  salts  of,  128 

chronic  poisoning  by,  129 

ammonia-chloride    of,   or   white    precipi- 
tate, 133 

oxide  of,  134 

sulphates  and  nitrates  of,  134 

methide  of,  134 
Metallic  irritants,   112 
Methide,  mercuric,  134 
Microscopical  evidence,  244,  620 
Milk,  detection  of,  in  the  stomach,  499 
Mind,  unsoundness  of,  633 
Mineral  green,  poisoning  with,  125 

solution,  Fowler's,  125 
Minium,  poisoning  with,  138 
Minor.    (See  Minority.) 
Minority,  questions  relating  to,  539 
Mirbane,  essence  of,  177 
Miscarriage,  legal  meaning  of,  444 
Mole-pregnancy,  441 
Moles,  nature  of,  441 

abortion  of,  441 
Monkshood,  poisoning  with,  197 
Monomania,  638 

suicidal,  630 

homicidal,  681 
Monorchides,  virility  of,  583 
Monsters,  abortion  of,  465,  508 

legal  definition  of,  542 

do  not  inherit,  538 

sexual,  569,  586 
Monsters,  destruction  of,  not  permitted,  508 
Monstrosity,  death  of  the  child  from,  507 
Monstrosity,  sexual,  569,  586 
Moral  insanity,  631,  681 
Morphia  and  its  salts,  poisoning  with,  167 

influence  of,  in  the  color-test,  190 

tests  for,  168 
Mortality  of  wounds,  256 
Motives  for  crime,  691 
Muco-purulent  discharges,  606 
Mucous  discharges,  characters  of,  604 
Muriate  of  iron,  146,  455 

of  morphia,  167 
Muriatic  Acid,  poisoning  with,  97 
Mushrooms,  poisoning  with,  183 


Mussels,  poisoning  with,  153 

Nam  mistaken  for  marks  of  violence,  528. 

Narcotic  poisons,  70,  165 

Narcotico-irritants,  effects  of,  70 

Navel-string  (see  Umbilical  Cord),  507 

Neck,  twisting  of  the,  in  the  new-born,  520 

Needles  and  pins,  action  of,  65 

Neurotic  poisons,  69,  1C5 

New-born  child,  legal  meaning  of,  466 

Nicotina,  poisoning  with,  182 

Nightshade  (see  Belladonna),  201 

Nitrate  of  potash,  106 

Nitre,  death  from,  106 

Nitric  Acid,  poisoning  with,  93 

vapor  of,  94 

analysis,  95 
Nitrobenzole,  176 
Noma  pudendi,  002 
Non  compos  mentis,  633 
Notes,  use  of,  in  evidence,  27 
Noxious  substances,  legal  meaning  of,  65,459 

animal  food,  152 
Nux  vomica,  poisoning  with,  185 

(Edema  of  the  lungs,  480 
OEnanthe  crocata,  195 

Oil  of  vitriol,  poisoning  with,  90.     (See  Sul- 
phuric Acid.) 

of  croton,  148 

bitter  almonds,  175 

of  savin,  453 

of  tansy,  454 
Operations,  surgical,  death  from,  270 
Operation,  Cesarean,  536 
Opium,  symptoms  caused  by,  165 

appearances  in  death  from,  166 

process  for  detecting,  167,  169 
Orbit,  wounds  of  the,  285 
Orpiment,  poisoning  by,  127 
Ovum,  examination  of  the,  440 
Oxalate  of  potash,  acid,  102 
Oxalic    Acid,    symptoms    and    appearances 
caused  by,  98 

Painter's  colic,  138 

Palsy  from  lead,  138 

Paper  hangings,  arsenic  in,  126 

Papier  Moure,  125 

Paraplegia,  virility  in  cases  of,  588 

Paregoric  elixir,  167 

Parental  likeness,  560 

Parturition  (see  Delivery),  430 

Partus,  the  new-born  child,  468,  547 

Paternity,  questions  on,  560 

Peach-nut  oil,  175 

Pearlash,  poisoning  with,  104 

Perforation  of  the  stomach  from  poison,  85 

spontaneous,  86 
Personal  injuries,  209 

death  from  slight,  261 
Phosphorus,  poisoning  by,  109 

red  or  amorphous,  action  of,  111 
Phrenic  hernia,  293 
Phrenitis,  638 
Picrotoxine,  effects  of,  183 
Pins  and  needles,  administration  of,  65 
Ploucquet's  test,  478 
Plural  births,  541 
Puis'iN*,  definition  of  a,  61 

law  respecting  the  administration  of,  63 

influence  of  habit  on,  65 
of  idiosyncrasy,  67 


74 


INDEX. 


Poison,  irritant  anil  corrosive.  68 

narcotic  and  narcotico-irritant,  70 

effects  modified  by  disease,  71 

slow  and  rapid  death  from,  78 

gaseous,  380 
Poisoned  game,  163 
Poisoned  grain,, 183 
Poisoning,  evidence  of,  in  the  living,  70 

disease  mistaken  for,  75 

feigned  and  imputed,  76 

evidence  in  the  dead,  78 

chronic,  80 

ulceration,  corrosion,  and  softening,  84 

rules  for  investigating  cases  of,  22,  77 

infanticide  by,  529 
Poisonous  food,  152 

gases,'  380 

fungi  or  mushrooms,  183 
Poppies,  syrup  of,  167 
Pork,  diseased,  poisoning  with,  76,  155 
Porphyridium  cruentum  taken  for  blood,  247 
Posthumous -children,  565 
Potash  and  its  carbonates,  poisoning  with,  104 

oxalate  of,  102 

nitrate  of,  106 

sulphate  of,  107 

arsenite  of,  125 

arsenate  of,  126 
Potassium,  cyanide  of,  174 
Precipitate,  white  and  red,  133,  134 
Pregnancy,  signs  of,  418 

feigned,  425 

plea  of,  in  bar  of  execution,  429 

concealment  of,  426 

unconscious,  427 

in  the  dead,  428 

plea  of,  429 

proof  of,  in  cases  of  abortion,  465 

longest  duration  of,  558 

before  menstruation,  590 

crimes  perpetrated  during,  707 

earliest  age  for,  589 

latest  age  for,  593 

following  rape,  019 
Premature  births,  547 

labor,  induction  of,  464 
Presumption  of  death,  724 

of  survivorship,  725 
Procreative  power,  age  for,  in  the  male,  580 

in  the  female,  589 
Projectiles,  306 
Protracted  births,  554 

gestation,  556 
Prussic  Acid,  symptoms  caused  by,  170 

fatal  doses  of,  171 

analysis,  171 

detection  of,  in  the  tissues,  174 
Ptyalism,  mercurial  (see  Salivation),  129 
Puberty  in  males,  579 

in  females,  489 

premature,  591 
Puerperal  mania,  706 
Pulmonary  tests,  478 
Punctured  wounds,  218 

Purulent  discharges  in  alleged  rape,  603,  60S 
Putrefaction,  effects  of,  59 

of  the  lungs,  484 
Putrescent  food,  153 
Pysemia  a  cause  of  death  in  wounds,  273 
Pyromania,  707 

Quickening  a  sign  of  pregnancy,  421 
Quicksilver,  128.   (See  Mercury.) 


Rape,  definition  of.  596 

proofs  of,  in  children  under  puberty,  597 

vulval  and  vaginal,  598 

evidence  from  marks  of  violence  in,  599 

loss  of  physical  evidence  in,  599,  618 

false  charges  of.  602 

gonorrhceal  discharge  in,  604 

on  girls  after  puberty,  607 

on  adults,  612 

under  narcotics,  614 

on  idiots,  615,  617 

during  sleep,  615 

from  mistake  of  person,  618 

pregnancy  following,  619 

microscopical  evidence  in,  620 

evidence  of,  in  the  dead  body,  624 

by  females  on  males,  624 

on  slaves.  625 
Red  lead  in  snuff,  138 
Red  phosphorus,  111 
Red  precipitate,  134 

Redness  of  the  stomach  in  poisoning,  83 
Re-examination,  46 
Reinsch's  process  for  arsenic,  118,  123 
Reports,  medico-legal,  28 
Respiration,  cessation  of  the,  in  death,  57 

signs  of,  in  the  new-born  child,  476 

imperfect,  476 

before  birth,  489 
Responsibility,  medical,  274,  464,  656 
Restraint  in  insanity,  647 
Rigidity,  cadaveric,  58 
Rigor  mortis,  59 

Rules  for  the  delivery  of  evidence,  50 
Rust,  stains  of,  mistaken  for  blood,  240 
Rye,  ergot  of,  action  of,  449,  451 

Saffron  as  an  abortive,  455 
Salivation,  arsenical,  113 

mercurial,   129 
Salt  of  sorrel.  ]o2 
Saltpetre,  action  of,  106 
Sal  volatile,  106 

Sanguineous  tumors  in  the  new-born,  517 
Sausage  poison,  154 
Savin,  poisoning  with.  147 

as  an  abortive,  452 
Scalding,  homicidal,  315 
Scalds  and  burns,  311 
Scalp,  wounds  of  the,  277 

tumor  in  new-born  children,  518 
Scammony,  147 
Scheele's  green,  125 

prussic  acid,  171 
Scirrhus  of  the  lungs,  480 
Secale  cornutum,  44',i 
Self-delivery,  violence  in,  521 
Self-inflicted  wounds,  222,  V"' 

Senile  dementia,  643  ,  "^ 

Sewer  gases,  noxious  effects  of,  398 
Sex,  distinction  of,  569 

mixed  and  dtfubtful  cases  of,  571 

civil  rights  depending  on,  574 
Sexual  malformation,  varieties  of,  569 

influence  of,  on  electoral  rights,  575 

a  cause  of  impotency,  586 
Shellfish,  poisoning  by,  153 
Shock,  death  from,  255 
Slo.t,  wounds  from,  308 
Skull,  fractures  of  the,  284,  518 

accidental  fracture  of,  in  parturition,  51S 
Sleep,  delivery  during,  436 

rape  during,  615 


INDEX. 


<  ,  0 


Sleep,  homicide  (luring,  717 
Slow  poisoning,  SO 

Small-shot,  wounds  produced  by,  308 
Smothering,  death  from,  377 
accidental,  cases  of,  378 
Snuff,  poisoned  with  lead,  138 
Soap-lees,  poisoning  by,  104 
Soda  and  its  carbonate,  poisoning  by,  104 
Sodomy,  625 

Softening  of  the  stomach  from  poison,  84 
Somnambulism,  responsibility  in  cases  of,  716 
Sorrel,  salt  of,  102 
Spanish  flies,  poisoning  with,  151 
Spasm,  cadaveric,  233,  327 
Specific  gravity  of  the  human  body,  331 
Spectral  analysis  of  blood,  250 
Spermatorrhoea  a  cause  of  impotency,  586 
Spermatozoa,  age  at  which  they  appear,  580 

examination  of  stains  for,  620 
Sphacelia  segetum  (see  Ergot),  449 
Spinal  marrow,  injuries  to  the,  286 

poisons,  70 
Spine,  concussion  of  the,  286 

fractures  of  the,  286 
Spirits,  poisoning  with  (see  Alcohol),  178 
Spirits  of  hartshorn,  death  from,  105 
Spirit  of  salt,  97.    (See  Muriatic  Acid.) 
Spleen,  ruptures  of  the,  296 
Spontaneous  combustion,  alleged,  315 

perforation  of  the  stomach,  86 
Stabs  and  cuts,  220 
Stains,  acid,  on  clothing,  93,  97 

of  blood  on  linen  and  weapons,  339 

of  meconium,  504 

of  amniotic  liquid,  465 

in  cases  of  rape,  620 
Starch,  detection  of,  497 
Starvation,  death  from,  413 

appearances  in  death  from,  415 

infanticide  by,  516 
Stas's  process  for  strychnia,  189 
Static  test,  the,  in  infanticide,  476 
Sterility  in  males  and  females,  578,  589 

causes  of,  593 
Stibiated  tartar,  141 
Still-births,  506 
Stomach,  redness  of  the,  82 

softening  of,  84 

perforation  of  the,  85 

wounds  and  ruptures  of  the,  297 

foetal,  contents  of  the,  502 
Stramonium,  poisoning  with,  207 
Strangulation,  cause  of  death,  354 

post-mortem  appearances  in,  355 

proofs  of,  on  the  living  body,  359 

accidental  and  suicidal,  361,  362 

homicidal,  363 

evidence  of,  from  marks  of  violence,  364 

imputed  homicidal,  367 

destruction  of  new-born  child  by,  522 

accidental,  by  umbilical  cord,  523 

marks  on  child  resembling,  528 
Strychnia,  poisoning  with,  1»5 

symptoms  and  appearances,  186 

analysis,  87 

in  organic  mixtures,  189 

influence  of  morphia  in    disguising    the 
usual  color  test  of,  190 
Subacetate  of  lead,  137 

of  copper,  139 
Sublimate,  corrosive,  poisoning  with,  128 
Subpoenas,  rules  respecting,  3y 
Sudden  death,  57 


Suffocation,  cause  of  death  in,  369 

post-mortem  appearances,  :i72 

evidence  of  death  from,  374 

accidental,   cases  of,  375 

of  children,  376 

from  gases,  380 

by  carbonic  acid,  381 

by  charcoal  vapor,  386 

by  carbonic  oxide,  389 

coal  vapor,  390 

by  vapors  of  lime  and  brickkilns,  391 

confined  air,  392 

by  coal-gas,  393 

sulphuretted  hydrogen,  395 

by  sewer  gases,  39'8 

of  new-born  children,  511 
Sugar,  detection  of,  in  the  foetal  stomach,  498 

of  lead,  poisoning  with,  135 
Suggillation  (Ecchymosis),  213 
Suicidal  wounds,  characters  of,  227 

mania,  640,  699 
Suicide  and  insanity,  672,  704      . 
Suicide,  699 

not  necessarily  from  insanity,  701,  706 

a  felony,  701 

in  relation  to  life  insurance,  703,  754 

hereditary  tendency  to,  706 
Sulphate  of  indigo,  91 

of  potash,  107 

of  copper,  139 

of  zinc,  145 
Sulphate  of  iron,  145 
Sulphide  of  ammonium,  399 
Sulphuretted  Hydrogen,  effects,  395 

appearance  in  death  from,  396 

detection  of,  401 
Sulphuric  Acid,  symptoms,  90 

analysis,  92 

burns  from,  317 
Sulphurous  acid,  action  of,  390 
Sunstroke,  death  from,  413 
Superconception,  566 
Superfoatation,  565 
Supposititious  children,  567 
Surgical  operations,  responsibility  for,  274 
Survivorship,  725 
Syncopal  asphyxia,  55 
Syncope,  death  from,  54 
Syphilis  in  case  of  rape,  606 
Syrup  of  poppies,  167 

Tansy,  oil  of,  454 

Tartar  Emetic,  poisoning  with,  141 

tests  for,  143 
Tartarated  antimony,  141 
Tartaric  acid,  102 
Tartarized  antimony,  141 
Technical  terms,  30,  53 
Tenancy  by  courtesy,  535 
Teratology  (see  Monsters),  541 
Testamentary  capacity,  672 
Testicles,  period  at  which  they  descend,  469 

non-descent  of  the,  583 
Testimonial  competency  from  age,  539 
Tetanus,  from  wounds,  268. 
Theft,  insane  propensity  to,  708 
Thornapple,  poisoning  with,  207 
Throat,  wounds  of  the,  228 
Thugs,  murder  by,  207,  363. 
Tobacco,  poisoning  with,  181 

Indian,  204 
Toucher  in  pregnancy,  424 
Trial  at  the  Assizes,  38 


776 


INDEX. 


Triehininsis,   157 
Trichomonas,  623 

Tumors  sanguineous,  517 

Ulceration  distinguished  from  corrosion,  83 
Umbilical  cord,  evidence  of  live  birth,  497 

laceration  of  the,  507 

death  from  compression  of  the,  507 

strangulation  by  the,  523 
Unconsciousness,  acts  in  a  state  of,  716 
Unconscious  pregnancy,  426 

delivery,  434 

intercourse,  615 
Unnatural  offences,  625 
Unsoundness  of  mind,  633 
Uterine  age  of  fetus,  440,  467 
Uterus,  changes  in  the,  from  pregnancy,  424 

Vagina,  wounds  of  the,  299,  600 

purulent  discharges  from,  603 
Vaginitis  in  infants,  603 
Vagitus  uterinus,  489,  535 
Vapors,  of  charcoal,  effects  of,  386 

of  coal  and  coke,  390 

of  lime,  brick,  and  cement  kilns,  391 

rape  under  narcotic,  614 
Vegetable  irritant  poisons,  147 
Veins,  wounds  of,  291 

death  from  entrance  of  air  into,  292 
Venereal  disease  in  cases  of  rape,  606 
Venter,  440.     (See  Ovum  or  Embryo.) 
Ventre,  inspicendo  de,  writ  of,  428 
Ventre  sa  mere,  in,  511 
Veratria,  150 
Verdigris,  138 
Veratrum  viride,  150 
Vermin  powder,  or  killer,  187 
Vertebrte,  fractures  of  the,  286 

in  drowning,  334 

injuries  to  the,  in  hanging,  350 

in  cases  of  child-murder,  521 
Vesications  from  burns  and  scalds,  513 
Vesicular  mole,  441 
Viability,  in  monstrosity,  541 

in  legitimacy,  551 

in  concealments  of  birth,  443. 
Violation,  596.     (See  Rape.) 
Virgo  intacta,  611 
Virginity,  signs  of,  608 
Virility,  proofs  of,  580 
Viscera,  preservation  of  the,  25 
Vitriol,  oil  of,  poisoning   by  (see   Sulphuric 
Acid),  90 

blue,  poisoning  by,  139 

white,  145 
Vitriol,  green,  145 
Vomica,  nux,  poisoning  with,  185 

Wadding,  wounds  from,  309 
Wall-papers,  arsenical,  effects  of,  125 
Water-hemlock,  194 

Waters,  potable,  poisoned  with  lead,  138 
Weapons,  used  in  producing  wounds,  213,  221 

evidence  from,  216,  220 

found  in  the  hands  after  death,  233 

blood  and  other  substances  on,  233 
Wheat,  poisoned,  183 
White  precipitate,  poisoning  with,  133 

lead,  138 
White  vitriol,  145 

hellebore,  149 
Wills  of  the  insane,  law  regarding,  672 


Wills,  proofs  of  eccentricity  in,  673 

burden  of  proof  in  alleged  insanity,  676 
in  senile  dementia  and  in  extremis,  675 
attesting  witnesses  to,  678 

made  in  drunkenness,  708 
Wine  of  colchicum,  148 
Witnesses,  medical,  40 

admitted  in  court,  46 

rules  respecting  the  examination  of,  47 
Wolfsbane,  poisoning  by,  197 
AVood,  smouldering,  death  from,  388 
Wounds,  medico-legal  definition  of,  209 

producing  grievous  bodily  harm,  210 

examination  of,  211 

vital  and  post-mortem,  212 

without  hemorrhage,  213 

produced  by  weapons,  217 

incised,  lacerated,  and  contused,  217,  218 

from  glass  or  earthenware,  218 

self-inflicted  or  imputed,  222 

evidence  from  situation,  225 

nature  and  extent  of,  226 

direction  and  shape  of,  227 

suicidal  and  accidental,  228 

by  right  or  left  hand,  229 

circumstantial  evidence  in,  222,  231 

foreign  substances  in,  251 

in  what  position  inflicted,  227 

direct  cause  of  death,  251 

fatal  from  hemorrhage,  252 

fatal  from  mechanical  injury,  255 

from  shock,  255 

from  erysipelas,  289 

from  delirium  tremens,  270 

mortality  of,  257 

death  from  latent  disease  in  cases  of,  259 

which  of  two  caused  death,  260 

death  from  slight  wounds,  261 

fatal  after  long  periods,  261 

secondary  causes  of  death  from,  262 

fatal  from  unskilful  treatment,  264 

fatal  from  imprudence,  265 

from  unhealthy  state  of  body,  266 

acceleration  of  death  from,  267 

fatal  from  abnormal  conditions,  268 

tetanus  following,  268 

fatal  from  surgical  operations,  270 

fatal  from  pyaemia,  273 

of  the  head,  276 

struggling  after  severe,  292 

of  the  face,  285 

of  the  spine  and  spinal  marrow,  286 

of  the  chest,  287 

of  the  lungs  and  heart,  28S,  289 
Wounds  of  the  arteries  and  vein.-,  291 

of  the  diaphragm,  293 

of  the  abdomen,  294 

of  the  liver,  spleen,  and  kidneys,  296,  297 

of  the  intestines  and  stomach,  297 

of  the  urinary  bladder,  297 

of  the  genitals,  299 

gunshot,  305 

from  gunpowder,  309 

caused  by  lightning,  404 

on  the  new-born  child  in  infanticide,  517 

Yellow  arsenic,  poisoning  with,  1-7 
Yew,  poisoning  with,  20S 

Zinc,  poisoning  by  the  salts  of,  145 
Zoosperms  (see  Spermatozoa),  580 


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subscribers  have  received,  without  expense,  such  works  as  "  Watson's  Practice." 
"Todd  and  Bowman's  Physiology,"  "West  on  Children,"  "Malgaione's  Surgery," 
&c.  &c.     And  in  1872  will  be  continued  to  completion  t he  valuable  practical  treatise 

*  Communications  are  invited  from  gentlemen  in  Jill  parts  of  the  country.  Elaborate  articles  inserted 
by  the  Editor  are  paid  for  by  the  Publisher  f 


Henry  C.  Lea's  Publications — (Am.  Journ.  Med.  Sciences).        3 
of  M.  P.  Gurrsant  ou  the  Surgical  Diseases  of  Children,  translated  by  R.  J. 

DuNGLISON,   M.  I). 

As  stated  above,  tlie  subscription  price  of  the  "Medical  News  and  Library"  is 
One  Dollar  per  annum  in  advance;  and  it  is  furnished  without  charge  to  all  advance 
paving  subscribers  to  the  "American  Journal  of  the  Medical  Sciences." 

III. 

THE  HALF-YEARLY  ABSTRACT  OF  THE  MEDICAL  SCIENCES 

is  issued  in  half-yearly  volumes,  which  will  be  delivered  to  subscribers  about  the  first 
of  February,  and  first  of  August.  Each  volume  contains  about  300  closely  printed 
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"Ranking's  Abstract*'  has  now  been  published  in  England  regularly  for  more  than 
twenty  years,  and  has  acquired  the  highest  reputation  for  the  ability  and  industry 
with  which  the  essence  of  medical  literature  is  condensed  into  its  pages.  It  pur- 
ports to  be  "A  Digest  of  British  and  Continental  Medicine,  and  of  the  Progress  of 
Medicine  and  the  Collateral  Sciences,"  and  it  is  even  more  than  this,  for  America  is 
largely  represented  in  its  pages.  It  draws  its  material  not  only  from  all  the  leading 
American.  British,  and  Continental  journals,  but  also  from  the  medical  works  and 
treatises  issued  during  the  preceding  six  months,  thus  giving  a  complete  digest  of 
medical  progress.  Each  article  is  carefully  condensed,  so  as  to  present  its  substance 
in  the  smallest  possible  compass,  thus  affording  space  for  the  very  large  amount  of  infor- 
mation laid  before  its  readers.     The  volumes  of  1871,  for  instance,  have  contained 

FORTY-FIVE  ARTICLES  ON  GENERAL  QUESTIONS  IN  MEDICINE. 

ONE  HUNDRED  AND  THIRTY  ARTICLES  ON  SPECIAL  QUESTIONS  IN  MEDICINE. 

ELEVEN  ARTICLES  ON  FORENSIC  MEDICINE 

ONE  HUNDRED  AND  THREE  ARTICLES  ON  THERAPEUTICS. 

FORTY-THREE  ARTICLES  ON  GENERAL  QUESTIONS  IN  SURGERY. 

ONE  HUNDRED  AND  TWENTY-ONE  ARTICLES  ON  SPECIAL  QUESTIONS  IN  SURGERY 

EIGHTY-EIGHT  ARTICLES  ON  MIDWIFERY  AND  DISEASES  OF  WOMEN  AND  CHILDREN 

FIVE  ARTICLES  IN  APPENDIX. 

Making  in  all  over  five  hundred  and  fifty  articles  in  a  single  year.  Each  volume, 
moreover,  is  systematically  arranged,  with  an  elaborate  Table  of  Contents  and  a  very 
full  Index,  thus  facilitating  the  researches  of  the  reader  in  pursuit  of  particular  sub- 
jects, and  enabling  him  to  refer  without  loss  of  time  to  the  vast  amount  of  information 
contained  in  its  pages. 

The  subscription  price  of  the  "  Abstract,"  mailed  free  of  postage,  is  Two 
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For  this  small  sum  the  subscriber  will  therefore  receive  three  periodicals  costing 
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senting a  complete  view  of  medical  progress  throughout  both  hemispheres. 

In  this  effort  to  bring  so  large  an  amount  of  practical  information  within  the  reach 
of  every  member  of  the  profession,  the  publisher  confidently  anticipates  the  friendly 
aid  of  all  who  are  interested  iu  the  dissemination  of  sound  medical  literature.  He 
trusts,  especially,  that  the  subscribers  to  the  "American  Medical  Journal"  will  call 
the  attention  of  their  acquaintances  to  the  advantages  thus  offered,  and  that  he  will 
be  sustained  in  the  endeavor  to  permanently  establish  medical  periodical  literature  on 
a  footing  of  cheapness  never  heretofore  attempted. 

PREMIUM  FOR  NEW  SUBSCRIBERS. 

Any  gentleman  who  will  remit  the  amount  for  two  subscriptions  for  1872,  one  of 
which  must  be  for  a  new  subscriber,  will  receive  as  a  premium,  free  by  mail,  a  copy  of 
the  new  edition  of  Tanner's  Clinical  Manual,  for  advertisement  of  which  see-  p.  5. 
or  of  Chambers'  Restorative  Medicine  (see  p.  17),  or  West  on  Nervous  Disorders 
of  Children  (sec  p.  21). 

%*  Centlemen  desiring  to  avail  themselves  of  the  advantages  thus  offered  will  do 
well  to  forward  their  subscriptions  at  an  early  day,  in  order  to  insure  the  receipt  of 
complete  sets  for  the  year  187 1 ,  as  the  constant  increase  in  the  subscription  list  almost 
always  exhausts  the  quantity  printed  shortly  after  publication. 

(ggr  The  safest  mode  of  remittance  is  by  bank  check  or  postal  money  order,  drawn 
to  the  order  ot  the  undersigned.  Where  these  are  not  accessible,  remittances  for  the 
"Journal"  may  be  made  at  the  risk  of  the  publisher,  by  forwarding  in  registered 
letter?.     Address, 

HENRY  C.  LEA, 
Nob.  706  and  7IIH  Sanhom  St..  Philadelphia,  Fa. 


Henry  C.  Lea's  Publications — (Dicticnaries). 


riUNGLISON  {ROBLEY),  M.D., 

~^  Professor  of  Institutes  of  Medicine  in  Jefferson  Medical  College,  Philadelphia. 

MEDICAL  LEXICON;  A  Dictionary  of  Medical  Science:  Con- 
taining ;i  concis*  explanation  of  the  various  Subjects  and  Terms  of  Anatomy,  Physio 
Pathology,  Hygiene.  Therapeutic?,  Pharmacology,  Pharmacy,  Snrgery,  Obstetrics,  Medical 
Jurisprudence,  ami  Dentistry.  Notices  of  Climate  and  of  Mineral  Waters:  Formulae  for 
Officinal, Empirical,  and  Dietetic  Preparation:-:;  with  the  Accentuation  and  Etymology  oi 
the  Terms,  and  the  French  and  other  Synonyraes;  so  as  to  constitute  a  French  as  well  p.s 
Engli-h  Medical  Lexicon.  Thoroughly  Revised,  and  very  greatly  Modified  and  Augmented. 
one  very  large  and  ham  octavo  volume  of  1048  double-columned  page3,  in 

small  type;  strongly  done  up  in  extra  cloth,  $6  00  j  leather,  raised  bands,  $6  75. 
The  object,  of  the  author  from  the  outset  hai  not  been  to  make  the  work  a  mere  lexicon  or 
dictionary  of  terms,  but  to  afford,  under  each,  a  condensed  view  of  its  various  medical  relation?, 
and  thus  to  render  the  work  an  epitome  of  the  existing  condition  of  medical  science.  Starting 
with  this  view,  the  immense  demand  which  has  existed  for  the  work  has  enabled  him,  in  repeated 
revisions,  to  augment  its  completeness  and  usefulness,  until  at  length  it  has  attained  the  position 
of  a  recognized  and  standard  authority  wherever  the  language  is  spoken.  The  mechanical  exe- 
cution of  this  edition  will  be  found  greatly  superior  to  that  of  previous  impressions.  By  enlarging 
the  i/e  of  the  volume  to  a  royal  octavo,  and  by  the  employment  of  a  small  but  clear  type,  on 
extra  fine  paper,  the  additions  have  been  incorporated  without  materially  increasing  the  bulk  oi 
the  volume,  and  the  matter  of  two  or  three  ordinary  octavos  has  been  compressed  into  the  space 
of  one  not  unhandy  for  consultation  and  reference. 

It  would  be  a  work  of  supererogation  to  bestow  a         It  5s  undoubtedly  the  most  complete  and   useful 
word   of  praise   u  i  We  can   only  i  medical  dictionary  hitherto  published  in  this  country. 

wonder  at  the  labor  expended, for  whenever  we  refer    — Chicago  Med.  Examiner,  February,  1S65. 
to  its   pages  for  Information  we   are  seldom  disap- !      what  we  take  to  be  decidedly  the  best  medical  die- 
pointed  in  finding  all  we  desire,  whether  it  he  in  ac-  .  tionasy  in  tte  English  language.    The  present  edition 
eentuation,  etymology,  or  definition  of  terms.—  hew    jH  brought  fully  up  to  the  advanced  state  of  seience. 
York  Medical  Journal,  .November,  1S65.  For  ma'Qy  a  long  year  "oUDgiison  »  has  been  at  our 


It  would  be  mere  waste  of  words  in  us  to  express  ;  elbow,   a  constant   companion   and    friend,   and   we 
f,ur  ad  a  work  which  is  so  universally    greet  him  in  his  replenished  and  improved  form  with 


and   deservedly  ap  The  most  admirable    especial  satisfaction. — Pacific  Med.  and  Surg.  Jour • 

work  of  its  kind  in  the  English  language.    As  a  book  <  nal,  June  27,  1865. 

.  it  is  Invaluable  to  the  medical  pracli-  j  ThiH  ■  perhaps,  the  book  of  all  others  which  the 
tloner,  and  in  every  instance  that  we  have  turned  pwgicjan  „r  KUrge,,n  should  have  on  his  shelves.  It 
over  it  ition  we  have  been  i  needed  at  th«  v  than  a  few  years 

by  the   i  —Canada  M  ,  Jufy,  1865. 


detail  wiiii  v.     i  We  can  mi 

.i  ly  commend  it  to  our  readers. — 
-;.  |  gow  11  dical  Journal,  Januar y,  1866. 

A  work  to  which  there  is  no  equal  in  the  English 
language. — Edinburgh  . 
It  la  more  than  a  dictionary,  and 

encyclopaedia.    This  edition  of  the 
sown  work  is  a  great  improvement  on 


It  deservedly  stands  at  the  head,  and  cannot  be 
uco. — Buffalo  Med.  and  Surg. 
Journal,  April,  1865. 

We  can  sincerely  commend  Dr.  Dnnglison's  work 
as  most  thorough,  scientific,  and  accurate.     We  have 
arching  its  pages  for  new  terms,  which 
have  abounded  so  much  of  late  in  medical  nomen- 
clature, and  our  search  has  been  successful  in  every 


rs.    The  book  Is  one  ol  t.he  very  few  of  which  stance.    We  have  been  particularly -truck  with  the 
y  be  sail  with   trim,   tl       ever;                        an  fttineBliof  the  synonymy "and  the  accuracy  of  the  de- 
ild  possess  It.— London  Medical  Times,  Aug.  26,  rfTation  of  words.    It  is  as  necessary  a  work  to  every 
1865.  ,  enlightened  physician  as  Worcester's  English  Die- 
Few  work^  of  tlo"               .i.t  ;■.  grander  monument  ,  tionary  is  to  every  one  who  would  keep  up  his  know- 
of  patient  research  and  oi                    >re.    '1  he  extent  ](.,;                   English  tongue  to  the  standard  of  the 
ofthe       eoftl      lexicon  is  sufficient  to  testify  to  it  to  our  mind,  the  most  complete 
usefulness,  and  to  the  great  service  conferred  by  Dr.  work  t)(  liie  kilJ,j  ^.j^  wi,ici1  we  are  acquainted.— 
Eobley  Dunglison  on  the  profession,  and  Indeed  on  j],,^,^  v,,i  ana  Surg.  Journal,  June  22,  1865. 
others,  by  its  issue. — London  Lancet,  May  13, 1865.  ,,.                          ,       .           .           ,            ... 
'     '                     ,         .                          '      '         .  We  are  free  to  confess  that  we  know  of  no  medical 
The  old  edition,  which  is  now  superseded  by  the  dictionary  more  complete;  no  one  better,  if  so  well 
new,                           ■••  -r-ally  looked  upon  by  the  rnedi-  |  adll,,[(  ,(  {,,r  ltie  UHe  ,,f  tne  student;  no  one  that  may 
cal  profession  as  a  work  ol  Immense  research  and  ,„.  coa^ited  with  more  satisfaction  by  the  medical 
g, .  al  value.     The  new  has  increased   usefulness  ;   for  practltioner.— Am.  Jour.  Med.  Science*,  April,  1865. 

medicine,  in  all  its  branches,  has  been  making  such  • 

sss  that  mani                              objects  have  re-  The  value  of  the  present  edition  has  been  greatly 

cenfiy  been  Introd*  iced  :  all  of  which  may  be  four  ''  '■>'  ***  introduction  of  new  subjects  and 

fnlly  defined  in  the  pre                        We  know  of  no  ^ms,  and  a  more  complete  etymology  and  accentua- 

othei  dictionary  in  the  English  language  that  can  Hon,  which  renders  the  work  not  only  satisfactory 

bear  a  comparison  with  It  In  point  of  completeness  of  I  ^°d  desirable,  but  Indispensable  to  the  physician.— 

racy  ol  statement.— N.   Y.  Drug-  OhicagoMed  Journal, April,  1865. 

gists'  Oirt  "'"  Wo  i  ntelligent  member  of  the  profession  can  or  will 

lor  many  years  Dunglison  -   Dictionary  has  been  be  witlj^u.t  *■—*.  Louis  Med.  and  Surg.  Journal 

the  standard  booh  oJ  reference  with  most  practition-  AI,ril>  1865. 

ers  in  this  country,  and  we  can  certainly  commend  It  has  the  rare  merit  that  it  certainly  has  no  rival 

.,.):   to   the  renewed  confidence  and   regard  of  j  in  the  English  language  o>r  aceuracy  and  extent  of 

our  readers. — Cincinnati  Lancet,  April,  1865.  'references. — Lond/m  Medical  Gazette. 


TJOBLYN  {RICHARD  D.),  M.D. 


A  DICTIONARY  OF  THE  TERMS  USED  IN  MEDICINE  AND 

THE  COLLATERAL  .SCIENCES.     Revised,  with  numerous  additions,  by  Isaac:    Hati 
M.L>-,  Editor  ofthe  "American  Journal  of  the  Medical   Sciences."      In  one  large  royal 
12rno.  volume  of  over  600  double-columned  pngeR  ;   extra  cloth,  $1    50  ;   leather,  $2  00. 
It  is  the  best  book  of  definitions  we  have,  and  ought  always  to  be  upon  the  student's  table. — Bouthtri* 
M-/i.  and  Surg.  Journal. 


Henry  C.  Lea's  Publications — (Manuals). 


^JEILL  (JOHN),  M.D.,    and      &MITH  (FRANCIS  G.),  M.D., 

Prof,  of  the  Institutes  of  Medicine  in  the  Univ.  of  Penna. 

AN    ANALYTICAL    COMPENDIUM    OF    THE   VARIOUS 

BRANCHES  OF  MEDICAL  SCIENCE  ;  for  the  Use  and  Examination  of  Students.     A 

new  edition,  revised  and  improved.    In  one  very  large  and  handsomely  printed  royal  12mo. 

volume,  of  about  one  thousand  pages,  with  374  wood  cuts,  extra  cloth,  $4;  strongly  bound 

in  leather,  with  raised  bands,  $4  75. 

cions  facts  treasured  up  in  this  little  volume.  A  com- 
plete portable  library  so  condensed  that  the  student 
may  make  it  his  constant  pocket  companion. —  West- 
ern Lancet. 


The  Compend  of  Drs.  Neilland  Smith  is  incompara- 
bly the  most  valuable  work  of  its  class  ever  published 
tn  this  country.  Attempts  have  been  made  in  various 
quarters  to  squeeze  Anatomy,  Physiology,  Surgery, 
the  Practice  of  Medicine,  Obstetrics,  Materia  Medica, 
and  Chemistry  into  a  single  manual;  but  the  opera- 
tion has  signally  failed  in  the  hands  of  all  up  to  the 
advent  of  "  Neill  and  Smith's"  volume,  which  is  quite 
a  miracle  of  success.  The  outlines  of  the  whole  are 
admirably  drawn  and  illustrated,  and  the  authors 
are  eminently  entitled  to  the  grateful  consideration 


In  the  rapid  course  of  lectures,  where  work  for  the 
students  is  heavy,  and  review  necessary  for  an  exa- 
mination, a  compend  is  not  only  valuable,  but  it  is 
almost  a  sine  qua  non.  The  one  before  us  is,  in  mo:;t 
of  the  divisions,  the  most  unexceptionable  of  all  books 
of  the  kind  that  we  know  of.  Of  course  it  is  useless 
for  us  to  recommend  it  to  all  last  course  students,  but 


of  the  student  of  every  class.—  N.  0.  Med.  and  Surg.  |  there  is  a  cias8  to  whom  we  very  sincerely  commend 

this  cheap  book  as  worth  its  weight  in  silver — that 
class  is  the  graduates  in  medicine  of  more  than  ten 


Journal. 

There  are  but  few  students  or  practitioners  of  me- 
dicine unacquainted  with  the  former  editions  of  this 
unassuming  though  highly  instructive  work.  The 
whole  science  of  medicine  appears  to  have  been  sifted, 
as  the  gold-bearing  sands  of  El  Dorado,  and  the  pre- 


years'  standing,  who  have  not  studied  medicine 
since.  They  will  perhaps  find  out  from  it  that  the 
science  is  not  exattly  now  what  it  was  when  they 
left  it  off. — The  Stethoscope. 


TTARTSHORNE  (HENRY),  M.  D., 

Professor  of  Hygiene  in  the  University  of  Pennsylvania. 

A    CONSPECTUS    OF    THE    MEDICAL    SCIENCES;   containing 

Handbooks  on   Anatomy,   Physiology,  Chemistry,  Materia   Medica,    Practical   Medicine, 
Surgery,  and  Obstetrics.     In  one  large  royal  12mo.  volume  of  1000  closely  printed  pages, 
with  over  300  illustrations  on  wood,  extra  cloth,  $4  50  ;    leather,  raised  bands,  $5  25. 
(Just  Issued.) 
The  ability  of  the  author,  and  his  practical  skill  in  condensation,  give  assurance  that  this 
work  will  prove  valuable  not  only  to  the  student  preparing  for  examination,  but  also  to  the  prac- 
titioner desirous  of  obtaining  within  a  moderate  compass,  a  view  of  the  existing  condition  of  the 
various  departments  of  science  connected  with  medicine. 

less  valuable  to  the  beginner.  Every  medical  student 
who  desires  a  reliable  refresher  to  his  memory  when* 
the  pressure  of  lectures  and  other  college  work  crowd* 
to  prevent  him  from  baring  an  opportunity  to  drink 
deeper  in  the  larger  works,  will  find  this  one  of  the 
greatest  utility.  It  is  thoroughly  trustworthy  from 
beginning  to  end  ;  and  as  we  have  before  intimated, 
a  remarkably  truthful  outline  sketch  of  the  present 
state  of  medical  science.  We  could  hardly  expect  it 
should  be  otherwise,  however,  under  the  charge  of 
such  a  thorough  medical  scholar  as  the  author  has 
alreadv  proved  himself  to  be. — N.  York  Med.  Record, 
March  15,  1869. 


This  work  is  a  remarkably  complete  one  in  its  way, 
and  comes  nearer  to  our  idea  of  what  a  Conspectus 
should  be  than  any  we  have  yet  seen.  Prof.  Harts- 
home,  with  a  commendable  forethought,  intrusted 
the  preparation  of  many  of  the  chapters  on  special 
subjects  to  experts,  reserving  only  anatomy,  physio- 
logy, and  practice  of%iedicine  to  himself.  As  a  result 
•w«  have  every  department  worked  up  to  the  latest 
date  and  in  a  refreshingly  concise  and  lucid  manner. 
There  are  an  immense  amount  of  illustrations  scat- 
tered throughout  the  work,  and  although  they  have 
often  been  seen  before  in  the  various  works  upon  gen- 
eral and  special  subjects,  yet  they  will  be  none  the 


J  DDLOW  (J.L.),  M.D. 

A   MANUAL   OF   EXAMINATIONS   upon   Anatomy,   Physiology, 

Surgery,  Practice  of  Medicine,  Obstetrics,  Materia  Medica,  Chemistry,  Pharmacy,  and 
Therapeutics.  To  which  is  added  a  Medical  Formulary.  Third  edition,  thoroughly  revised 
and  greatly  extended  and  enlarged.  With  370  illustrations.  In  one  handsome  royal 
12ino.  volume  of  816  large  pages,  extra  cloth,  $3  25;  leather,  $3  75. 
The  arrangement  of  this  volume  in  the  form  of  question  and  answer  renders  it  especially  suit- 
able for  the  office  examination  of  students,  and  for  those  preparing  for  graduation. 


WANNER  (THOMAS  HAWKES),  M.D.,  $-c. 

A  MANUAL  OF  CLINICAL  MEDICINE  AND  PHYSICAL  DIAG- 

NOSIS.     Third  American  from  the  Second  London  Edition.     Revised  and  Enlarged  by 

Tilbury  Fox,  M.  D.,  Physician  to  the  Skin  Department  in  University  College  Hospital, 

Ac.    In  one  neat  volume  small  12mo.,  of  about  375  pages,  extra  cloth.   $150.    (Jnsl  Issued.) 

*#*  By  reference  to  the  "  Prospectus  of  Journal"  on  page  3,  it  will  be  seen  that  this  work  is 

offered  as  a  premium  for  procuring  new  subscribers  to  the  "American  Journal  of  the  Medica*, 

Sciences." 

TakenasawhoIe.it  is  the  most  compact  vade  me-  |  The  objections  commonly,  and  justly,  urged  against 
enm  for  (he  use  of  the  advanced  student  and  junior  *  the  general  run  of  "compends,"  "conspectuses,"  and 
practitioner  with  which  we  ate  acquainted. — Boston  i  otheraids  to  indolence,  are  not  applicable  to  this  lUlle 
Med.  and  Surg.  Journal,  Sept.  22,  L870.  volume,  which  contains  in  concise  phrase  just  those 

It  contains  so  much  that  is  valuable,  presented  in  Practical  details  that  are  of  most  use  in  daily  diag- 
so  attractive  a  form,  that  it  can  hardly  be  spared  no,sls-  bnt  whlc  '  the  y?un«  Petitioner  finds  it  dilll- 
even  in  the  presence  of  more  full  and  complete  works.  «"»"  l?  carry  a  ways  la  hw  memory  withaaj  some 
The  additions  made  to  the  volume  by  Mr.  Fox  very    1<»<*!y  accessible  means  of  reference.     Altogether, 


i  by  Mr.  t'ox  very 
materially  enhance  its  value,  and  almost  make  it  a 
new  work.  Its  convenient  size  makes  it  a  valuable 
companion  to  the  country  practitioner,  and  if  con- 
stantly carried  by  him,  would  often  render  him  good 
service,  and  relieve  many  a  doubt  and  perplexity. — 
Leavenworth  Med.  llerald,  July,  1870. 


the  book  is  one  which  we  can  heartily  commend  lo 
those  who  have  not  opportunity  for  extensive  read- 
ing, or  who,  having  read  much,  still  wish  an  occa- 
sional practical  reminder.— .V.  Y.  Sled.  Gazette,  Nov. 
10,  1870. 


Henry  C.  Lea's  Publications — {Anatomy). 


(IRA  Y  (HENR  Y) ,  F.  R.  S., 

Lecturer  on  Anatomy  at  St.  George's  Hospital,  London 

ANATOMY,    DESCRIPTIVE    AND    SURGICAL.      The  Drawings  by 

H.  V.  Carter,  M.  D.,  late  Demonstrator  on  Anatomy  at  St.  George's  Hospital;  the  Dissec- 
tions jointly  by  the  Author  and  Dr.  Carter.     A  new  American,  from  the  fifth  enlarged 
and  improved  London  edition.     In  one  magnificent  imperial  octavo  volume,  of  nearly  900 
pages,  with  4fi5  large  and  elaborate  engravings  on  wood.     Price  in  extra  cloth,  $6  00 ; 
leather,  raised  bands,  $7  00.     (Just  Issued.) 
The  author  has  endeavored  in  this  work  to  cover  a  more  extended  range  of  subjects  than  is  cus- 
tomary in  the  ordinary  text-books,  by  giving  not  only  the  details  necessary  for  the  student,  but 
also  the  application  of  those  details  in  the  practice  of  medicine  and  surgery,  thus  rendering  it  both 
a  guide  for  the  learner,  and  an  admirable  work  of  reference  for  the  active  practitioner.     The  en- 
gravings form  a  special  feature  in  the  work,  many  of  them  being  the  size  of  nature,  nearly  all 
original,  and  having  the  names  of  the  various  parts  printed  on  the  body  of  the  cut,  in  place  of 
figures  of  reference,  with  descriptions  at  the  foot.    They  thus  form  a  complete  and  splendid  series, 
which  will  greatly  assist  the  student  in  obtaining  a  clear  idea  of  Anatomy,  and  will  also  serve  to 
refresh  the  memory  of  those  who  may  find  in  the  exigencies  of  practice  the  necessity  of  recalling 
the  details  of  the  dissecting  room  ;  while  combining,  as  it  does,  a  complete  Atlas  of  Anatomy,  with 
a  thorough  treatise  on  systematic,  descriptive,  and  applied  Anatomy,  the  work  will  be  found  of 
essential  use  to  all  physicians  who  receive  students  in  their  offices,  relieving  both  preceptor  and 
pupil  of  much  labor  in  laying  the  groundwork  of  a  thorough  medical  education. 

Notwithstanding  the  enlargement  of  this  edition,  it  has  been  kept  at  its  former  very  moderate 
price,  rendering  it  one  of  the  cheapest  works  now  before  the  profession. 


The  illustrations  are  beautifully  executed,  and  ren- 
der this  work  an  indispensable  adjunct  to  the  library 
of  the  surgeon.  This  remark  applies  with  great  force 
to  those  surgeons  practising  at  a  distance  from  our 
large  cities,  as  the  opportunity  of  refreshing  their 
memory  by  actual  dissection  is  not  always  attain- 
able.—  Canada  Med   Journal,  Aug.  1S70. 

The  work  is  too  well  known  and  appreciated  by  the 
profession  to  need  any  comment.  No  medical  man 
can  afford  to  be  without  it,  if  its  only  merit  were  to 
serve  as  a  reminder  of  that  which  so  soon  becomes 
forgotten,  when  not  called  into  frequent  use.  viz  ,  the 
relations  and  names  of  the  complex  organism  of  the 
human  body.  The  present  edition  is  much  improved. 
—California  Med   Gazette,  July,  1870. 

Gray's  Anatomy  has  been  so  long  the  standard  of 
perfection  with  every  student  of  anatomy,  that  we 
need  do  no  more  than  call  attention  to  the  improve- 


From  time  to  time,  as  successive  editions  have  ap- 
peared, we  have  had  much  pleasure  in  expressing 
the  general  judgment  of  the  wonderful  excelleuce  of 
Gray's  Anatomy. — Cincinnati  Lancet,  July,  1870. 

Altogether,  it  is  unquestionably  the  most  complete 
and  serviceable  text-book  in  anatomy  that  has  ever 
been  presented  to  the  student,  and  forms  a  striking 
contrast  to  the  dry  and  perplexing  volumes  on  the 
same  subject  through  which  their  predecessors  strug- 
gled in  days  gone  by. — N.  T.  Med.  Record,  June  15, 
1S70. 

To  commend  Gray's  Anatomy  to  the  medical  pro- 
fession is  almost  as  much  a  work  of  supererogation 
as  it  would  be  to  give  a  favorable  notice  of  the  Bible 
in  the  religious  press  To  say  that  it  is  the  most 
complete  and  conveniently  arranged  text  book  of  its 
kind,  is  to  repeat  what  each  generation  of  studeuts 
has  learned  as  a  tradition  of  the  elders,  and  verified 


ment  in  the  present  edition. — Detroit  Review  of  Med.    by  personal  experience. — N.  ¥.  Med.  Gazette,  Dec. 
and  Pharm.,  Aug.  1870.  I  17,  1870.  # 


VMITH  {HENRY  H.),  M.D.,         and     TJORNER  (  WILLIAM  E.),  M.D., 

Prof,  of  Surgery  in  the  Univ.  of  Penna.,  &c.  Late  Prof,  of  Anatomy  in  the  Univ.  ofPenna.,  &c. 

AN    ANATOMICAL    ATLAS,   illustrative   of  the   Structure  of  the 

Human  Body.     In  one  volume,  large  imperial  octavo,  extra  cloth,  with  about  six  hundred 

and  fifty  beautiful  figures.     $4  50. 
The  plan  of  this  Atlas,  which  renders  it  so  pecu-  I  the  kind  that  has  yet  appeared;  and  we  must  add, 
liarly  convenient  for  the  student,  and  its  superb  ar-  |  the  very  beautiful  manner  in  which  it  is  "got  up," 
tistical  execution,  have  been  already  pointed  out.  We    is  so  creditable  to  the  country  as  to  be  flattering  to 
must  congratulate  the  student  upon  the  completion     our  national  pride. — American  MedicalJoumal. 
of  this  Atlas,  as  it  is  the  most  convenient  work  of  I 


VHARPEY  (  WILLIAM),  M.D.,      and       Q  VAIN  [JONES  tf  RICHARD). 
HUMAN  ANATOMY.   Revised,  with  Notes  and  Additions,  by  Joseph 

Leidt,  M.D.,  Professor  of  Anatomy  in  the  University  of  Pennsylvania.     Complete  in  two 
large  octavo  volumes,  of  about  1300  pages,  with  511  illustrations;  extra  cloth,  $6  00. 
The  very  low  price  of  this  standard  work,  and  its  completeness  in  all  departments  of  the  subject, 
should  command  for  it  a  place  in  the  library  of  all  anatomical  students. 


fTODGES,  {RICHARD  M.),  M.D., 

■*■-*■  Late  Demonstrator  of  Anatomy  in  the  Medical  Department  of  Harvard  University. 

PRACTICAL  DISSECTIONS.     Seoond  Edition,  thoroughly  revised.     In 

one  neat  royal  12mo.  volume,  half-bound,  $2  00. 
The  object  of  this  work  is  to  present  to  the  anatomical  student  a  clear  and  concise  description 
of  that  which  he  is  expected  to  observe  in  an  ordinary  course  of  dissections.  The  author  has 
endeavored  to  omit  unnecessary  details,  and  to  present  the  subject  in  the  form  which  many  years' 
experience  has  shown  him  to  be  the  most  convenient  and  intelligible  to  the  student.  In  the 
revision  of  the  present  edition,  he  has  sedulously  labored  to  render  the  volume  more  worthy  of 
the  favor  with  which  it  has  heretofore  been  received. 


Henry  C.  Lea's  Publications — (Anatomy) 


1 


WILSON  [ERASMUS),  F.R.S. 

A  SYSTEM  OF  HUMAN  ANATOMY,  General  and  Special.    Edited 

by  W.  H.  Gobrecht,  M.  D.,  Professor  of  Generaland  Surgical  Anatomy  in  the  Medical  Col- 
lege of  Ohio.     Illustrated  with  three  hundred  and  ninety-seven  engravings  on  wood.     In 
one  large  and  handsome  octavo  volume,  of  over  600  large  pages;  extra  cloth,  $4  00;   lea- 
ther, $5  00. 
The  publisher  trusts  that  the  well-earned  reputation  of  this  long-established  favorite  will  be 
more  than  maintained  by  the  present  edition.     Besides  a  very  thorough  revision  by  the  author,  it 
has  be«n  most  carefully  examined  by  the  editor,  and  the  efforts  of  both  have  been  directed  to  in- 
troducing everything  which  increased  experience  in  its  use  has  suggested  as  desirable  to  render  it 
a  complete  text-book  for  those  seeking  to  obtain  or  to  renew  an  acquaintance  with  Human  Ana- 
tomy.    The  amount  of  additions  which  it  has  thus  received  may  be  estimated  from  the  fact  that 
the  present  edition  contains  over  one-fourth  more  matter  than  the  last,  rendering  a  smaller  type 
and  an  enlarged  page  requisite  to  keep  the  volume  within  a  convenient  size.     The  author  has  not 
only  thus  added  largely  to  the  work,  but  he  has  also  made  alterations  throughout,  wherever  there 
appeared  the  opportunity  of  improving  the  arrangement  or  style,  so  as  to  present  every  fact  in  ite 
most  appropriate  manner,  and  to  render  the  whole  as  clear  and  intelligible  as  possible.    The  editor 
has  exercised  the  utmost  caution  to  obtain  entire  accuracy  in  the  text,  and  has  largely  increased 
the  number  of  illustrations,  of  which  there  are  about  one  hundred  and  fifty  more  in  this  edition 
than  in  the  last,  thus  bringing  distinctly  before  the  eye  of  the  student  everything  of  interest  or 
importance. 

JJEATE  [CHRISTOPHER),  F.  R.  O.  S., 

■*--*-  Teacher  of  Operative  Surgery  in  University  College,  London. 

PRACTICAL   ANATOMY:    A   Manual   of  Dissections.     From   the 

Second  revised  and  improved  London  edition.     Edited,  with  additions,  by  W.  W.  Keen, 

M.D.,  Lecturer  on  Pathological  Anatomy  in  the  Jefferson  Medical  College,  Philadelphia. 

In  one  handsome  royal  12mo.  volume  of  578  pages,  with  247  illustrations.     Extra  cloth, 

$3  50 ;  leather,  §4  00.      {Just  Issued.) 
Dr.  Keen,  the  American  editor  of  this  work,  in  his  ,  Such  manuals  of  anatomy  are  always  favorite  works 
preface,  says:  "In  presenting  this  American  edition  j  with  medical  students.     We  would  earnestly  recom- 
:'(  '  Heath's  Practical  Anatomy,'  I  feel  that  I  have  I  mend  this  one  to  their  attention;  it  has  excellences 


been  iestrumental  ia  supplying  a  want  long  felt  for 
a  real  dissector's  manual,"  and  this  assertion  of  its 
editor  we  deem  is  fully  justified,  after  an  examina- 
tion of  its  contents,  for  it  is  really  an  excellent  work. 
I. ndeed,  we  do  not  hesitate  to  say,  the  best  of  its  class 
with  which  we  are  acquainted  ;  resembling  Wilson 
in  terse  and  clear  description,  excelliug  most  of  the 
so-called  practical  anatomical  dissectors  in  the  scope 
of  the  subject  and  practical  selected  matter, 


which  make  it  valuable  as  a  guide  in  dissecting, 
well  as  in  studying  anatomy. — Buffalo  Medical  and 
Surgical  Journal,  Jan.  1871. 

The  first  Euglish  edition  was  issned  about  six  years 
ago,  and  was  favorably  received  not  ouly  on  account 
of  the  great  reputation  of  its  author,  but  also  from 
its  great,  value  and  excellence  as  a  guide-book  to  the 
practical  anatomist.     The  American  edition  has  un- 
,    .  dergone'some  alterations  and  additions  which  will 
la  reading  this  work,  one  is  forcibly  impressed  with-1  no  doubt  enhance  its  value  materially.     The  conve- 
ne great  pains  the  author  takes  to  impress  the  sub-    uience  of  the  studeQt  has  been  carefully  consulted  in 


,ject  upon  the  mind  of  the  student.  He  is  full  of  rare 
and  pleasing  little  devices  to  aid  memory  in  main- 
taining its  hold  upon  the  slippery  slopes  of  anatomy. 
— St.  Louis  Med.  and  Surg.  Journal,  Mar.  10,  1871. 

It  appears  to  us  certain  that,  as  a  guide  in  dissec- 
tion, aud  as  a  work  containing  facts  of  anatomy  in 
brief  and  easily  understood  form,  this  manual  is 
complete.     This  work  contaius,  also,   very  perfect 


illy  i 

the  arrangement  of  the  text,  and  the  directions  given 
for  the  prosecution  of  certain  dissections  will  be'duly 
appreciated. — Canada  Lancet,  Feb.  1S71. 

This  is  an  excellent  Dissector's  Manual.;  one  which 
is  not  merely  a  descriptive  manual  of  anatomy,  but 
a  guide  to  the  student  at  the  dissecting  table,  enabling 
him,  though  a  beginner,  to  prosecute  his  work  intel- 
ligently, and  without  assistance.     The  American  edi 


illustrations  of  parts  which  can  thus  be  more  easily  i  tor  has  made  many  valuable  alterations  and  addi- 
anderstood  and  studied ;  in  this  respect  it  compares  j  tions  to  the  original  work. — Am.  Joum.  of  Obstetrics, 
favorably  with  works   of  much  greater  pretension.  I  Feb.  1871. 


MACLISE  [JOSEPH). 

SURGICAL   ANATOMY.      By  Joseph  Maclise,  Surgeon.     In  one 

volume,  very  large  imperial  quarto;  with  68  large  and  splendid  plates,  drawn  in  the  best 
style  and  beautifully  colored,  containing  190  figures,  many  of  them  the  size  of  life;  together 
with  copious  explanatory  letter-press       Strongly  and  handsomely  bound  in  extra  cloth. 
Price  $14  00. 
As  no  complete  work  of  the  kind  has  heretofore  been  published  in  the  English  language,  the 
present  volume  will  supply  a  want  long  felt  in  this  country  of  an  accurate  and  comprehensive 
Atlas  of  Surgical  Anatomy,  to  which  the  student  and  practitioner  can  at  all  times  refer  to  ascer- 
tain the  exact  relative  positions  of  the  various  portions  of  the  human  frame  towards  each  other 
and  to  the  surface,  as  well  as  their  abnormal  deviations.     Notwithstanding  the  large  size,  beauty 
and  finish  of  the  very  numerous  illustrations,  it  will  be  observed  that  the  price  is  so  low  as  to 
place  it  within  the  reach  of  all  members  of  the  profession. 

We  know  of  no  work  on  surgical  anatomy  which    refreshed   by   those   clear  and   distinct  dissections, 


can  compete  with  it. — Lancet 

The  work  of  Maclise  on  surgical  anatomy  is  of  the 
highest  value.  In  some  respects  it  is  the  best  publi- 
cation of  its  kind  we  have  seen,  and  is  worthy  of  a 
place  in  the  libiary  of  any  medical  man,  while  the 
student  could  scarce!  y  make  a  better  investment  than 
this. — The  Western  Journal  of  Medicine  and  Sitrgery. 

No  such  lithographic  illustrations  of  surgical  re- 
gions have  hitherto,  we  think,  been  given.  While 
the  operator  is  shown  every  vessel  and  nerve  where 


which  every  one  must  appreciate  who  has  a  particle 
of  enthusiasm.  The  English  medical  press  has  quite 
exhausted  the  words  of  praise,  in  recommenuing  tins 
admirable  treatise.  Those  who  have  any  curiosity 
to  gratify,  in  reference  to  the  perfectibility  of  the 
lithographic  art  in  delineating  the  complex  mechan- 
ism of  the  human  body,  are  invited  to  examine  our 
specimen  copy.  If  anything  will  induce  surgeons 
and  students  to  patronize  a  book  of  such  rare  value 
and  everyday  importance  to  them,  it'will  be  a  survey 
of  the  artistical  skill  exhibited  in  these  fac-similee  ot 


an  operation  is  contemplated,  the  exact  anatomist  is  j  nature. — Boston  Med.  and  Surg.  Journal. 

HORNER'S  SPECIAL  ANATOMY  AND  HISTOLOGY.  I      In  2  vols.  Svo.,  of  over  1000  pages,  with  more  than 
Eighth  edition,  extensively  revised  and  modified.  |      300  wood-cuts ;  extra  cloth,  $6  00. 


Henry  C.  Lea's  Publications — {Physiology). 


1TARSHALL  (JOHN),  F.  R.  S., 

JXL  Professor  of  Surgery  in  University  College,  London,  &c. 

OUTLINES  OF  PHYSIOLOGY,  HUMAN  AND  COMPARATIVE. 

"With  Additions  by  Francis  Gurney  Smith,  M.  D.,  Professor  of  the  Institutes  of  Medi- 
cine in  the  University  of  Pennsylvania,  &c.  With  numerous  illustrations.  In  one  large 
and  handsome  octavo  volume,  of  1026  pages,  extra  cloth,  $6  50  ;  leather,  raised  bands. 
$7  50. 


In  fact,  in  every  respect,  Mr.  Marshall  has  present- 
ed us  with  a  most  complete,  reliable,  and  scientific 
work,  and  we  feel  that  it  is  worthy  our  warmest 
commendation. — St.  Louis  Med.  Reporter,  Jan.  1S69. 

This  is  an  elaborate  and  carefully  prepared  digest 
of  human  and  comparative  physiology,  designed  for 
the  use  of  general  readers,  but  more  especially  ser- 
viceable to  the  student  of  medicine.  Its  style  is  con- 
cise, clear,  and  scholarly;  its  order  perspicuous  and 
exact,  and  its  range  of  topics  extended.  The  author 
and  his  American  editor  have  been  careful  to  bring 
to  the  illustration  of  the  subject  ihe  important  disco- 
veries of  modern  science  in  the  various  cognate  de- 
partments of  investigation  This  is  especially  visible 
in  the  variety  of  interesting  information  derived  from 
the  departments  of  chemistry  and  physics.  The  great 
amount  and  variety  of  matter  contained  in  the  work 
16  strikingly  illustrated  by  turning  over  the  copious 
index,  covering  twenty-four  closely  printed  pages  in 
double  columns. — Silliman's  Journal,  Jan.  1S69. 

"We  doubt  if  there  is  in  the  English  language  any 
compend  of  physiology  more  useful  to  the  student 
than  this  work. — St.  Louis  Med.  and  Surg.  Journal, 
Jan.  1S69. 

It  qnite  fulfils,  in  our  opinion,  the  author's  design 
of  making  it  truly  educational  in  its  character — which 
is,  perhaps,  the  highest  commendation  that  can  be 
asked. — Am.  Journ.  Med.  Sciences,  Jan.  1S69. 

We  may  now  congratulate  him  on  having  com- 
pleted the'  latest  as  well  as  the  best  summary  of  mod- 


ern physiological  science,  both  human  and  compara- 
tive, with  which  we  are  acquainted.  To  speak  of 
this  work  in  the  terms  ordinarily  used  on  such  occa- 
sions would  not  be  agreeable  to  ourselves,  and  would 
fail  to  do  justice  to  its  author.  To  write  such  a  book 
requires  a  varied  and  wide  range  of  knowledge,  con- 
siderable power  of  analysis,  correct  judgment,  skill 
in  arrangement,  and  conscientious  spirit.  It  must 
have  entailed  great  labor,  but  now  that  the  task  has 
been  fulfilled,  the  book  will  prove  not  only  invaluable 
to  the  student  of  medicine 'and  surgery,  but  service- 
able to  all  candidates  in  natural  science  examinations, 
to  teachers  in  schools,  and  to  the  lover  of  nature  gene- 
rally. In  conclusion,  we  can  only  express  the  con- 
viction that  the  merits  of  the  work  will  command  for 
it  that  success  which  the  ability  and  vast  labor  dis- 
played in  its  production  so  well  deserve. — London 
Lancet,  Feb.  22,  1S6S. 

If  the  possession  of  knowledge,  and  peculiar  apti- 
tude and  skill  in  expounding  it,  qualify  a  man  to 
write  an  educational  work,  Mr.  Marshall's  treatise 
might  be  reviewed  favorably  without  even  opening 
the  covers.  There  are  few,  if  any,  more  accomplished 
anatomists  and  physiologists  than  the  distinguished 
professor  of  surgery  at  University  College;  and  he 
has  long  enjoyed  the  highest  reputation  as  a  teacher 
of  physiology,  possessing  remarkable  powers  of  clear 
exposition  and  graphic  illustration.  We  have  rarely 
the  pleasure  of  being  able  to  recommend  a  text-book 
so  unreservedly  as  this. — British  Med.  Journal,  Jan. 
25,  186S. 


flARPENTER  (WILLIAM  B.),  31.  D.,  F.  R.  S., 

v^  Examiner  in  Physiology  and  Comparative  A  natomy  in  the  University  of  London. 

PRINCIPLES  OF  HUMAN  PHYSIOLOGY;  with  their  chief  appli- 

cations  to  Psychology,  Pathology,  Therapeutics,  Hygiene  and  Forensic  Medicine.  A  new 
American  from  the  last  and  revised  London  edition.  With  nearly  three  hundred  illustration?. 
Edited,  with  additions,  by  Francis  Gurney  Smith,  M.  D.,  Professor  of  the  Institutes  of 
Medicine  in  the  University  of  Pennsylvania,  <fec.  In  one  very  large  and  beautiful  octavo 
volume,  of  about  900  large  pages,  handsomely  printed;  extra  cloth,  $5  50  ;  leather,  raised 
bands,  $6  50. 


With  Dr.  .Smith,  we  confidently  believe  "that  the 
present  will  more  than  sustain  the  enviable  reputa- 
tion already  attained  by  former  editions,  of  being 
one  of  the  fullest  and  most  complete  treatises  on  the 
subject  in  the  English  language."  We  know  of  none 
from  the  pages  of  which  a  satisfactory  knowledge  of 
the  physiology  of  the  human  organism  can  be  as  well 
obtained,  none  better  adapted  for  the  use  of  such  as 
take  up  the  study  of  physiology  in  its  reference  tof 
the  instil. ites  and  practice  of  medicine. — Am.  Jour. 
Med.  Sciences. 


We  doubt  not  it  is  destined  to  retain  a  strong  hold 
on  public  favor,  and  remain  the  favorite  text-book  in 
our  colleges. —  Virginia  Medical  Journal. 

The  above  is  the  title  of  what  is  emphatically  the 
great  work  on  physiology ;  and  we  are  conscious  that 
it  would  be  a  useless  effort  to  attempt  to  add  any- 
thing to  the  reputation  of  this  invaluable  work,  and 
ma  only  say  to  all  with  whom  our  opinion  has  any 
influence,  that  it  is  our  authority. — Atlanta  Med. 
Journal. 


T>Y  THE  SAME  AUTHOR. 

PRINCIPLES  OF  COMPARATIVE  PHYSIOLOGY.    New  Ameri- 

can,  from  the  Fourth  and  Revised  London  Edition.     In  one  large  and  handsome  octavo 
volume,  with  over  three  hundred  beautiful  illustrations     Pp.  752.    Extra  cloth,  $5  00. 
As  a  complete  and  condensed  treatise  on  its  extended  and  important  subject,  this  work  becomes 

a  necessity  to  students  of  natural  science,  while  the  very  low  price  at  which  it  is  offered  places  it 

within  the  reach  of  all. 


JTIRKES  (WILLIAM  SEXHOUSE),  M.D. 

A  MANUAL  OF  PHYSIOLOGY.     A  new  American  from  the  third 

and  improved  London  edition      With  two  hundred  illustrations.     In  one  large  and  hand- 
some royal  12mo.  volume.     Pp.  586.     Extra  cloth,  $2  25  ;  leather,  $2  75. 


It  is  at  once  convenient  in  size,  comprehensive  in 
•design,  and  concise  in  statement,  and  altogether  well 
adapted  for  the  purpose  designed. — St.  Louis  Med. 
and  Surg.  Journal. 

The  physiological  reader  will  And  it  a  most  excel- 


lent guide  in  the  study  of  physiology  in  its  most  ad- 
vanced and  perfect  form.  The  author  has  shown 
himself  capable  of  giving  details  sufficiently  ample 
in  a  condensed  and  concentrated  shape,  on  a  science 
in  which  it  is  necessary  at  once  to  be  correct  and  not 
lengthened. — Edinburgh  Med.  and  Surg.  Journal. 


Henry  C.  Lea's  Publications — (Physiology). 


T\ALTON  (J.  C),  M.  D., 

-*-r  Professor  of  Physiology  in  the  College  of  Physicians  and  Stirgeons,  New  York,  &c. 

A  TREATISE  ON  HUMAN  PHYSIOLOGY.    Designed  for  the  use 

of  Students  and  Practitioners  of  Medicine.  Fifth  edition,  revised,  with  nearly  three  hun- 
dred illustrations  on  wood.  In  one  very  beautiful  octavo  volume,  of  over  700  pages,  extra 
cloth,  $5  25  ;  leather,  $6  25.     (Now  Ready.) 

Preface  to  the  Fifth  Edition. 
In  preparing  the  present  edition  of  this  work,  the  general  plan  and  arrangement  of  the  previous 
editions  have  been  retained,  so  far  as  they  have  been  found  useful  and  adapted  to  the  purposes  of 
a  text-book  for  students  of  medicine.  The  incessant  advance  of  all  the  natural  and  physical 
sciences,  never  more  active  than  within  the  last  five  years,  has  furnished  many  valuable  aids  to 
the  special  investigations  of  the  physiologist ;  and  the  progress  of  physiological  research,  during 
the  same  period,  has  required  a  careful  revision  of  the  entire  work,  and  the  modification  or  re- 
arrangement of  many  of  its  parts.  At  this  day,  nothing  is  regarded  as  of  any  value  in  natural 
science  which  is  not  based  upon  direct  and  intelligible  observation  or  experiment;  and,  accord- 
ingly, the  discussion  of  doubtful  or  theoretical  questions  has  been  avoided,  as  a  general  rule,  in 
the  present  volume,  while  new  facts,  from  whatever  source,  if  fully  established,  have  been  added 
and  incorporated  with  the  results  of  previous  investigation.  A  number  of  new  illustrations  have 
been  introduced,  and  a  few  of  the  older  ones,  which  seemed  to  be  no  longer  useful,  have  been 
omitted.  In  all  the  changes  and  additions  thus  made,  it  has  been  the  aim  of  the  writer  to  make  the 
book,  in  its  present  form,  a  faithful  exponent  of  the  actual  conditions  of  physiological  science. 
New  York,  October,  1871. 
In  this,  the  standard  text-book  on  Physiology,  all  that  is  needed  to  maintain  the  favor  with  which 
it  is  regarded  by  the  profession,  is  the  author's  assurance  that  it  has  been  thoroughly  revised  and 
brought  up  to  a  level  with  the  advanced  science  of  the  day.  To  accomplish  this  has  required 
some  enlargement  of  the  work,  but  no  advance  has  been  made  in  the  price. 
A  few  notices  of  previous  editions  are  subjoined. 

It  is  no  disparagement  of  the  many  excellent  works 
on  physiology,  published  prior  to  chat  of  Dalton,  to 
say  that  none  of  them,  either  in  plan  of  arrangement 
or  clearness  of  execution,  could  be  compared  with  hi 


for  the  use  of  students  or  general  practitioners  of 
medicine.  For  this  purpose  his  book  has  no  equal  in 
the  English  language. —  Western  Journal  of  Medi- 
cine, Nov.  1S67. 

A  capital  text-book  in  every  way.  We  are,  there- 
fore, glad  to  see  it  in  its  fourth  edition.  It  has  already 
been  examined  at  full  length  in  these  columns,  so  that 
we  need  not  now  further  advert  to  it  beyond  remark- 
ing that  both  revision  and  enlargement  have  been 
most  judicious. — London  Med.  Times  and  Gazette, 
Oct.  19,  1S67. 

No  better  proof  of  the  value  of  this  admirable 
work  could  be  produced  than  the  fact  that  it  has  al- 
ready reached  a  fourth  edition  in  the  short  space  of 
eight  years.  Possessing  in  an  eminent  degree  the 
merits  of  clearness  and  condensation,  and  being  fully 
brought  up  to  the  present  level  of  Physiology,  it  is 
undoubtedly  one  of  the  most  reliable  text-books 
upon  this  science  that  could  be  placed  in  the  hands 
of  the  medical  student. — Am.  Journal  Med.  Sciences, 
.Oct.  1867. 


Prof.  Dalton's  work  has  such  a  well-established 
reputation  that  it  does  not  stand  in  need  of  any  re- 
commendation. Ever  since  its  first  appearance  it  has 
become  the  highest  authority  in  the  English  language; 
and  that  it  is  able  to  maintain  the  enviable  position 
which  it  has  taken,  the  rapid  exhaustion  of  the  dif- 
ferent successive  editions  is  sufficient  evidence.  The 
present  edition,  which  is  the  fourth,  has  been  tho- 
roughly revised,  and  enlarged  by  the  incorporation 
of  all  the  many  important  advances  which  have 
lately  been  made  in  this  rapidly  progressing  science. 
— N.  Y.  Med.  Record,  Oct.  15,  1867. 

As  it  stands,  we  esteem  it  the  very  best  of  the  phy- 
siological text-books  for  the  student,  and  the  most 
concise  reference  and  guide-book  for  the  practitioner 
— N.  Y.  Med.  Journal,  Oct.  1867. 

The  present  edition  of  this  now  standard  work  fully 
sustains  the  high  reputation  of  its  accomplished  au- 
thor. It  is  not  merely  a  reprint,  but  has  been  faith- 
fully revised,  and  enriched  by  such  additions  as  the 
progress  of  physiology  has  rendered  desirable.  Taken 
as  a  whole,  it  is  unquestionably  the  most  reliable  and 
useful  treatise  on  the  subject  that  has  been  issued 
from  the  American  press. — Chicago  Med.  Journal, 
Sept.  1867. 


D 


UNGLISON  {ROBLEY),  31.  D., 

Professor  of  Institutes  of  Medicine  in  Jefferson  Medical  College,  Philadelphia. 

HUMAN  PHYSIOLOGY.     Eighth  edition.     Thoroughly  revised  and 

extensively  modified  and  enlarged,  with  five  hundred  and  thirty-two  illustrations.  In  two 
large  and  handsomely  printed  octavo  volumes  of  about  1500  pages,  extra  cloth.     $7  00. 

TEHMANN  (C.   G.). 

PHYSIOLOGICAL  CHEMISTRY.  Translated  from  the  second  edi- 
tion by  George  E.  Day,  M.  D.,  F.  R.  S.,  &c,  edited  by  R.  E.  Rogers,  M.  D.,  Professor  of 
Chemistry  in  the  Medical  Department  of  the  University  of  Pennsylvania,  with  illustrations 
selected  from  Funke's  Atlas  of  Physiological  Chemistry,  and  an  Appendix  of  plates.  Com- 
plete in  two  large  and  handsome  octavo  volumes,  containing  1200  pages,  with  nearly  two 
hundred  illustrations,  extra  cloth.     $6  00. 

J>  Y  THE  HA  ME  AUTHOR. 

MANUAL  OF  CHEMICAL  PHYSIOLOGY.    Translated  from  the 

German,  with  Notes  and  Additions,  by  J  Cheston  Morris,  M.  D.,  with  an  Introductory 
Essay  on  Vital  Force,  by  Professor  Samuel  Jackson,  M.  D.,  of  the  University  of  Pennsyl- 
vania. With  illustrations  on  wood.  In  one  very  handsome  octavo  volume  of  336  pages. 
extra  cloth.     $2  25. 

rpODD  {ROBERT  B.),  M.  D.  F.  R.  S.,  and  JjO  WMAN  (  W.),  F.R.S. 
THE    PHYSIOLOGICAL   ANATOMY  AND   PHYSIOLOGY   OF 

MAN.  With  about  three  hundred  large  and  beautiful  illustrations  on  wood.  Complete  in 
one  large  octavo  volume  of  950  pages,  extra  cloth.     Price  $4  75. 


10 


Henry  C.  Lea's  Publications — (Chemistry). 


A  TTFIELD  (JOHN),  Ph.  D., 

-*■  Professor  of  Practical  Chemistry  to  the  Pharmaceutical  Society  of  Great  Britain,  &c. 

CHEMISTRY,    GENERAL,  MEDICAL,  AND  PHARMACEUTICAL  ; 

including  the  Chemistry  of  the  U.  S.  Pharmacopoeia.  A  Manual  of  the  General  Principles 
of  the  Science,  and  their  Application  to  Medicine  and  Pharmacy.  From  the  Second  and 
Enlarged  English  Edition,  revised  by  the  author.  In  one  handsome  royal  12mo.  volume 
of  about  550  pages  ;  extra  cloth,  $2  75  ;  leather,  $3  25.  {Just  Issued.) 
It  contains  a  most  admirable  digest  of  what  is  spe-  ]  required  at  his  examinations. — Tlte  Pliarmaceutieal 
cialty  needed  by  the  medical  student  in  all  that  re-  j  Journal. 

lates  to  practical  chemistry,  and  constitutes  for  him  At  page  350  of  the  c,ment  volume  of  this  journal 
a  sound  and  useful  text-book  on  the  suhjpct.  .  .  .  _e  remavked  that  "  there  is  a  sad  dearth  of  [medicar 
We  commend  it  to  the  noticeof  every  medical,  as  well  i  stu(jellts>  text-books  in  chemistry."  Dr.  Attfield's 
as  pharmaceutical,  student.  We  only  regret  that  we  I  voiumei  just  published,  is  rather  a  new  book  than  a 
had  not  the  book  to  depend  upon  in  working  up  the  j  se0Ond  edition  of  his  previous  work,  and  more  nearly 
subiect  of  practical  and  pharmaceutical  chemistry  for  rea]jzes  0llr  ideal  than  any  book  we  have  before  seen 
the  University  of  Loudon,  for  which  it  seems  to  us  j  on  the  subject.— The  British  Medical  Journal. 
that  it  is  exactly  adapted.     This  is  paying  the  book  a  i      _,...,..         ,.  ,.      ,  .'.     . 

i  rlLi       rri.c  Tn-n^t        rjl  The  introduction  of  new  mat ter  has  not  destroyed 

hisrh  compliment. — 1  he  Lancet.  \  t,  .   .      ,     .  c  .,  ,  J 

uigu  uumj/Luiou,  (  t^e  orl;?lnai  character  of  the  work,  as  a  treatise  on 

Dr.  Attfield's  hook  is  written  in  a  clear  and  able     pharmaceutical  and  medical  chemistry,  but  has  sim- 
manner;  it  is  a  work  suigeneris  and  without  a  rival ;  !  plyextended  the  foundations  of  these  special  depart- 
it  will  be  welcomed,  we  think,  by  every  reader  of  the  !  meuts  of  the  science. — The  Chemist  and  Druggist. 
'Pharmacopoeia,'  and  is  quite  as  well  sui_ted  for  the  j      We  believe   that  this  manual   has  been  already 


medical  student  as  for  the  pharmacist.— The  Chemi 
col  News. 

A  valuable  guide  to  practical  medical  chemistry, 
and  an  admirable  companion  to  the  "British  Phar- 
macopoeia "    It  is  rare  to  find  so  many  qualities  corn- 


adopted  as  the  class-book  by  many  of  the  professors 
in  thepublic  schools  throughoutthe  United  Kingdom. 
...  In  pharmaceutical  chemistry  applied  to  the  phar- 
macopoeia, we  know  of  no  rival.  It  is,  therefore,  par- 
ticularly suited  to  the  medical  student.  —  The  Medical 

bined",  and  quite  curious  to  note  how  much  valuable  (  Press  and  Circular. 

information  fiuds  a  mutual  interdependence  —Medi-        It  in  every  way  fulfils  the  intention  of  the  author. 

cal  Times  and  Gazette.  [  y?e  can  strongly  recommend  it  as  a  most  complete 


Btud 


It  is  almost  the  only  book  from  which  the  medical     manual  of  chemistry,  alike  useful  to  the  physician 
adent  can  work  up  the  pharmacopceial  chemistry  j  and  pharmaceutist. — Canada  Med.  Journ.,  Not. '70. 


fkDLING  ( WILLIAM), 

^-'  Lecturer  on  Chemistry,  at  St.  Bartholomew's  Hospital,  d-c. 

A  COURSE  OF  PRACTICAL  CHEMISTRY,  arranged  for  the  Use 

of  Medical  Students.    "With  Illustrations.    From  the  Fourth  and  Revised  London  Edition. 

In  one  neat  royal  12mo.  volume,  extra  cloth.  $2.  {Lately  Issued.) 
As  a  work  for  the  practitioner  it  cannot  be  excelled.  |  ganic  chemistry,  etc.  The  portions  devoted  to  a  dis- 
It  is  written  plainly  and  concisely,  and  gives  in  a  very  cussion  of  these  subjects  are  very  excellent.  In  no 
small  compass  the  information  required  by  the  busy  |  work  can  the  physician  find  more  thai  is  valuable 
practitioner.  It  is  essentially  a  work  for  the  physi-  j  and  reliable  in  regard  to  urine,  bile,  milk,  bone,  uri- 
cian,  and  no  one  who  purchases  it  will  ever  regret  the  j  nary  calculi,  tissue  composition,  etc.  The  work  is 
outlay.  In  addition  to  all  that  is  usually  given  in  j  small,  reasonable  in  price,  and  well  published. — 
connection  with  inorganic  chemistry,  there  are  most  Richmond  and  Louisville  Med.  Joumal,Dec.  1869. 
valuable  contributions  to  toxicology,  animal  and  or-  | 


B 


OWMAN  (JOHN  E.),M.  D. 

PRACTICAL  HANDBOOK  OF  MEDICAL  CHEMISTRY.     Edited 

by  C.  L.  Bloxam,  Professor  of  Practical  Chemistry  in  King's  College,  London.  Fifth 
American,  from  the  fourth  and  revised  English  Edition.  In  one  neat  volume,  royal  12mo., 
pp.  351,  with  numerous  illustrations,  extra  cloth.     82  25.     (Just  Issued.) 


The  fourth  edition  of  this  invaluable  text-book  of 
Medical  Chemistry  was  published  in  England  in  Octo- 
ber of  the  last  year.  The  Editor  has  brought  down 
the  Handbook  to  that  date,  introducing,  as  far  as  was 
compatible  with  the  necessary  conciseness  of  such  a 
work,  all   the  valuable  discoveries  in   the  science 


which  have  come  to  light  since  the  previous  edition 
was  printed.  The  work  is  indispensable  to  every 
student  of  medicine  or  enlightened  practitioner.  It 
is  printed  iu  clear  type,  and  the  illustrations  ara 
numerous  and  intelligible. — Boston  Med.  and  Svrg. 
Journal. 


T>Y  THE  SAME  AUTHOR. 

INTRODUCTION   TO   PRACTICAL  CHEMISTRY,  INCLUDING 

ANALYSIS.     Fifth  American,  from  the  fifth  and  revised  London  edition.     With  numer- 
ous illustrations.     In  one  neat  vol.,  royal  12mo.,  extra  cloth.     $2  25.      (Just  Issued.) 
One  of  the  most  complete  manuals  that   has  for  a     It  is  by  far  the  best  adapted  for  the  Chemical  student 
long    time  been    given    to  the    medical    student. —    of  any  that  has  yet  fallen  in  onr  way. — British  and 
AthenaWm.  Foreign  Medico-Chirurgical  Review. 

We  regard  it  as  realizing  almost  everything  to  he        The  best  introductory  work  on   the  subject  with 
desired  in  an  introduction  to  Practical  Chemistry,     which  we  are  acquainted. — Edinburgh  Monthly  Jour. 


S1RA HA M  ( THOMAS),  F.  R.  S. 

THE   ELEMENTS  OF  INORGANIC  CHEMISTRY,  including  the 

Applications  of  the  Science  in  the  Arts.  New  and  much  enlarged  edition,  by  Hesrt 
Watts  and  Robert  Bridges,  M.  D.  Complete  in  one  large  and  handsome  octavo  volume, 
of  over  800  very  large  pages,  with  two  hundred  and  thirty-two  wood-cuts,  extra  cloth. 
$5  50. 


KNAPP'S  TECHNOLOGY  ;  or  Chemistry  Applied  to 
the  Arts,  and  to  Manufactures.  With  American 
additions,  by  Prof.  Walter  K.  Johnson.    In  two 


very  handsome  octavo  volumes,  with  500  trood 
engravings,  extra  cloth,  $8  00. 


Henry  C.  Lea's  Publications — (Chemistry,  Pharmacy, &c).       11 


JjTOWNES  {GEORGE),  Ph.  D. 

A  MANUAL  OF  ELEMENTARY  CHEMISTRY;   Theoretical  and 

Practical.  With  one  hundred  and  ninety-seven  illustrations.  A  new  American,  from  the 
tenth  and  revised  London  edition.  Edited  by  Robert  Bridges,  M.  D.  In  one  large 
royal  12mo.  volume,  of  about  850  pp  ,  extra  cloth,  $2  75  ;  leather,  $3  25.  (Just  Issued.) 
Some  years  having  elapsed  since  the  appearance  of  the  last  American  edition,  and  several 
revisions  having  been  made  of  the  work  in  England  during  the  interval,  it  will  be  found  very 
greatly  altered,  and  enlarged  by  about  two  hundred  and  fifty  pages,  containing  nearly  one  half 
more  matter  than  before.  The  editors,  Mr.  Watts  and  Dr.  Bence  Jones,  have  labored  sedulously 
to  render  it  worthy  in  all  respects  of  the  very  remarkable  favor  which  it  has  thus  far  enjoyed,  by 
incorporating  in  it  all  the  most  recent  investigations  and  discoveries,  in  so  far  as  is  compatible  with 
its  design  as  an  elementarjr  text-book.  While  its  distinguishing  characteristics  have  been  pre- 
served, various  portions  have  been  rewritten,  and  especial  pains  have  been  taken  with  the 
department  of  Organic  Chemistry  in  which  late  researches  have  accumulated  so  many  new  facts 
and  have  enabled  the  subject  to  be  systematized  and  rendered  intelligible  in  a  manner  formerly 
impossible.  As  only  a  few  months  have  elapsed  since  the  work  thus  passed  through  the  hftnds 
of  Mr.  Watts  and  Dr.  Bence  Jones,  but  little  has  remained  to  be  done  by  the  American  editor. 
Such  additions  as  seemed  advisable  have  however  been  made,  and  especial  care  has  been  taken 
to  secure,  by  the  closest  scrutiny,  the  accuracy  so  essential  in  a  work  of  this  nature. 

Thus  fully  brought  up  to  a  level  with  the  latest  advances  of  science,  and  presented  at  a  price 
within  the  reach  of  all,  it  is  hoped  that  the.  work  will  maintain  its  position  as  the  favorite  text- 
book of  the  medical  student. 

the  General  Principles  of  Chemical  Philosophy,  and 
the  greater  part  of  the  organic  chemistry,  have  beea 
rewritten,  and  the  whole  work  revised  in  accordance 
with  the  recent  advances  in  chemical  knowledge.  It 
remains  the  standard  text-book  of  chemistry. — Dub- 
lin Quarterly  Journal,  Feb.  1S69. 

There  is  probably  not  a  student  of  chemistry  in  this 
country  to  whom  the  admirable  manual  of  the  late 
Professor  Fownes  is  unknown  It  has  achieved  a 
success  which  we  believe  is  entirely  without  a  paral- 
lel among  scientific  text-books  in  our  language.  This 
success  has  arisen  from  the  fact  that  there  is  no  En- 
glish work  on  chemistry  which  combines  so  many 
excellences.  Of  convenient  size,  of  attractive  form, 
clear  and  concise  in  diction,  well  illustrated,  and  of 
moderate  price,  it  would  seem  that  every  requisite 
for  a  student's  hand-book  has  been  attained.  The 
ninth  edition  was  published  under  the  joint  editor- 
ship of  Dr.  Bence  Jones  and  Dr.  Hofmann;  the  new 
one  has  been  superintended  through  the  press  by  Dr. 
Bence  Jones  and  Mr.  Henry  Watts.  It  is  not  too 
much  to  say  that  it  could  not  possibly  have  been  in 
better  hands.  There  is  no  one  in  England  who  can 
compare  with  Mr.  Watts  in  experience  as  a  compiler 
iu  chemical  literature,  and  we  have  much  pleasure 
in  recording  the  fact  that  his  reputation  is  well  sus- 
tained by  this,  his  last  undertaking. — The  Chemical 
News,  Feb.  1S69. 

Here  is  a  new  edition  which  has  been  long  watched 
for  by  eager  teachers  of  chemistry.  In  its  new  garb, 
and  under  the  editorship  of  Mr.  Watts,  it  has  resumed 
its  old  place  as  the  most  successful  of  text-books. — 
Indian  Medical  Gazette,  Jan.  1,  1869 


This  work  is  so  well  known  that  it  seems  almost 
superfluous  for  us  to  speak  about  it.  It  has  been  a 
favorite  text-book  with  medical  'Students  for  years, 
and  its  popularity  has  in  no  respect  diminished. 
Whenever  we  have  been  consulted  by  medical  stu- 
dents, as  has  frequently  occurred,  what  treatise  on 
chemistry  they  should  procure,  we  have  always  re- 
commended Fownes',  for  we  regarded  it  as  the  best. 
There  is  no  work  that  combines  so  many  excellen- 
ces. It  is  of  convenient  size,  not  prolix,  of  plain 
perspicuous  diction,  contains  all  the  most  recent 
discoveries,  aud  is  of  moderate  price. — Cincinnati 
Med.  Repertory,  Aug.  1S69. 

Large  additions  have  been  made,  especially  in  the 
department  of  organic  chemistry,  and  we  know  of  no 
other  work  that  has  greater  claims  on  the  physician, 
pharmaceutist,  or  student,  than  this.  We  cheerfully 
recommend  it  as  the  best  text-book  on  element:! ry 
chemistry,  and  bespeak  for  it  the  careful  attention 
of  students  of  pharmacy. — Chicago  Pharmacist,  Aug. 
1869. 

The  American  reprint  of  the  tenth  revised  and  cor- 
rected Euglish  edition  is  now  issued,  and  represents 
the  present  condition  of  the  science.  No  comments 
are  necessary  to  insure  it  a  favorable  reception  at 
the  hands  of  practitioners  and  students.  —  Boston 
Med.  and  Surg.  Journal,  Aug.  12,  1869. 

It  will  contin  ue,  as  heretofore,  to  hold  the  first  rank 
as  a  text-book  for  students  of  medicine. — Chicago 
Med.  Examiner,  Aug.  1869. 
-  This  work,  long  the  recognized  Manual  of  Chemistry, 
appears  as  a  tenth  edition,  under  the  able  editorship 
of  Bence  Jones  and  Henry  Watts.     The  chapter  on 


JDRANDE  (  WM.  T.),  D.  G.  L.,  and    fTA  FLOP  {ALFRED  S.),  M.D.,  F.  R.S. 
CHEMISTRY.     Second  American  edition,  thoroughly  revised  by  Dr. 

Taylor.     In  one  handsome  8vo.  volume  of  764  pages,  extra  cloth,  $5  00  ;  leather,  $6  00. 
From  Dr.  Taylor's  Preface. 

"The  revision  of  the  second  edition,  in  consequence  of  the  death  of  my  lamented  colleague, 
has  devolved  entirely  upon  myself..  Every  chapter,  and  indeed  every  page,  has  been  revised, 
and  numerous  additions  made  in  all  parts  of  the  volume.  These  additions  have  been  restricted 
chiefly  to  subjects  having  gome  practical  interest,  and  they  have  been  made  as  concise  as  possible, 
in  order  to  keep  the  book  within  thpse  limits  which  may  retain  for  it  the  character  of  a  Student's 
Manual  " — London,  June  29,  1867. 

A  book  that  has  already  so  established  a  reputa-  I  of  information  with  the  most  sparing  use  of  technical 
tion,  as  has  Brande  aud  Taylor's  Chemistry,  can  !  terms  aud  phraseology,  so  as  to  furnish  the  reader, 
hardly  need  a  notice,  save  to  mention  the  additions  |  "whether  a  student  of  medicine,  or  a  man  of  the 
and  improvements  of  the  edition.  Doubtless  the  world,  with  a  plain  introduction  to  the  science  and 
work  will  long  remain  a  favorite  text-book  in  the  practice  of  chemistry." — Journal  nf  Applied  Chem- 
schools,  as  well  as  a  convenient  book  of  reference  for  !  tstry,  Oct.  1867. 

This  second  American  edition  of  an  excellent  trea- 


tise on  chemical  science  is  not  a  mere  republication 
from  the  Euglish  press,  but  is  a  revision  and  en- 
largement of  the  original,  under  the  supervision  of 


all.— N.  ¥.  Midical  Gazette,  Oct.  12,  1867. 

For  this  reason  we  hail  witb  delight  the  republica- 
tion, in  a  form  which  will  meet  with  general  approval 
and  command  public  attention,  of  this  really  valua- 
ble standard  work  on  chemistry — more  particularly  j  the"  surviving  author,  Dr.  Taylor.  The  favorable 
as  it  has  been  adapted  with  such  care  to  the  wants  of  opinion  expressed  on  the  publication  of  the  former 
the  general  public.  The  well  known  scholarship  of  ;  edition  of  this  work  is  fully  sustained  by  the  present 
its  authors,  and  their  extensive  researches  for  many  |  revision,  in  which  Dr.  T.  has  increased  the  size  of 
years  in  experimental  chemistry,  have  been  long  ap-  '  the  volume,  hy|an  addition  of  sixty-eight  pages. — Am. 
predated  iu  the  scientific  world,  but  in  this  work  i  hey  Journ.  Med.  Sciences,  Oct.  1867. 
have  been  careful  to  give  the  largest  possible  amount  J 


12       Henry  C.  Lea's  Publications — {Mat.  Med.  and  Therapeutics). 
pARRlSH  (ED  WARD), 

Professor  of  Materia  Medica  in  the  Philadelphia  College  of  Pharmacy. 

A  TREATISE  OX  PHARMACY.     Designed  as  a  Text-Book  for  the 

Student,  and  as  a  Guide  for  the  Physician  and  Pharmaceutist.     With  many  Formulae  and 
Prescriptions.     Third  Edition,  greatly  improved.     In  one  handsome  octavo  volume,  of  850 
pages,  with  several  hundred  illustrations,  extra  cloth.     $5  00:  leather,  $6  00. 
The  immeftse  amount  of  practical  information  condensed  in  this  volume  may  be  estimated  from 
the  fact  that  the  Index  contains  about  4700  items.      Under  the  head  of  Acids  there  are  312  refer- 
ences; under  Emplastrum,  36;  Extracts,  159;  Lozenges,  25;  Mixtures,  55;  Pills,  56;  Syrups, 
131 ;  Tinctures,  138  ;  Unguentum,  57,  <fec. 

We  have  examined  this  large  volume  with  a  good    not  wish  it  to  be  understood  as  very  extravagant 
deal  of  care,  and  find  that  the  author  has  completely    praise.     In  truth,  it  is  not  so  much  the  best  as  the 
exhausted  the  subject  upon  which  he  treats  ;  a  more  i  only  book.— The  London  Chemical  News. 
complete  work,  we  think,  it  would  be  impossible  to  .       .  .  ...      ...  .     .      . 

find  ,  To  the  student  of  pharmacy  the  work  is  indis-  i  _  A*  »'  emPt  to  ^rnwh  anything  like  an  analysis  of 
pensaW;  indeed,  so  far  as  we  know,  it  is  the  only  one  !  Parish's  very  valuable  and  elaborate  Treatise  on 
of  its  kind  in  existence,  and  even  to'  the  physician  or  Practical  Pharmacy  would  require  more  spacethan 
medical  student  who  can  spare  five  dollars  to  pur-  ™  \aTe  at  ™r  disposal  This,  however,  is  not  so 
chase  it,  we  feel  sure  the  practical  information  he  ™"ch  »  matter  of  regret,  inasmuch  as  it  would  be 
will  obtain  will  more  than  compensate  him  for  the    dlfficult  \°  'hlnk  ,of  anr  Point-  h°wfV>  ,   , 

^tU7. -Canada  Med.  Journal,  Nov.  1S64.  •  apparently  trivral,  connected  witn   he  manipulation 

1  '  ,  if  pharmaceutic  substances  or  appliances  whieh  has 

The  medical  student  and  the  practising  physician    not  been  clearly  and  carefully  disc assed  in  this  vol- 
will  fi  ad  the  volume  of  inestimable  worth  for  study    ume     Want  of  space  prevents  our  enlarging  further 


and  reference.— San  Francisco  Med.   Press,   July,    on  tn;3  valuable  work,  and  we  must  conclude  by  a 
1864. 

When  we  say  that  this  book  is  in  some  respects 
the  best  which  has  been  published  on  the  subject  in 
the  English  language  for  a  great  many  years,  we  do 


1864.  simple  expression  of  our  hearty  appreciation  of  its 

When  we  say  that  this  book  is  in  some  respects    merits.—  LtMin  Quarterly  Jour,  of  Medical  Science, 
the  best  which  has  been  published  on  the  subject  in     August,  1S64. 


VTILLE  (ALFRED),  31.  D., 

*3  Professor  of  Theory  and  Practice  of  Medicine  in  the  University  of  Penna. 

THERAPEUTICS  AND  MATERIA  MEDICA;  a  Systematic  Treatise" 

on  the  Action  and  Uses  of  Medicinal  Agents,  including  their  Description  and  History. 
Third  edition,  revised  and  enlarged.  In  two  large  and  handsome  octavo  volumes  of  about 
1700  pages,  extra  cloth,  $10  ;  leather,  $12. 

Dr.  Stille's  splendid  work  on  therapeutics  and  ma-  ;  abroad  itsreputation  as  a  standard  treatiseon  Materia 
teria  medica. — London  Med.  Times,  April  8,  1S65.  Medica  is  securely  established.     It  is  second  to  no 

Dr.  Stille  stands  to-day  one  of  the  best  and  most  wol\k  on  the  subject  in  the  English  tongue  and,  in- 
honored  represeniatives  at  home  and  abroad,  of  Ame-  de«d'  ls  decidedly  superior  in  some  respects  to  any 
rican  medicine ;  and  these  volumes,  a  library  in  them-  other. -Pae^e  Med.  and  Surg  Journal,  Jnly,  1868. 
selves,  a  treasure-house  for  every  studious  physician,  Stille's  Therapeutics  is  incomparably  the  best  work 
assure  his  fame  even  had  he  done  nothing  more. — The  on  the  subject. — If.  T.  Med.  Gazette,  Sept.  26,  1868. 
Western  Journal  of  Medicine,  Dec.  186S.  Dr  stille's  work  is  becoming  the  test  known  of  any 

We  regard  this  work  as  the  best  one  on  Materia    of  our  treatises  on  Materia  Medica.  .    .    .    One  of  the 
Medica  in  the  English  language,  and  as  such  it  de-    most  valuable  works  in  the  language  on  the  subjeets 
serves  the  favor  it  has  received. — Am.  Journ.  Medi-    of  which  it  treats. — X  T.  Med.  Journal,  Oct.  IStfS. 
cal  Sciences,  July  1868.  '■      The  rapid  exhaustion  of  two  editions  of  Prof.  Stille*s 

We  need  not  dwell  on  the  merits  of  the  third  edition  scholarly  work,  and  the  consequent  neces.-ity  for  a 
of  this  magnificently  conceived  work.  It  is  the  work  third  edition,  is  sufficient  evidence  of  the  high  esti- 
on  Materia  Medica,  in  which  Therapeutics  are  prima-  mate  placed  upon  it  by  the  profession.  It  is  no  exag- 
rily  considered — the  mere  natural  history  of  drugs  geration  to  say  that  there  is  no  superior  work  upoa 
being  briefly  disposed  of.  To  medical  practitioners  the  subject  in  the  English  language.  The  present 
this  is  a  very  valuable  conception.  It  is  wonderful  edition  is  fully  up  to  the  most  recent  advance  in  the 
how  much  of  the  riches  of  the  literature  of  Materia  science  and  art  of  therapeutics. — Leavenworth  Medi- 
Medica  has  been  condensed  into  this  book.    The  refer-  i  cal  Herald,  Aug.  1868. 

ences  alone  would  make  it  worth  possessing.  But  it  The  wovk  of  Prof  mn6  has  rapidly  taken  a  hieh 
is  not  a  mere  compilation.  The  writer  exercises  a  place  in  profeSsional  esteem,  and  to  say  that  a  third 
good  judgment  of  his  own  on  the  great  doctrines  and  edition  is  demanded  and  now  appears  before  us,  suffi- 
points  of  Therapeutics  For  purposes  of  practice,  ciently  attests  the  firm  position  this  treatise  has  made 
Stille  s  book  is  almost  unique  as  a  repertory  of  in-  for  itself  As  a  work  of  gl.eat  research,  and  scholar- 
formation,  empirical  and  scientific,  on  the  actions  and  ship  it  is  safe  t0  say  we  have  nothing  superior.  It  is 
uses  of  medicines.—  London  Lancet,  Oct.  31,  ls6S.  exceedingly  full,  and  the  busy  practitioner  will  find 

Through  the  former  editions,  the  professional  world  ample  suggestions  upon  almost  every  important  point 
is  well  acquainted  with  this  work.     At  home  and     of  therapeutics. — Cincinnati  Lancet,  Aug.  1S6S. 


/GRIFFITH  (ROBERT  E.),  M.D. 

A  UNIVERSAL  FORMULARY,   Containing  the  Methods  of  Pre- 
paring and  Administering  Officinal  and  other  Medicines.     The  whole  adapted  to  Physician! 
and  Pharmaceutists.     Second  edition,  thoroughly  revised,  with  numerous  additions,   by 
Robert  P.  Thomas,  M.D.,  Professor  of  Materia  Medica  in  the  Philadelphia  College  of 
Pharmacy.     In  one  large  and  handsome   octavo  volume  bf  650  pages,  double-columns. 
Extra  cloth,  $4  00;  leather,  $5  00. 
Three  complete  and  extended  Indexes  render  the  work  especially  adapted  for  immediate  consul- 
tation.    One,  of  Diseases  and  their  Remedies,  presents  under  the  head  of  each  disease  the 
remedial  agents  which  have  been  usefully  exhibited  in  it,  with  reference  to  the  formulae  containing 
them — while  another  of  Pharmaceutical  and  Botanical  Names,  and  a  very  thorough  General 
Index  afford  the  means  of  obtaining  at  once  any  information  desired.     The  Formulary  itself  is 
arranged  alphabetically,  under  the  heads  of  the  leading  constituents  of  the  prescriptions. 
We  know  of  none  in  our  language,  or  any  other,  so  comprehensive  in  its  details. — London  Lancet. 
One  of  the  most  complete  works  of  the  kind  in  any  language. — Edinburgh  Med.  Journal. 
We  are  not  cognizant  of  the  existence  of  a  parallel  work. — London  Med.  Gosette. 


Henry  C.  Lea's  Publications — (Mat.  Med.  and  Therapeutics).      13 

p ERE IRA  {JONATHAN),  M.D.,  F.R.S.  and  L.S. 

MATERIA   MEDIC  A   AND  THERAPEUTICS;   being  an  Abridg- 

ment  of  the  late  Dr.  Pereira's  Elements  of  Materia  Medica,  arranged  in  conformity  with 
the  British  Pharmacopoeia,  and  adapted  to  the  use  of  Medical  Practitioners,  Chemists  and 
Druggists,  Medical  and  Pharmaceutical  Students,  &a.  By  F.  J.  Farre,  M.D.,  Senior 
Physician  to  St.  Bartholomew's  Hospital,  and  London  Editor  of  the  British  Pharmacopoeia; 
assisted  by  Robert  Bentley,  M.R.C.S.,  Professor  of  Materia  Medica  and  Botany  to  the 
Pharmaceutical  Society  of  Great  Britain;  and  by  Robert  Warington,  F.R.S.,  Chemical 
Operator  to  the  Society  of  Apothecaries.  With  numerous  additions  and  references  to  the 
United  States  Pharmacopoeia,  by  Horatio  C.  Wood,  M.D.,  Professor  of  Botany  in  the 
University  of  Pennsylvania.  In  one  large  and  handsome  octavo  volume  of  1040  closely 
printed  pages,  with  236  illustrations,  extra  cloth,  $7  00;    leather,   raised  bands,  $8  00. 


The  task  of  the  American  editor  has  evidently  been 
CO  sinecure,  for  not  only  has  he  given  to  us  all  that 
is  contained  in  the  abridgment  useful  for  our  pur- 
poses, but  by  a  careful  and  judicious  embodiment  of 
over  a  hundred  new  remedies  has  increased  the  size 
of  the  former  work  fully  one-third,  besides  adding 
many  new  illustrations,  some  of  which  are  original. 
We  unhesitatingly  say  that  by  so  doing  he  has  pro- 
portionately increased  the  value,  not  only  of  the  con- 
densed edition,  but  has  extended  the  applicability  of 
the  great  original,  and  has  placed  his  medical  coun- 
trymen under  lasting  obligations  to  him.  The  Ame- 
rican physician  now  has  all  that  is  needed  in  the 
shape  of  a  complete  treatise  on  materia  medica,  and 
the  medical  student  has  a  text-book  which,  for  prac- 
tical utility  and  intrinsic  worth,  stands  unparalleled. 
Although  of  considerable  size,  it  is  none  too  large  for 
the  purposes  for  which  it  has  been  intended,  and  every 
medical  man  should,  in  justice  to  himself,  spare  a 
place  for  it  upon  his  book-shelf,  resting  assured  that 
the  more  he  consults  it  the  better  he  will  be  satisfied 
of  its  excellence. — JV.  Y.  Med.  Record,  Nov.  15,  1868. 

It  will  fill  a  place  which  no  other  work  can  occupy 
lu  the  library  of  the  physician,  student,  and  apothe- 
cary.— Boston  Med.and  Surg.  Journal,  Nov.  8,  1866. 

Of  the  many  works  on  Materia  Medica  which  have 
appeared  since  the  issuing  of  the  British  Pharmaco- 


poeia, none  will  be  more  acceptable  to  the  student 
and  practitioner  than  the  present.  Pereira's  Materia 
Medica  had  long  ago  asserted  for  itself  the  position  of 
being  the  most  complete  work  on  the  subject  in  the 
English  language.  But  its  very  completeness  stood 
in  the  way  of  its  success.  Except  in  the  way  of  refer- 
ence, or  to  those  who  made  a  special  study  of  Materia 
Medica,  Dr.  Pereira's  work  was  too  full,  and  its  pe- 
rusal required  an  amount  of  time  which  few  had  at 
their  disposal.  Dr.  Farre  has  very  judiciously  availed 
himself  of  the  opportunity  of  the  publication  of  the 
new  Pharmacopoeia,  by  bringing  out  an  abridged  edi- 
tion of  the  great  work.  This  edition  of  Pereira  is  by 
no  means  a  mere  abridged  re-issue,  but  contains  ma- 
ny improvements,  both  in  the  descriptive  and  thera- 
peutical departments.  We  can  recommend  it  as  a 
very  excellent  and  reliable  text-book. — Edinburgh 
Med.  Journal,  February,  1866. 

The  reader  cannot  fail  to  be  impressed,  at  a  glance, 
with  the  exceeding  value  of  this  work  as  a  compeud 
of  nearly  all  useful  knowledge  on  the  materia  medica. 
We  are  greatly  indebted  to  Professor  Wood  for  his 
adaptation  of  it  to  our  meridian.  Without  his  emen- 
dations and  additions  it  would  lose  much  of  its  value 
to  the  American  student.  With  them  it  is  an  Ameri- 
can book.  —  Pacific  Medical  and  Surgical  Journal, 
December,  1S66. 


WjLLIS  {BENJAMIN),  M.D. 
THE  MEDICAL  FORMULARY:  being  a  Collection  of  Prescriptions 

derived  from  the  writings  and  practice  of  mnny  of  the  most  eminent  physicians  of  America 
and  Europe.    Together  with  the  usual  Dietetic  Preparations  and  Antidotes  for  Poisons.    The 
whole  accompanied  with  a  few  brief  Pharmaceutic  and  Medical  Observations.    Twelfth  edi- 
tion, carefully  revised  and  much  improved  by  Albert  H.  Smith,  M.  D.    In  one  volume  8vo. 
of  376  pages,  extra  cloth,  $3  00.     {Lately  Published.) 
This  work  has  remained  for  some  time  out  of  print,  owing  to  the  anxious  care  with  which  the 
Editor  has  sought  to  render  the  present  edition  worthy  a  continuance  of  the  very  remarkable 
favor  which  has  carried  the  volume  to  the  unusual  honor  of  a  Twelfth  Edition.     He  has  sedu- 
lously endeavored  to  introduce  in  it  all  new  preparations  and  combinations  deserving  of  confidence, 
besides  adding  two  new  classes,  Antemetics  and  Disinfectants,  with  brief  references  to  the  inhalation 
of  atomized  fluids,  the  nasal  douche  of  Thudichum,  suggestions  upon  the  method  of  hypodermic 
injection,  the  administration  of  anaesthetics,  &e.  &c.     To  accommodate  these  numerous  additions, 
he  has  omitted  much  which  the  advance  of  science  has  rendered  obsolete  or  of  minor  importance, 
notwithstanding  which  the  volume  has  been  increased  by  more  than  thirty  pages.     A  new  feature 
will  be  found  in  a  copious  Index  of  Diseases  and  their  remedies,  which  ennnot  but  increase  the 
value  of  the  work  as  a  suggestive  book  of  reference  for  the  working  practitioner.    Every  precaution 
has  been  taken  to  secure  the  typographical  accuracy  so  necessary  in  a  work  of  this  nature,  and  it 
is  hoped  that  the  new  editioi^  will  fully  maintain  the  position  which  "  Ellis'  Formulary"  has 
long  occupied. 


f( ARSON  {JOSEPH),  M.D., 

^S  Professor  of  Materia  Medica  and  Pharmacy  in  the  University  of  Pennsylvania,  &c. 

SYNOPSIS  OF  THE   COURSE   OF   LECTURES   ON   MATERIA 

MEDICA  AND  PHARMACY,  delivered  in  the  University  of  Pennsylvania.  With  three 
Lectures  on  the  Modus  Operandi  of  Medicines.  Fourth  and  revised  edition,  extra  cloth, 
$3  00. 


EUNGLl.SOJTS  NEW  REMEDIES,  WITH  FORMULAE 
FOR  THEIR  PREPARATION  AND  ADMINISTRA- 
TION Seventh  edition,  with  rxtensive  additions. 
One  vol.  8vo.,  pp.  770;  extra  cloth.    $1  00. 

ROVLE'S  MATERIA  MEDICA  AND  THERAPEU- 
TICS. Ediled  by  Joskph  Carson,  M.  D.  With 
ninety-eight  illustrations.  1  vol.  8vo.,  pp.  700,  ex- 
tra cloth      | .  <  00. 

CHRISTISON'S  DISPENSATORY.  With  copious  ad- 
ditions, and   213   large  wood-engravings.      By  R 


Eglespeld  Griffith,  M.D.  One  vol.  Svo.,  pp.  1000; 
extra  cloth.     *-l  00. 

CARPENTER'S  PRIZE  ESSAY  ON  THE  USE  OF 
Alcoholic  Liquors  in  Health  and  Disease.  New 
edition,  with  a  Preface  by  D.  F.  Condie,  M.D.,  and 
explanations  of  scientific  words.  In  one  neat  l'2mo. 
volume,  pp.  178,  extra  cloth.     60  cents. 

De  JONGH  ON  THE  THREE  KINDS  OF  COD-LIVER 
Oil,  with  their  Chemical  and  Therapeutic  Pro- 
perties    1  vol.  12mo.,  cloth.     75  cents. 


14  Henry  C.  Lea's  Publications — (Pathology,  &c.} 


(1  RE  EN  ( T.  HENR  Y) ,  31.  D. , 

Lecturer  on  Pathology  and  Morbid  Anatomy  at  Charing-Cross  Hospital  Medical  School. 

PATHOLOGY  AND  MORBID  ANATOMY.     With  numerous  Illus- 

(rations  on  Wood.     In  one  very  handsome  octavo  volume  of  over  250  pages,  extra  clotb, 
$2  50.      (Just  Ready.) 
The  scope  and  object  of  this  volume  can  be  gathered  from  the  Following  condensed 

SUMMARY    OF    CONTKNTS. 

Introduction.  Chapter  I.  The  "Cell."  II.  Nutrition  Arrested.  III.  Nutrition  Impaired. 
IV.  Fatty  Degeneration.  V.  Mucoid  and  Colloid  Degeneration.  VI.  Fatty  Infiltration.  VII. 
Amyloid  Degeneration.  VIII.  Calcareous  Degeneration.  IX.  Pigmentary  Degeneration.  X. 
Nutrition  Increased.  XI.  New  Formations.  XII.  The  Fibromata.  XIII.  The  Sarcomata. 
XIV  The  Gummata.  XV.  The  Myxomata.  XVI.  The  Lipomata.  XVII.  The  Enchondromata. 
XVIII.  The  Osteomata.  XIX.  The  Lymphomata.  XX.  Tubercle.  XXI.  The  Papillomata. 
XXII.  The  Adenomata.  XXIII.  The  Careinomata.  XXIV.  The  Myomata,  Neuromata,  and 
Angeomata.  XXV.  Cysts.  XXVI.  Inflammation.  XXVII.  Inflammation  of  Non- Vascular 
Tissues.  XXVIII.  Inflammation  of  Vascular  Connective  Tissues.  XXIX.  Inflammation  of 
Bloodvessels  and  Heart.  XXX.  Inflammation  of  Lymphatie  Strut-tares.  XXXI.  Inflammation 
(if  Mucous  Membmnes.  XXXII.  Inflammation  of  Serous  Membranes.  XXXIII.  Inflammation 
of  the  Liver.  XXXIV.  Inflammation  of  the  Kidney.  XXXV.  Inflammation  of  the  Lungs. 
XXXVI.  Inflammation  of  Brain  and  Spinal  Cord.  XXXVII.  Changes  in  the  Blood  and  Circu- 
lation.    XXXVIII.   Thrombosis.     XXX;X.  Embolism. 

We  have  beea  very  much  pleased  by  our  perusal  of    information  is  up  to  the  day,  well  and  compactly  ar- 
this  little  volume.    It  is  the  only  one  of  the  kind  with     ranged,  without  being  at  all  scanty. — London  Lan- 
which  we  are  acquainted,  and  practitioners  as  well     cet,  Oct.  7,  1S71. 
as  students  will  find  it  a  very  useful  guide  :  for  the 


fyROSS  {SAMUEL  D.),  M.  D., 

^J~  Professor  of  Surgery  in  the  Jefferson  Medical  College  of  Philadelphia. 

ELEMENTS    OP    PATHOLOGICAL   ANATOMY.     Third    edition, 

thoroughly  revised  and  greatly  improved.  In  one  large  and  very  handsome  octavo  volume 
of  nearly  800  pages,  with  about  three  hundred  and  fifty  beautiful  illustrations,  of  which  n 
large  number  are  from  original  drawings  ;   extra  cloth.     $4  00. 

TONES  {C.  HANDFIELD),  F.R.S.,  and  SIEV EKING  [ED.  H.),  M.D., 

*J  Assistant  Physicians  and  Lecturers  in  St.  Mary's  Hospital. 

A  MANUAL  OF   PATHOLOGICAL  ANATOMY.     First  Anierk-nn 

edition,  revised.  With  three  hundred  and  ninety-seven  handsome  wood  engravings.  In 
one  large  and  beautifully  printed  octavo  volume  of  nearly  750  pages,  extra  cloth,  $3  50. 


B 


ARCLAY  (A.  W.),  M.  D. 

A  MANUAL  OF  MEDICAL  DIAGNOSIS;  being  an  Analysis  of  the 

Signs  and  Symptoms  of  Disease.  Third  American  from  the  second  and  revised  London 
edition.     In  one  neat  octavo  volume  of  451  pages,  extra  cloth.     §3  50. 

WILLIAMS  {CHARLES  J.  B.),  M.D., 

'  '  Professor  of  Clinical  Medicine  in  University  College,  London. 

PRINCIPLES  OF  MEDICINE.    An  Elementary  Yiew  of  the  Causes, 

Nature,  Treatment,  Diagnosis,  and  Prognosis  of  Disease;  with  brief  remarks  on  Hygienics, 
or  the  preservation  of  health.  A  new  American,  from  the  third  and  revised  London  edition. 
In  one  octavo  volume  of  about  500  pages,  extra  cloth.     $3  50. 

GLUGE'S  ATLAS  OF  PATHOLOGICAL  HISTOLOGY.  I  tical  Relations.  In  two  large  and  handsome  octavo 
Translated,  with  Notes  and  Additions,  by  Joseph  j  volumes,  of  nearlv  1,500  pages,  extra  cloth,  $7  00. 
Lbidy,  M.  D^  In  one  volume,  very  large  imperial  HOLLAND'S  MEDICAL  NOTES  ANI  REFLEC- 
quarto    with   320  copper-plate    figures,  plam  and        TI0S3      ,  Til,    Syo„  pp.  600,  extra  clotfl.    S3  50 

™™rP»Sl,V                 ,     •        ,  WHATTO  OBSERVE  ATTHE  BEDSIDE  AND  AFTER 

SIMOH IS  GENERAL  PATHOLOGY    as  condncve  io  DEATn  „  Memcal  Cases.     pub,isnP(}  UDdeT  lbe 

the  Establishment  of  Rational   Principles  for  th«  authority  of  the  London  Society  for  Medical  Obser- 

Preveution   and  Cure  of  Disease.     In   one  odavo  vation     From  ,he  seCl>nd  London  edUioa.     1  vol. 

volume  of  212  pages,  extra  cloth.     $1  2o.                      i  r0yal  12mo.,  extra  cloth.     $100. 

SOLLY  ON  THE  HUMAN  BRAIN;  its  Structure,  Phy-  i  LAYCOCK'S    LECTURES    ON    THE    PRINCIPLES 

siology,  and  Diseases.     From  the  Second  and  much  AVD   Methods  of  Mbdical  Observatkn  axd  Rb- 

enlarged  London  edition.    In  one  octavo  volume      |  SEARCH.    For  the  use  of  advanced   students  and 

500 pages,  with  120  wood-cuts;  extra    cloth.    $2  50.  junior  practitioners.   In  one  very  neat  royal  12mo. 

LA  ROCHE  ON  YELLOW  FEVER,  considered  iD  its  I  volume,  extra  cloth.     $1  00. 
Historical,  Pathological,  Etiological,  and  Therapeu- 


fkUNGLISON,  FORBES,   TWEEDTE,  AND  CONOLLY. 

THE  CYCLOPAEDIA   OF   PRACTICAL  MEDICINE:   comprising 

Treatises  on  the  Nature  and  Treatment  of  Diseases,  Materia  Medica  and  Therapeutics, 
Diseases  of  Women  and  Children,  Medical  Jurisprudence,  <tc.  Ac.  In  four  large  super-royal 
octavo  volumes,  of  3254  double-columned  pages,  strongly  and  handsomely  bound  in  leather, 
$15;  extra  cloth,  $11. 

*#*  This  work  contains  no  less  than  four  hundred  and  eighteen  distinct  treatises,  contributed 
by  sixty-  eight  distinguished  physicians. 


Henry  C.  Lea's  Publications — (Practice  of  Medicine). 


15 


WLINT  (A  USTIN),  M.  D„ 

•*-  Professor  of  the  Principles  and  Practice  of  Medicine  in  Bellemie  Med.  College,  AT.  F. 

A    TREATISE    ON    THE    PRINCIPLES    AND    PRACTICE    OF 

MEDICINE  ;   designed  for  the  use  of  Students  and  Practitioners  of    Medicine.       Third 

edition,  revised  and  enlarged.     In  one  large  and  closely  printed  octavo  volume  of  1(102 

pages ;  handsome  extracioth,  $6  00;  or  strongly  bound  in  leather,  with  raised  bands,  $7  00. 

{Lately  PublisJied.) 

By  common  consent  of  the  English  and  American  medical  press,  this  work  has  been  assigned 

to  the  highest  position  as  a  complete  and  compendious  text-book  on  the  most  advanced  condition 

of  medical  science.     At  the  very  moderate  price  at  which  it  is  offered  it  will  be  found  one  of  the 

cheapest  volumes  now  before  the  profession. 

Much  valuable  matter  lias  Vcu  added,  and  by  mak- 
ing the  type  smaller,  the  bulk  of  the  volume  is  not 
much  increased.  The  weak  point  in  many  American 
works  is  pathology,  but  Br.  Flint  has  taken  peculiar 
pains  on  this  point,  greatly  to  the  value  of  the  book. 
—London  Med.  Times  and  Gazette,  Feb.  6,  1669. 

Published  in  1S66;  this  valuable  book  of  Dr.  Flint's 
has  in  two  years  exhausted  two  editions,  and  now 
we  gladly  announce  a  third.  We  say  we  gladly  an- 
nounce it,  because  we  are  proud  of  it  as  a  national 
representative  work  of  not  only  American,  but  of 
cosmopolitan  medicine.  In  it  the  practiceof  medicine 
is  young  and  philosophical,  based  on  reason  and  com- 
mon sense,  and  as  such,  we  hope  it  will  be  at  the 
right  hand  of  every  practitioner  of  this  vast  continent. 
— California  Medical  Gazette,  March,  1S69. 

Considering  the  large  number  of  valuable  works  ia 
the  practice  of  medicine,  already  before  the  profes- 
sion, the  marked  favor  wUh  which  this  has  been  re- 
ceived, necessitating  a  third  edition  in  the  short  space 
of  two  years,  indicates  unmistakably  that  it  is  a  work 
of  more  than  ordinary  excellence,  and  must  be  accept- 
ed as  evidence  that  it  has  largely  fulfilled  the  object 
fur  which  the  author  intended  it.  A  marked  feature 
in  the  work,  and  one  which  particularly  adapts  it  for 
the  use  of  students  as  a  text-book,  and  certainly  ren- 
ders it  none  the  less  valuable  to  the  busy  practitioner 
as  a  work  of  reference,  is  ■brevity  and  simplicity. 
The  present  edition  has  been  thoroughly  revised,  au<i 
much  new  matter  incorporated,  derived,  as  the  author 
informs  us,  both  from  his  own  clinical  studies,  and 
from  the  latest  contributions  to  medical  literature, 
thus  bringing  it  fully  up  with  the  most  recent  ad- 
vances of  the  science,  and  greatly  enhancing  its  ;u-.<<.' 
tical  utility;  while,  by  a  slight  modification  of  its 
typographical  arrangement,  the  additions  have  been 
accommodated  without  materially  increasing  its 
bulk. — St  Louis  Med.  Archives,  Feb.  1669. 

If  there  be  among  our  readers  any  who  are  not  fa- 
miliar with  the  treatise  before  us,  we^h;til  do  them 
a  serviee  in  persuading  them  to  repair  their  omission 
forthwith.  Combining  to  a  rare  degree  the  highest 
scientific  attainments  with  the  most  practical  com- 
mon sense,  and  the  closest  habits  of  observation,  the 
author  has  given  us  a  volume  which  not  only  sets 
forth  the  results  of  the  latest  investigations  of  other 
laborers,  hut  contains  more  original  views  than  any 
other  single  work  upon  this  well-worn  theme  within 
our  knowledge. — N.  Y.  Med.  Gazette,  Feb.  27,  1S69.* 


Admirable  and  unequalled.  —  Western,  Journal  of 
Medicine,  Nov.  I860, 

Dr.  Flint's  work,  though  claiming  no  higher  title 
than  that  of  a  text-book,  is  really  more.  He  is  a  man 
of  large  clinical  experience,  and  his  book  is  full  of 
HUch  masterly  descriptions  of  disease  as  can  only  be 
drawn  by  a  man  intimately  acquainted  with  their 
various  forms.  It  is  not  so  long  since  we  had  the 
pleasure  of  reviewing  his  first  edition,  and  we  recog- 
cize  a  great  improvement,  especially  in  the  general 
part  of  the  work.  It  is  a  work  which  we  can  cordially 
recommend  to  our  readers  as  fully  abreast  of  the  sci- 
ence of  the  day. — Edinburgh  Mid.  Journal,  Oct.  '69. 

One  of  the  best  works  of  the  kissd  for  the  practi- 
tioner, and  the  nvostconvenientof  ait  for  the  student. 
— Am.  Jowti.  Med.  Sciences,  Jan.  IS69. 

This  work,  which  stands  pre-eminently  as  the  ad- 
vance standard  of  medical  science  up  to  the  present 
time  in  the  practice  of  medicine,  has  for  its  author 
■  ine  who  is  well  and  widely  known  as  one  of  the 
leading  practitioners  of  this  continent.  le  fact,  it  is 
neldota  that  any  work  is  ever  issued  from  the  press 
more  deserving  of  universal  recommendation. — Do- 
minion  Med  Journal,  M-ay,  ISCS9. 

The  third  edition  of  this  most  excellent  book  scarce- 
ly needs  any  comtnendatiou  from  us  The  volume, 
rt-s  it  stands  now,  is  really  a  marvel:  first  of  all,  it  is 
excellently  printed  and  bound — and  we  eucounter 
that  luxury  of  America,  the  ready-cut  pages,  which 
the  Yankees  are  'cute  enough  to  insist  upon — nor  are 
these  byauy  means  trifles  ;  but  the  contents  of  the 
book  are  astonishing.  Not  oniy  is  it  wonderful  that 
s.ny  one  man  can  have  grasped  in  his  mind  the  whole 
«cope  of  medicine  with  that  vigor  which  Dr.  Flint 
shows,  but  the  condensed  yet  clear  way  in  which 
this  is  done  is  a  perfect  literary  triumph  Dr.  Flint 
Is  pre-eminently  one  of  the  strong  men,  whose  right 
to  do  this  kind  of  thing  is  well  admitted  ;  and  we  say 
no  more  than  the  truth  when  we  affirm  that  he  is 
vary  nearly  the  only  living  man  that  could  do  it  with 
such  results  as  the  volume  before  us. — 2'he  Londoii 
Practitioner,  March,  1S69. 

This  is  in  some  respects  the  best  text-book  of  medi- 
cine in  our  language,  and  It  is  highly  appreciated  on 
the  other  s.ide  of  the  Atlantic,  inasmuch  as  the  first 
edition  was  exhausted  iu  a  few  months.  The  second 
edition  was  little  more  than  a  reprint,  but  the  present 
has,  as  the  author  says,   been  thoroughly  revised. 


BARLOW'S  MANUAL  OF  THE  PRACTICE  OF  ]  TODD'S  CLINICAL  LECTURES  ON  CERTAIN  ACUTE 
MEDICINE.  With  Additions  by  D.  F.  Cosdie,  J  Diseases.  In  one  neat  octavo  volume,  of  320  pages. 
M.  D.    1  vol.  hvo.,  pp.  600,  eloib.     $2  50.  I      extracioth.    $2  50. 


P 


4VF(F.  Wl.),MiD.,F.R.S., 

Senior  Asst.  Physician  to  and  Lecturer  on  Physiology,  at  Guy's  Hospital,  &c. 

A  TREATISE  ON  THE    FUNCTION  OF   DIGESTION;  its  Disor- 

ders  and  their  Treatment.     From  the  second  London  edition.     In  one  handsome  volume, 
small  octavo,  extra  cloth,  $2  00.     {Lately  Published.) 
Tin  work  before  us  is  one  which  deserves  a  wide     treatise,  and  sufficiently  exhaustive  for  all  practical 
circulation.     We  know  of  no  better  guide  to  the  study     purposes  —  L<vt  run  worth  Med.  Herald,  July,  1S69. 
of  diction  and  its  disorder..-^,  f.ouis  Med.  and        K  rill)iu!j|e  work  ou  the  subject  of  which  it 

Surg.  Journal,  July  10,  1*59.  UviL)s      Sma^  y„,  i(  is  hM  of  „,„.,;,,,„  iul-(mmUioa. 

A  thoroughly  good  book,  being  a  careful  systematic     — Cincinnati  Med.  Repertory,  June,  IS$9. 


jyRINTON  (  WILLI  A  M),  M.  D.,  F.  R.  S. 

LECTURES  ON  THE  DISEASES  OF  THE   STOMACH;   with  an 

Introduction  on  its  Anatomy  and  Physiology.  From  the  second  and  enlarged  London  edi- 
tion. With  illustrations  on  wood.  In  one  handsome  octavo  volume  of  about  300  pages, 
extra  cloth.     $3  25. 


16 


Henry  C.  Lea's  Publications — {Practice  of  Medicine). 


fTARTSHORNE  (HENRY),  31. D., 

■*■■*■  Professor  of  Hygiene  in  the  University  of  Pennsylvania. 

ESSENTIALS  OF  THE  PRINCIPLES  AND   PRACTICE  OF  MEDI- 

CINE.     A  handy-book  for  Students  and  Practitioners.     Third  edition,  revised  and  im- 
proved.    In  one  handsome  royal  )2mo.  volume  of  487  pages,  clearly  printed  on  small  type, 
cloth,  $2  38;  half  bound,  $2  63.      {Now  Ready.) 
The  very  remarkable  favor  which  has  been  bestowed  upon  this  work,  as  manifested  in  the  ex- 
haustion of  two  large  editions  within  four  years,  shows  that  it  has  successfully  supplied  a  want 
felt  by  both  student  and  practitioner  of  a  volume  which  at  a  moderate  price  and  in  a  convenient 
size  should  afford  a  clear  and  compact  view  of  the  most  modern  teachings  in  medical  practice. 
In  preparing  the  work  for  a  third  edition,  the  author  has  sought  to  maintain  its  character  by  very 
numerous  additions,  bringing  it  fully  up  to  the  science  of  the  day,  but  so  concisely  framed  that 
the  size  of  the  volume  is  increased  only  by  thirty  or  forty  pages.     The  extent  of  the  new  informa- 
tion thus  introduced  may  be  estimated  by  the  fact  that  there  have  been  two  hundred  and  sixty 
separate  additions  made  to  the  text,  containing  references  to  one  hundred  and  eighty  new  authors. 

This  little  epitome  of  medical  knowledge  has  al-  mulas  are  appended,  intended  as  examples  merely, 
ready  been  noticed  by  us.  It  is  a  vade  mecuin  of  not  as  guides,  for  unthinking  practitioners.  A  corn- 
value,  including  in  a  short  space  most  of  what  is  es-  plete  index  facilitates  the  use  of  this  little  volume,  in 
sential  in  the  science  and  practice  of  medicine.  The  which  all  important  remedies  lately  introduced,  such 
third  edition  is  well  up   to  the   present  day  in  the  as  chloral  hydrate  and  carbolic  acid,  have  received 


modern  methods  of  treatment,  audin  the  use  of  newly 
discovered  drugs. — Boston  Med.  and  Surg.  Journal, 
Oct.  19,  1871. 

Certainly  very  few  volumes  contain  so  much  pre- 
cise information  within  so  small  a  compass. — jV.  Y. 
Med.  Journal,  Nov.  1871. 


The  diseases  are  conveniently  classified;  symptoms, 
causation,  diagnosis,  prognosis,  and  treatment  are 
carefully  considered,   the  whole   being  marked    by  :  demand 
briefness,  but  clearness  of  expression.     Over  2o0  for- 


their  full  shareof  attention. — Am.  Jonrn.  of  Pharm. 
Nv.  1871. 

It  is  an  epitome  of  the  whole  science  and  practice 
of  medicine,  and  will  be  found  most  valuable  to  the 
practitioner  for  easy  reference,  and  especially  to  the 
student  in  attendance  upon  lectures,  whose  time  is 
too  much  occupied  with  many  studies,  to  consult  the 
larger  works.  Such  a  work  must  always  be  in  great 
Cincinnati  Med.  Repertory,  Nov.  1871. 


TKTATSON  (THOMAS),  M.  D.,  §-c. 

LECTURES    ON    THE     PRINCIPLES    AND    PRACTICE    OF 

PHYSIC.     Delivered  at  King's  College.  London.     A  new  American,  from  the  Fifth  re- 
vised and  enlarged  English  edition.     Edited,   with  additions,  by  Henry  Hartshorne, 
M.D.,  Professor  of  Hygiene  in  the  University  of  Pennsylvania.     In  two  large  and  hand- 
some octavo  volumes.      (Shortly.) 
With  the  assistance  of  Professor  George  Johnson,  his  successor  in  the  chair  of  Practice  of  Medi- 
cine in  King's  College,  the  author  has  thoroughly  revised  this  work,  and  has  sought  to  bring  it 
on  a  level  with  the  most  advanced  condition  of  the  .-ubject.     As  he  himself  remarks  :   "Consider- 
ing the  rapid  advance  of  medical  science  during  the  last  fourteen  years,  the  present  edition  would 
be  worthless,  if  it  did  not  differ  much  from  the  last"  —  but  in  the  extensive  alterations  and  addi- 
tions that  have  been  introduced,  the  effort  of  the  author  has  been  to  retain  the  lucid  and  collo- 
quial style  of  the  lecture-room,  which  has  made  the  work  so  deservedly  popular  with  all  classes 
of  the  profession.    Notwithstanding  these  changes,  there  are  some  subjects  on  which  the  American 
reader  mighUreasonably  expect  more  detailed  information  than  has  been  thought  requisite  in 
England,  ana  these  deficiencies  the  editor  has  endeavored  to  supply. 

The  large  size  to  which  the  work  has  grown  seems  to  render  it  necessary  to  print  it  in  two  vol- 
umes, in  place  of  one,  as  in  the  last  American  edition.  It  is  therefore  presented  in  that  shape, 
handsomely  printed,  at  a  very  reasonable  price,  and  it  is  hoped  that  it  will  fully  maintain  the 
position  everywhere  hitherto  accorded  to  it,  of  the  standard  and  classical  representative  of  Eng- 
lish practical  medicine. 


At  length,  after  many  months  of  expectation,  we 
have  the  satisfaction  of  finding  ourselves  this  week  in 
possession  of  a  revised  and  eularged  edition  of  Sir 
Thomas  Watsou's  celebrated  Lectures.  It  is  a  sub- 
ject for  congratulation  and  for  thankfulness  that  Sir 
Thomas  Watson,  during  a  period  of  comparative  lei- 
sure, after  a  long,  laborious,  and  most  honorable  pro- 
fessional career,  while  retaining  full  possession  of  his 
high  mental  faculties,  should  have  employed  the  op- 
portunity to  submit  Ins  Lectures  to  a  more  thorough 


revision  than  was  possible  during  the  earlier  and 
busier  period  of  his  life.  Carefully  passing  in  review 
some  of  the  most  intricate  and  important  pathological 
and  practical  ciuestions,  the  results  of  his  clear  insight 
and  bis  calm  judgment  are  now  recorded  for  the  bene- 
fit of  mankind,  in  language  which,  for  precision,  vigor, 
aud  classical  elegance,  has  rarely  been  equalled,  and 
never  surpassed  The  revision  has  evidently  been 
most  carefully  done,  and  the  results  appear  in  almost 
every  page. — Brit.  Med.  Journ.,  Oct.  14,  ls>71. 


(IB. AMBERS  (T.  K.),  M.D., 

V_/  Consulting  Physician  to  St.  Mary's  Hospital,  London,  &c. 

THE  INDIGESTIONS ;  or,  Diseases  of  the  Digestive  Organs  Functionally 

Treated.    Third  and  revised  Edition.    In  one  handsome  octavo  volume  of  383  pages,  extra 

cloth.     $3  00.     (Lately  Published.) 

merit,  we  know  of  no  more  desirable  acquisition  to 
a  physician's  library  than  the  book  before  us.  He 
who  should  commit  its  contents  to  his  memory  would 


So  very  large  a  proportion  of  the  patients  applying 
to  every  general  practitioner  suffer  from  some  form 
of  indigestion,  that  whatever  aids  him  in  their  man- 
agement directly  "puts  money  in  his  purse,"  and  in- 
directly does  more  than  auythingelse  to  advance  his 
reputation  witli  the  public.  From  this  purely  mate- 
rial point  of  view,  setting  aside  its  higher  claims  to 


find  its  price  an  investment  of  capital  that  returned 
him  a  most  usurious  rate  of  interest. — S.  Y.  Medical 
Gazette,  Jan  2S,  1871. 


jDl"  THE  SAME  AUTHOR.     (Just  Ready.) 

RESTORATIVE  MEDICINE.  An  Harveian  Annual  Ovation,  deliv- 
ered at  the  Royal  College  of  Physicians,  London,  on  June  24,  1871.  With  Two  Sequels. 
In  one  very  handsome  volume,  small  12tuo.,  extra  cloth,  §1  00. 


Henry  C.  Lea's  Publications — (Diseases  of  Lungs  and  Heart).     17 


JjlLINT  (AUSTIN),  M.D., 

-*-  Professor  of  the  Principles  and  Practice  of  Medicine  in  Bellevue  Hospital  Med.  College,  N.  Y. 

A  PRACTICAL  TREATISE  ON  THE  DIAGNOSIS,  PATHOLOGY, 

AND  TREATMENT  OF  DISEASES  OP  THE  HEART.     Second  revised  and  enlarged 

edition.     In  one  octavo  volume  of  550  pages,  with  a  plate,  extra  cloth,  $i.     (Just  Issued.) 

The  author  has  sedulously  improved  the  opportunity  afforded  him  of  revising  this  work.   Portions 

of  it  have  been  rewritten,  and  the  whole  brought  up  to  a  level  with  the  most  advanced  condition  of 

science.  It  must  therefore  continue  to  maintain  its  position  as  the  standard  treatise  on  the  subject. 


Dr.  Flint  chose  a  difficult  subject  for  his  researches, 

and  has  shown  remarkahle  powers  of  observation 
and  reflection,  as  well  as  great  industry,  in  his  treat- 
ment of  it.  His  book  must  be  considered  the  fullest 
and  clearest  practical  treatise  on  those  subjects,  and 
should  be  in  the  hands  of  all  practitioners  and  stu- 
dents. It  is  a  credit  to  American  medical  literature. 
— Amer.  Journ.  of  the  Med.  Sciences,  July,  1S60. 

We  question  the  fact  of  any  recent  American  author 
in  our  profession  being  more  extensively  kuown,  or 
more  deservedly  esteemed  in  this  country  than  Dr. 
Flint.  We  willingly  acknowledge  his  success,  more 
particularly  in  the  volume  on  diseases  of  the  heart, 
in  making  an  extended  personal  clinical  study  avail- 


able for  purposes  of  illustration,  in  connection  with 
cases  which  have  been  reported  by  other  trustworthy 
observers. — Brit,  and  For.  Med.-Chirurg.  Review. 

In  regard  to  the  merits  of  the  work,  we  have  no 
hesitation  in  pronouncing  it  full,  accurate,  and  judi- 
cious. Considering  the  present  state  of  science,  such 
a  work  was  much  needed.  It  should  be  in  the  hands 
of  every  practitioner. — Chicago  Med.  Journ. 

With  more  than  pleasure  do  we  hail  the  advent  of 
this  work,  for  it  fills  a  wide  gap  on  the  list  of  text- 
books for  our  schools,  aud  is,  for  the  practitioner,  the 
most  valuable  practical  work  of  its  kind. — N.  0.  Med. 
News. 


B 


T  THE  SAME  AUTHOR. 

PRACTICAL  TREATISE  ON  THE  PHYSICAL  EXPLORA- 
TION OP  THE  CHEST  AND  THE  DIAGNOSIS  OF  DISEASES  AFFECTING  THE 
RESPIRATORY  ORGANS.  Second  and  revised  edition.  In  one  handsome  octavo  volume 
of  595  pages,  extra  cloth,  $4  50. 

which  pervades  his  whole  work  lend  an  additional 
force  to  its  thoroughly  practical  character,  which 
cannot  fail  to  obtain  for  it  a  place  as  a  standard  work 
on  diseases  of  the  respiratory  system. — London 
Lancet,  Jan.  19,  1867. 

This  is  an  admirable  book.  Excellent  in  detail  and 
execution,  nothiug  better  could  be  desired  by  the 
practitioner.  Dr.  Flint  enriches  his  subject  with 
much  solid  and  not  a  little  original  observation. — 
Ranking's  Abstract,  Jan.  1S67. 


Dr.  Flint's  treatise  is  one  of  the  most  trustworthy 
guides  which  he  can  consult.  The  style  is  clear  and 
distinct,  and  is  also  concise,  being  free  from  that  tend- 
ency to  over-refinement  and  unnecessary  minuteness 
which  characterizes  many  works  on  the  same  sub- 
ject,— Dublin  Medical  Press,  Feb.  6,  1867. 

The  chapter  on  Phthisis  is  replete  with  interest ; 
and  his  remarks  on  the  diaguosis,  especially  in  the 
early  stages,  are  remarkable  for  their  acumen  and 
great  practical  value.  Dr.  Flint's  style  is  clear  and 
elegant,  and  the  tone  of  freshness  and  originality 


F 


ULLER  {HENRY  WILLIAM),  M.  D., 

Physician  to  St.  George's  Hospital,  London. 

ON  DISEASES  OF  THE    LUNGS    AND   AIR-PASSAGES.     Their 

Pathology,  Physical  Diagnosis,  Symptoms,  and  Treatment.     From  the  second  and  revised 
English  edition.     In  one  handsome  octavo  volume  of  about  500  pages,  extra  cloth,  $3  50. 

Dr.  Fuller's  work  on  diseases  of  the  chest  was  so  ;  accordingly  we  have  what  might  be  with  perfect  jus- 


favorably  received,  that  to  many  who  did  not  know 
the  extent  of  his  engagements,  it  was  a  matter  of  woni- 
der  that  it  should  be  allowed  to  remain  three  years 
out  of  print.  Determined,  however,  to  improve  it, 
Dr.  Fuller  would  not  consent  to  a  mere  reprint,  and 


tice  styled  an  entirely  new  work  from  his  pen,  the 
portion  of  the  work  treating  of  the  heart  and  great 
vessels  being  excluded.  Nevertheless,  this  volume  is 
of  almost  equal  size  with  the  first. — London  Medical 
Times  and  Gazette,  July  2C,  1867. 


TWILLIAMS  (G.  J.  B.),  M.D., 

Senior  Consulting  Physician  to  the  Hospital  for  Consumption,  Brompton,  and 

TV7LLIAMS  {CHARLES  T.),  ALB., 

Physician  to  the  Hospital  for  Consumption. 

PULMONARY  CONSUMPTION;  Its  Nature,  Varieties,  and  Treat- 

ment.     With  an  Analysis  of  One  Thousand  cases  to  exemplify  its  duration.     In  one  neat 
octavo  volume  of  about  350  pages,  extra  cloth.      (Just  Ready.)     $2  50. 


He  can  still  speak  from  a  more  enormous  experi- 
ence, and  a  closer  study  of  the  morbid  processes  in- 
volved iu  tuberculosis,  than  most  living  men.  He 
owed  it  to  himself,  and  to  the  importance  of  the  sub- 
ject, to  embody  his  views  in  a  separate  work,  and 
we  are  glad  that  he  has  accomplished  this  duty. 
After  all,  the  grand  teaching  which  Dr  Williams  has 
for  the  profession  is  to  be  found  in  his  therapeutical 
chapters,  and  in  the  history  of  individual  cases  ex- 
tended, by  dint  of  care,  over  ten,  twenty,  thirty,  and 
even  forty  years. — London  Lancet,  Oct.  21,  1871. 

His  results  are  more  favorable  than  those  of  any 


previous  author  ;  but  probably  there  is  no  malady, 
the  treatment  of  which  has  been  so  much  improved 
within  the  last  twenty  years  as  pulmonary  consump- 
tion. To  ourselves,  Dr.  Williams's  chapters  on  Treat- 
ment are  amongst  the  most  valuable  and  attractive  in 
the  book,  and  would  alone  render  it  a  standard  work 
of  reference.  In  conclusion,  we  would  record  our 
opinion  that  Dr.  Williams's  great  reputation  is  fully 
maintained  by  this  hook.  It  is  undoubtedly  one  of 
the  most  valuable  works  in  the  language  upon  any 
special  disease. — Lond.  Med.  Times  and  Gaz.,  Nov. 
4,  1871. 


LA  ROCHE  ON  PNEUMONIA.  1  vol.  8vo.,  extra 
cloth,  of  500  pages.     Price  $3  00. 

BUCKLER  ON  FIBRO-BRONCHITIS  AND  RHEU- 
MATIC PNEUMONIA.     1  vol.  8vo.     $1  25. 

FISKE  FUND  PRIZE  ESSAY8  ON  CONSUMPTION. 
1  vol  8vo,,  extra  cloth,    $1  00. 


SMITH  ON  CONSUMPTION;  ITS  EARLY  ANDRE. 

MEDIABLE  STAGES.     1  vol.  8vo.,  pp.  254.     $2  25. 
SALTER  ON  ASTHMA.     1  vol.  8vo.     $2  50. 
WALSHE  ON  THE  DISEASES  OF  THE  HEART  AND 

GREAT  VESSELS.     Third  American   edition.     In 

1  vol.  Svo.,  420  pp.,  cloth.    %i  00. 


18  Henry  C.  Lea's  Publications — (Practice  of  Medicine). 

ROBERTS  (  WILLIAM),  M.  D.. 

■*-  *  Lecturer  on  Medicine  in  the  Manchester  School  of  Medicine,  &c. 

A  PRACTICAL  TREATISE    ON  URINARY  AND    RENAL   DIS- 

EASES,  including  Urinary  Deposits.     Illustrated  by  numerous  cases  and  engravings.    Sec- 
ond Edition,  Revised.     In  one  very  handsome  octavo  volume.      [Preparing.) 


-DASH AM  (TYi?.),  M.D.,       ^~ 

-*-*  Senior  Physician  to  the  Westminster  Hospital,  &c. 

RENAL  DISEASES:  a  Clinical  Guide  to  their  Diagnosis  and  Treat- 
ment. With  illustrations.  In  one  neat  royal  12mo.  volume  of  304  pages.  $2  00.  (Just 
Issued.) 

The  chapters  on  diagnosis  and  treatment  are  very 
good,  aud  the  student  and  voting  practitioner  will 
find  them  full  of  valuable  practical  hints.  The  third 
part,  on  the  urine,  is  excellent,  aud  we  cordially 
recommend  its  perusal.  The  author  has  arranged 
his  matter  in  a  somewhat  novel,  and,  we  think,  use- 
ful form.  Here  everything  can  be  easily  found,  and, 
what  is  more  important,  easily  read,  for  all  the  dry 


ment  render  the  hook  pleasing  and  convenient. — Am. 
Journ.  Med.  Sciences,  July,  1S70. 

A  book  that  we  believe  will  be  found  a  valuable 
assistant  to  the  practitioner  and  guide  to  the  student. 
— Baltimore  Med.  Journal,  July,  1S70. 

The  treatise  of  Dr.  Bashsm  differs  from  the  rest  in 
its  special  adaptation  to  clinical  study,  and  its  con- 


details  of  larger  books  here  acquire  a  new  interest  |  densed  and  almost  aphorismal  style,  which  makes  it 
from  the  author's  arrangement.  This  part  of  the  easily  read  and  easily  understood.  Besides,  the 
book  is  full  of  good  work.— Brit,  and  For.  Medico-  autri0r  expresses  some  new  views,  which  are  well 
Chirurgical  Revieio,  July,  1870.  I  worthy  of  consideration.     The  volume  is  a  valuable 

addition  to  this  department   of  knowledge. — Pacific 
The  easy  descriptions  and  compact  modes  of  state-  '  Med.  and  Surg.  Journal,  July,  1870. 

MORLAND  ON   RETENTION  IN  THE   BLOOD  OF  THE  ELEMENTS  OF  THE  URINARY    SECRETION. 
1  vol.  Svo.,  extra  cloth.    75  cents. 


TONES  [C.  HANDFIELD).  M.  D., 

"  Physician  to  St.  Mary's  Hospital,  &c. 

CLINICAL    ORSERYATIONS 

DISORDERS.     Second  American  Edition, 
extra  cloth,  $3  25. 
Taken  as  a  whole,  the  work  before  us  furnishes  a  I 
short  but  reliable  account  of  the  pathology  and  treat- 
ment of  a  class  of  very  common  but  certainlv  highly 
obscure  disorders.    The  advanced  student  will  find  it 
a  rich  mine  of  valuable  facts,  while  the  medical  prac- 
titioner will  derive  from  it  many  a  suggestive  hint  to 
aid  him  in  the  diagnosis  of  "nervouscases,"  and  in 
determining  the  true  indications  for  their  ameliora- 
tion or  cure.—  Amer.  Journ.  Med.  Set,  Jan.  1867. 


ON    FUNCTIONAL   NERVOUS 

In  one  handsome  octavo  volume  of  348  pages, 

We  must  cordially  recommend  it  to  the  profession 
of  this  country  as  supplying,  in  a  great  measure,  a 
deficiency  which  exists  in  the  medical  literature  of 
the  English  language. — yew  York  Med.  Journ.,  April, 
1867. 

The  volume  is  a  most  admirable  one — full  of  hints 
and  practical  suggestions.  —  Canada  Med.  Journal, 
April,  1S67. 


JPSSAYS  ON  NERVOUS  DISEASES.     {Xuiv  Ready.) 

ON   DISEASES    OF    THE    SPINAL    COLUMN    AND    OF    THE 

NERVES.  By  C.  B.  Radcliff,  M.  D.,  John  Nettex  Radcliff,  J.  Warbcrtox  Beg- 
bie,  M.  D.,  Francis  E.  Aixstie,  M.  D.,  and  J.  Russell  Reynolds,  M.  D.  1  vol.  Svo., 
extra  cloth,  SI  50. 

This  volume,  which  has  been  passing  through  the  Library  Department  of  the  "Medical 
News"  for  1S70,  consists  of  a  series  of  essays  from  "  Reynolds'  System  of  Medicine"  by  gentle- 
men who  have  paid  especial  attention  to  the  several  affections  of  the  nervous  system. 


s 


LADE  (D.  D.),  M.D. 

DIPHTHERIA;  its  Nature  and  Treatment,  with  an  account  of  the  His- 
tory of  its  Prevalence  in  various  Countries.  Second  and  revised  edition.  In  one  neat 
royal  12mo.  volume,  extra  cloth.     $1  25. 


TTUDSON  {A.),  31.  D.,  M.  R.  I.  A., 

-*■-*■        Physician  to  the  Neath  Hospital. 

LECTURES  ON  THE    STUDY  OF  FEYER. 

Cloth,  $2  50. 


In  one  vol.  8vo.,  extra 


As  an  admirable  summary  of  the  present  state  of 
our  knowledge  concerning  fever,  the  work  will  be  as 
welcome  to  the  medical  man  in  active  practice  as  to 
the  student.  To  the  hard-worked  practitioner  who 
wishes  to  refresh  his  notions  concerning  fever,  the 

book  will  prove  most  valuable We  heartily 

commend  his  excellent  volume  to  students  and  the 
profession  at  large. — London  Lancet,  June  22,  1S67. 

The  truly  philosophical  lectures  of  Dr.  Hudson  add 


much  to  our  previous  knowledge,  all  of  which  they, 
moreover,  analyze  and  condense.  This  well-conceived 
task  has  been  admirably  executed  iu  the  lectures,  il- 
lustrative cases  and  quotations  being  arranged  in  an 
appendix  to  each.  We  regret  that  space  forbids  our 
quotation  from  the  lectures  on  treatment,  which  are, 
iu  regard  to  research  and  judgment,  most  masterly, 
and  evidently  the  result  of  extended  and  mature  ex- 
perience.— British  Medical  Journal,  Feb.  22,  lStfS. 


tYONS  {ROBERT  D.),  K.  C.  C. 
A  TREATISE  ON  FEYER;  or,  Selections  from  a  Course  of  Lectures 

on  Fever.    Being  part  of  a  Course  of  Theory  and  Practice  of  Medicine.    In  one  neat  octavo 
volume,  of  362  pages,  extra  cloth.     $2  25. 


Henry  C.  Lea's  Publications — (Venereal  Diseases,  etc.). 


19 


T>UMSTEAD  (FREEMAN  J.),  M.D., 

J->        Professor  of  Vi  n,  real  Diseases  at  the  Col.  of  Phys.  and  Surg.,  New  York,  &c. 

THE    PATHOLOGY   AND   TREATMENT   OF   VENEREAL  DIS- 
EASES.    Including  the  results  of  recent  investigations  upon  the  subject.     Third  edition, 
revised  and  enlarged,  with  illustrations.     In  one  large  and  handsome  octavo  volume  of 
over  700  pages,  extra  cloth,  $5  00  ;  leather,  $6  00.      (Just  Issued.) 
In  preparing  this  standard  work  again  for  the  press,  the  author  has  subjected  it  to  a  very 
thorough  revision.    Many  portions  have  been  rewritten,  and  much  new  matter  added,  in  order  to 
bring  it  completely  on  a  level  with  the  most  advanced  condition  of  syphilograpby,  but  by  careful 
compression  of  the  text  of  previous  editions,  the  work  has  been  increased  by  only  sixty-four  pages. 
The  labor  thus  bestowed  upon  it,  it  is  hoped,  will  insure  for  it  a  continuance  of  its  position  as  a 
complete  and  trustworthy  guide  for  the  practitioner. 

It  is  the  most  complete  book  with  which  we  are  ac-    much  special  commendation  as  if  its  predecessors  bad 


quainted  in  the  language.  The  latest  views  of  the 
best  authorities  are  put  forward,  and  the  information 
is  well  arranged — a  great  point  for  the  student,  and 
still  more  for  the  practitioner.  The  subjects  of  vis- 
ceral syphilis,  syphilitic  affections  of  the  eyes,  and 
the  treatment  of  syphilis  by  repeated  inoculations,  are 
very  fully  discussed. — London  Lancet,  Jan   7,  1871. 

Dr.  Bumstead's  work  is  already  so  universally 
known  as  the  best  treatise  in  the  English  language  on 
venereal  diseases,  that  it  may  seem  almost  superflu- 
ous to  say  more  of  it  than  that  a  new  edition  has  been 

issued.     But  the  author's  industry  has  rendered  this  I  Journal,  March,  1871. 
new  edition  virtually  a  new  work,  and  so  merits  as  I 


not  been  published.  As  a  thoroughly  practical  book 
on  a  class  of  diseases  which  form  a  large  share  of 
nearly  every  physician's  practice,  the  volume  before 
us  is  bv  far  the  best  of  which  we  have  knowledge. — 
N.  Y.  Medical  Gazette,  Jan.,28,  1871. 

It  is  rare  in  the  history  of  medicine  to  find  any  one 
book  which  contains  all  that  a  practitioner  needs  t  :> 
know;  while  the  possessor  of  "  Bumstead  on  Vene- 
rea  I"  has  no  occasion  to  look  outside  of  its  covers  for 
anything  practical  connected  with  the  diagnosis,  his- 
tory, or  treatment  of  these  affections. — N.  Y.  Medical 


(1ULLERIER  (A.),  and 

^  Surgeon  to  the  Ubpital  du  Midi. 


T?UMSTEAD  {FREE 31  AN  J.). 

J-t       Professor  of  Venereal  Diseases  in  the  Collegeof 
Physicians  and  Surgeons,  N.  Y. 

AN    ATLAS    OF   VENEREAL   DISEASES.      Translated   and   Edited    by 

Freeman  J.  Bumstead.     In  cne  large  imperial  4to.  volume  of  328  pages,  double-columns, 
with  26  plates,  containing  about  150  figures,  beautifully  colored,  •many  of  them  the  size  of 
life;  strongly  bound  in  extra  cloth,  $17  00  ;  also,  in  five  parts,  stout  wrappers  for  mailing,  at 
$3  per  part.     [Lately  Published.) 
Anticipating  a  very  large  sale  for  this  work,  it  is  offered  at  the  very  low  price  of  Three  Dol- 
lars a  Part,  thus  placing  it  within  the  reach  of  all  who  are  interested  in  this  department  of  prac- 
tice.    Gentlemen  desiring  early  impressions  of  the  plates  would  do  we1 1  to  order  it  without  delay. 
A  specimen  of  the  plates  and  text  sent  free  by  mail,  on  receipt  of  25  cents. 

We  wish  for  once  that  our  province  was  not  restrict-  I      The  fifth  and  concluding  number  of  this  magnificent 
ed  to  methods  of  treatment,  that  we  might  say  some-  |  work  has  reached  us,  and  we  have  no  hesitation  in 


thing  of  the  exquisite  colored  plates  in  this  volume 
— London  Practitioner,  May,  1S69. 

As  a  whole,  it  teaches  all  that  can  be  taught  by 
means  of  plates  and  print. — London  Lancet..  .March 
13,  1869. 

Superior  to  anything  of  the  kind  ever  before  issued 
on  this  continent  — Canada  Med.  Journal,  March,  '69. 

The  practitioner  who  desires  to  understand  this 
branch  of  medicine  thoroughly  should  obtain  this, 
the  most  complete  and  best  work  ever  published. — 
Dominion  Med.  Journal,  May,  1S69. 

This  is  a  work  of  master  hands  on  both  sides.  M. 
Cnllerier  is  scarcely  second  to,  we  think  we  may  truly 
say  is  a  peer  of  the  illustrious  and  venerable  Ricord, 
while  in  this  country  we  do  not  hesitate  to  say  that 
Dr.  Bumstead,  as  au  authority,  is  without  a  rival. 
Assuring  our  readers  that  these  illustrations  tell  the 
whole  history  of  venereal  disease,  from  its.  inception 
to  its  end,  we  do  not  know  a  single  medical  work, 
which  for  its  kind  is  more  necessary  for  them  to  have. 
—California  Med.  Gazette,  March,  1869. 

The  most  splendidly  illustrated  work  in  the  lan- 
guage, and  in  our  opinion  far  more  useful  tlnn  the     a  very  readable  one. — Brit,  and  For.  Medico-Chir 
French  original. — Am.Journ.  Med.  Sciences,  Jau.'Bf)    '  Review,  July,  1S69, 


saying  that  its  illustrations  surpass  those  of  previous 
numbers.— Boston  Med.  and  Surg.  Journal,  Jan.  14, 

181  :>. 

Other  writers  besides  M.  Cullerier  have  given  us  a 
good  account  of  the  diseases  of  which  he  treats,  but 
no  one  has  furnished  us  with  such  a  complete  series 
of  illustrations  of  the  venereal  diseases.  There  is, 
however,  an  additional  interest  and  value  possessed 
by  the  volume  before  us  ;  for  it  is  an  American  reprint 
and  translation  of  M.  Cullerier's  work,  with  inci- 
dental remarks  by  one  of  the  most  eminent  American 
svphilographers,  Mr.  Bumstead.  The  letter-press  is 
chiefly  M.  Cullerier's,  but  every  here  and  there  a  few 
lines  or  sentences  are  introduced  by  Mr.  Bumstead  ; 
and,  as  M.  Cullerier  is  a  unicist,  while  Mr.  Bumstead 
is  a  dualist,  this  method  of  treating  the  subject  adds 
very  much  to  its  interest.  By  this  means  a  liveliness 
is  imparted  to  the  volume  which  many  other  treatises 
sorely  lack.  It  is  like  reading  the  report  of  a  conver- 
sation or  debate  ;  for  Mr.  Bumstead  often  finds  occa- 
sion to  question  M. Cullerier's  statements  or  inferences, 
and  this  he  does  in  a  short  and  forcible  way  which 
helps  to  keep  up  the  attention,  and  to  make  the  book 


H' 


ILL  (BERKELEY), 

Surgeon  to  the  Lock  Hospital,  London. 

ON  SYPHILIS  AND  LOCAL  CONTAGIOUS  DISORDERS.     In 


one  handsome  octavo  volume  :  extra  cloth 
Bringing,  as  it  does,  the  entire  literature  of  the  dis- 
ease down  to  the  present  day,  and  giving  with  great 
ability  the  results  of  modern  research,  it  is  in  every 
respect  a  most  desirable  work,  and  one  which  should 
find  a  place  in  the  library  of  every  surgeon.  —  Cali- 
fornia Mil.  Gazette,  June,  1869. 

Considering  the  scope  of  the  book  and  the  careful 
attention  to  the  manifold  aspects  and  details  of  its 
subject,  it  is  wonderfully  concise.  All  these  qualities 
render  it  an  especially  valuable  book  to  thebeginner, 


25.      (Lately  Published.) 

to  whom  we  would  most  earnestly  recommend  its 
study  ;  while  it  is  no  less  useful  to  the  practitioner. — 
St.  Louis  M"l.  and  Surg.  Journal,  May,  LS   '. 

The  most  convenient  and  ready  book  of  reference 
we  have  met  with.— X.  Y.  Med.  Record,  May  1,1869. 

Most  admirably  arranged  for  both  student  and  prac- 
titioner, no  other  work  on  the  subject  equals  it  ;  it  is 
more  simple,  more  easily  studied. — Buffalo  Med.  and 
Surg.  Journal,  March,  1S69. 


LALLEMAND    AXD    WILSON    ON    THE    CAUSES 
SYMPTOMS,    AND    TREATMENT    OF    SPERMA- 


TORRHOEA. 

cloth,  *2  7.5. 


In  one  vol.  Svo.,  of  about  400  pp., 


20 


Henry  C.  Lea's  Publications — (Diseases  of  the  Skin). 


"WILSON  {ERASMUS),  F.R.S. 

ON  DISEASES  OF  THE  SKIN.     With  Illustrations  on  wood.    Sev- 

enth  American,  from  the  sixth  and  enlarged  English  edition.     In  one  large  octavo  volume 
of  over  800  pages,  $5.      (Lately  Published.) 

A  SERIES   OF   PLATES   ILLUSTRATING-  "WILSON   ON   DIS- 
EASES OF  THE  SKIN  ;"  consisting  of  twenty  beautifully  executed  plates,  of  which  thir- 
teen are  exquisitely  colored,  presenting  the  Normal  Anatomy  and  Pathology  of  the  Skin, 
and  embracing  accurate  representations  of  about  one  hundred  varieties  of  disease,  most  of 
them  the  size  of  nature.     Price,  in  extra  cloth,  $5  50. 
Also,  the  Text  and  Plates,  bound  in  one  handsome  volume.     Extra  cloth,  $10. 
The  industry  and  care  with  which  the  author  has  revised  the  present  edition  are  shown  by  the 
fact  that  the  volume  has  been  enlarged  by  more  than  a  hundred  pages.     In  its  present  improved 
form  it  will  therefore  doubtless  retain  the  position  which  it  has  acquired  as  a  standard  and  classical 
authority,  while  at  the  same  time  it  has  additional  claims  on  the  attention  of  the  profession  a3 
the  latest  and  most  complete  work  on  the  subject  in  the  English  language. 


Such  a  work  as  the  one  before  us  is  a  most  capital 
and  acceptable  help.  Mr.  Wilson  has  long  been  held 
as  high  authority  in  this  department  of  medicine,  and 
his  book  on  diseases  of  the  skin  has  long  been  re- 
garded as  one  of  the  best  text-books  extant  on  the 
subject.  The  present  edition  is  carefully  prepared, 
and  brought  up  iu  its  revision  to  the  present  time.  In 
this  edition  we  have  also  included  the  beautiful  series 
of  plates  illustrative  of  the  text,  and  in  the  last  edi- 
tion published  separately.  There  are  twenty  of  these 
plates,  nearly  all  of  them  colored  to  nature,  and  ex- 
hibiting with  great  fidelity  the  various  groups  of 
diseases  treated  of  in  the  body  of  the  work. — Cin- 
cinnati Lancet,  June,  1863. 

No  one  treating  skin  diseases  should  be  without 
a  copy  of  this  standard  work.  —  Canada  Lancet. 
August,  1863. 

>Y  THE  SA3IE  AUTHOR.  — 


We  can  safely  recommend  it  to  the  profession  as 
the  best  work  on  the  subject  now  in  existence  in 
the  English  language. — Medical  Times  and  Gazette. 

Mr.  Wilson's  volume  is  an  excellent  digest  of  the 
actual  amount  of  knowledge  of  cutaneous  diseases: 
it  includes  almost  every  fact  or  opinion  of  importance 
connected  with  the  anatomy  and  pathology  of  the 
skin. — British  and  Foreign  Medical  Review. 

These  plates  are  very  accurate,  and  are  executed 
with  an  elegance  and  taste  which  are  highly  creditable 
to  the  artistic  .skill  of  the  American  artist  who  executed 
them. — St.  Louis  Med.  Journal. 

The  drawings  are  very  perfect,  and  the  finish  and 
coloring  artistic  and  correct ;  the  volume  is  an  indis- 
pensable companion  to  the  book  it  illustrates  and 
completes. — Charleston  Medical  Journal. 


B 


THE  STUDENT'S  BOOK  OF  CUTANEOUS  MEDICINE  and  Dis- 

eases  of  the  skin.    In  one  very  handsome  royal  12mo.  volume.    $3  50.    (Lately  Issued.) 


J\JELIGAN  (J.  MO  ORE),  M.D.,  M.R.I.  A. 

A    PRACTICAL    TREATISE    ON    DISEASES    OF    THE    SKIN. 

Fifth  American,  from  the  second  and  enlarged  Dublin  edition  by  T.  W.  Belcher,  M.  D. 
In  one  neat  royal  12mo.  volume  of  462  pages,  extra  cloth.     $2  25. 


Fully  equal  to  all  the  requirements  of  students  and 
young  practitioners.  It  is  a  work  that  h,as  stood  its 
ground,  that  was  worthy  the  reputation  of  the  au- 
thor, and  the  high  position  of  which  has  been  main- 
tained by  its  learned  editor. — Dublin  Med.  Pressand 
Circular,  Nov.  17,  1S69. 


fully  up  to  the  times,  and  is  thoroughly  stocked  with 
most  valuable  information. — New  York  Med.  Record, 
Jan.  15,  1867. 

This  instructive  little  volume  appears  once  more. 
Since  the  death  of  its  distinguished  author,  the  study 
of  skin  diseases  has  been  considerablv  advanced,  and 


Of  the  remainder  of  the  work  we  have  nothing  be-  '  the  results  of  these  investigations  have  been  added 
yond  unqualified  commendation  to  offer.  It  is  so  far  I  by  the  present  editor  to  the  original  work  of  Dr.  Neli- 
the  most  complete  one  of  its  size  that  has  appeared,  \  gan.  This,  however,  has  not  so  far  increased  its  bulk 
and  for  the  student  there  can  be  none  which  can  com-  as  to  destroy  its  reputation  as  the  most  convenient 
pare  with  it  in  practical  value.  All  the  late  disco-  ,  manual  of  diseases  of  the  skin  that  can  be  procured 
veries  in  Dermatology  have  been  duly  noticed,  and  j  by  the  student. — Chicago  Med.  Journal,  Dec.  1S66. 
their  value  justly  estimated;  in  a  word,  the  work  is 

}Y  THE  SAME  AUTHOR.  

ATLAS   OF   CUTANEOUS    DISEASES.      In   one  beautiful   quarto 

volume,  with  exquisitely  colored  plates,  &c,  presenting  about  one  hundred  varieties  of 
Extra  cloth,  $5  50. 

inclined  to  consider  it  a  very  superior  work,  com- 
bining accurate  verbal  description  with  sound  views 
of  the  pathology  and  treatment  of  eruptive  diseases. 
—  Glasgow  Med.  Journal. 

A  compend  which  will  very  much  aid  the  practi- 
tioner in  this  difficult  branch  of  diagnosis  Taken 
with  the  beautiful  plates  of  the  Atlas,  which  are  re- 
markable for  their  accuracy  and  beauty  of  coloring, 
it  constitutes  a  very  valuable  addition  to  the  library 
of  a  practical  man. — Buffalo  Med.  Journal. 


By 


disease. 

The  diagnosis  of  eruptive  disease,  however,  under 
all  circumstances,  is  very  difficult.  Nevertheless, 
Dr.  Neligan  has  certainly,  "as  far  as  possible,"  given 
a  faithful  and  accurate  representation  of  this  class  of 
diseases,  and  there  can  be  no  doubt  that  these  plates 
will  be  of  great  use  to  the  student  and  practitioner  in 
drawing  a  diagnosis  as  to  the  class,  order,  and  species 
to  which  the  particular  case  may  belong.  While 
looking  over  the  "Atlas"  we  have  been  induced  to 
examine  also  the  "Practical  Treatise,"  and  we  are 


TJILLIER  {THOMAS),  M.D., 

-*—^-  Physician  to  the  Skin  Department  of  University  College  Hospital,  &-c. 

HAND-BOOK  OF  SKIN  DISEASES,  for  Students  and  Practitioners. 

Second  American  Edition.     In   one  royal  12mo.  volume  of  358  pp.     With  Illustrations. 
Extra  cloth,  $2  25.      (Just  Issued.) 


We  can  conscientiously  recommend  it  to  the  stu- 
dent; the  style  is  clear  and  pleasant  to  read,  the 
matter  is  good,  and  the  descriptions  of  disease,  with 
the  modes  of  treatment  recommeuded,  are  frequently 
Illustrated  with  well-recorded  cases. — London  Med. 
Times  and  Gazette,  April  1,  1865. 


It  is  a  concise,  plain,  practical  treatise  on  the  vari- 
ous diseases  of  the  skin  ;  just  such  a  work,  indeed, 
as  vras  much  needed,  both  by  medical  students  and 
practitioners.  —  Chicago  Medical  Examiner,  May, 
1S65. 


Henry  C.  Lea's  Publications — (Diseases  of  Children). 


21 


&3IITH  {J.  LE  WIS),  M.  D., 

A3  Professor  of  Morbid  Anatomy  in  the  Bellevue  Hospital  Med.  College,  N  T. 

A  COMPLETE  PRACTICAL  TREATISE  ON  THE  DISEASES  OF 

CHILDREN.     Second  Edition,  revised  and  greatly  enlarged.     In  one  handsome  octavo 

volume.      (Nearly  Ready.) 

work  is  an  illustration,  and  pervading  every  chapter 
of  it  is  a  spirit  of  sound  judgment  and  common  sense, 
without  which  any  work  on  any  department  of  the 
practice  of  medicine  is,  to  use  the  mildest  word,  de- 
fective. We  are  sorry  that  we  cannot  give  further 
illustrations  of  the  excellence  of  this  book. — London 
Lancet,  Sept.  4,  1S69. 


An  original  and  valuable  work.  —  Glasgow  Med. 
Journal,  Feb.  1871. 

The  excellence  of  this  book  is  one  explanation  of 
our  not  having  reviewed  it  sooner.  Taking  it  up  from 
time  to  time,  we  have  been  freshly  interested  in  its 
various  chapters,  and  so  been  led  to  defer  writing  our 
opinion  of  it.  It  is  one  of  those  works  with  which 
we  are  happily  becoming  familiar,  as  coming  to  us 
from  time  to  time  from  across  the  Atlantic,  which 
contain  all  that  is  good  in  European  works  of  the 
same  kind,  together  with  much  that  is  original,  both 
in  reflection  and  observation.  It  is  astonishing  how 
well  the  American  writers  succeed  in  gleaning,  and 
yet  giving  a  fresh,  character  to  their  books.     This 


We  have  no  work  upon  the  Diseases  of  Infancy  and 
Childhood  which  can  compare  with  it. — Buffalo  Med. 
and  Surg.  Journal,  March,  1S69. 

The  description  of  the  pathology,  symptoms,  and 
treatment  of  the  different  diseases  is  excellent. — Am. 
Med.  Journal,  April,  1869. 


nONDIE  [D.  FRANCIS),  M.  D. 

A  PRACTICAL  TREATISE  ON  THE  DISEASES  OF  CHILDREN, 

Sixth  edition,  revised  and  augmented.     In  one  large  octavo  volume  of  nearly  800  closely- 
printed  pages,  extra  cloth,  $5  25;  leather,  $6  25.       (Lately  Issued.) 

The  present  edition,  which  is  the  sixth,  is  fully  up 
to  the  times  in  the  discussion  of  all  those  points  in  the 
pathology  and  treatment  of  infantile  diseases  which 
have  been  brought  forward  by  the  Germau  and  French 
teachers.  As  a  whole,  however,  the  work  is  the  best 
American  one  that  we  have,  and  in  its  special  adapta- 
tion to  American  practitioners  it  certainly  has  no 
equal.  —  New  York  Med.  Record,  March  2,  1S6S. 

No  other  treatise  on  this  subject  is  better  adapted 
to  the  American  physician.  Dr.  Condie  has  long  stood 
before  his  countrymen  as  one  peculiarly  pre-eminent 


in  this  department  of  medicine  His  work  has  been 
so  long  a  standard  for  practitioners  and  medical  stu- 
dents that  we  do  no  more  now  than  refer  to  the  fact 
that  it  has  reached  its  sixth  edition.  We  are  glad 
once  more  to  refresh  the  impressions  of  our  earlier 
days  by  wandering  through  its  pages,  and  at  the  same 
time  to  be  able  to  recommend  it  to  the  youngest  mem- 
bers of  the  profession,  as  well  as  to  those  who  have 
the  older  editions  on  their  shelves. — St.  Louis  Med. 
Reporter,  Feb.  15,  1868. 


TXTEST  [CHARLES),  M.D., 

'  '  Physician  to  the  Hospital  for  Sick  Children,  &c. 

LECTURES   ON   THE   DISEASES   OF   INFANCY  AND   CHILD- 

HOOD.  Fourth  American  from  the  fifth  revised  and  enlarged  English  edition.  In  one 
large  and  handsome  octavo  volume  of  656  closely-printed  pages.  Extra  cloth,  $4  50 ; 
leather,  $5  50. 

Of  all  the  English  writers  on  the  diseases  of  chil-  I  living  authorities  in  the  difficult  department  of  medi- 
dren,  there  is  no  one  so  entirely  satisfactory  to  us  as  |  cal  science  in  which  he  is   most  widely  known. — 
Dr.  West.    For  years  we  have  held  his  opinion  as  I  Boston  Med.  and  Surg.  Journal,  April  26,  1S66. 
judicial,  and  have  regarded  him  as  one  of  the  highest  | 


T>Y  THE  SAME  AUTHOR.    (Just  Ready.) 

ON  SOME  DISORDERS  OF  THE  NERVOUS  SYSTEM  IN  CHILD- 

HOOD;  being  the  Lumleian  Lectures  delivered  at  the  Royal  Collega^of  Physicians  of  Lon- 
don, in  March,  1871.     In  one  volume,  small  12mo.,  extra  cloth,  $1  00. 


&MITH  [E  USTA  CE),  M.  D., 

Physician  to  the  Northwest  London  Free  Dispensary  for  Sick  Children. 

A  PRACTICAL  TREATISE   ON   THE  WASTING   DISEASES  OF 

INFANCY  AND  CHILDHOOD.     Second  American,  from  the  second  revised  and  enlarged 
English  edition.     In  one  handsome  octavo  volume,  extra  cloth,  $2  50.      (Now    Ready.) 
This  is  in  every  way  an  admirable  book.     The  |  scribed  as  a  practical  handbook  of  the  common  dis- 


modest  title  which  the  author  has  chosen  for  it  scarce- 
ly conveys  an  adequate  idea  of  the  many  mbjects 
upon  which  it  treats.  Wasting  is  -to  constant  an  at 
tendant  upon  the  maladies  of  childhood,  that  a  trea 
tlse  upon  the  wasting  diseases  of  children  must  neces 
sarily  embrace  the  consideration  of  many  affecliom 
of  which  it  is  a  symptom  ;  and  this  is  excellently  well  j  April  8,  1871 
done  by  Dr.  Smith.     The  book  might  fairly  be  de-  | 


eases  of  children,  so  numerous  are  the  affections  con- 
sidered either  collaterally  or  directly.  We  are 
acqnainted  with  no  safer  guide  to  the  treatment  of 
children's  diseases,  and  few  works  give  the  insight 
into  the  physiological  and  other  peculiarities  of  chil- 
dren that  Dr.  Smith's  book  does. — Brit.  Med.  Journ., 


QUERSANT  [P.),  M.  D., 

Honorary  Surgeon  to  the  Hospitalfor  Sick  Children,  Paris. 

SURGICAL  DISEASES  OF  INFANTS  AND  CHILDREN.     Trans- 

lated  by  R.  J.  Dunglison,  M.  D.     (Publishing  in  the  Medical  News  and  Library.) 
As  this  work  embodies  the  experience  of  twenty  years'  service  in  the  great  Children's  Hospital 
of  Paris,  it  can  hardly  fail  to  maintain  the  reputation  of  the  valuable  practical  series  of  volumes 
which  have  been  laid  before  the  subscribers  of  the  "  American  Journal  of  the  Medical  Sci- 
ences."    For  terms,  see  p.  3. 

DEWEES  ON'  THE  PHYSICAL  AND  MEDICAL  TREATMENT  OF  CHILDREN.     Eleventh  edition.     1  vol. 
Svo.  of  548  pages.    $2  80. 


22 


Henry  C.  Lea's  Publications — (Diseases  of  Women). 


T 


'HOMAS  {T.GAILLARD),M.D.. 

/.•  f  s.tor  of  Obstetrics,  &c  in  the  College  of  Physicians  and  Sxirgeons,  N.  ¥.,  &c. 

A  PRACTICAL  TREATISE  ON  THE  DISEASES  OF  WOMEN.    Third 

edition,   revised  and  enlarged      In  one   large  and  handsome   octavo  volume.      {Nearly 
Ready.) 

From  the  Preface  to  the  Second  Edition. 
In  a  science  so  rapidly  progressive  as  that  of  medicine,  the  profession  has  a  rignt  to  expect  that, 
when  its  approbation  of  a  work  is  manifested  by  a  call  for  a  new  edition,  the  author  should  re- 
spond by  giving  to  his  book  whatever  of  additional  value  may  be  derivable  from  more  extended 
experience,  maturer  thought,  and  the  opportunity  for  correction.  Fully  sensible  of  this,  the 
author  of  the  present  volume  has  sought  by  a  careful  revision  of  the  whole,  and  by  the  addition 
of  a  chapter  on  Chlorosis,  to  render  his  work  more  worthy  of  the  favor  with  which  it  has  been 
received. — New  York,  March,  1869. 

If  tbe  excellence  of  a  work  is  to  be  judged  by  its 
rapid  sale,  this  one  must  take  precedence  of  all  others 
upon  the  same,  or  kindred  subjects,  as  evidenced  in 
the  short  time  from  its  first  appearance,  in  which  a 
new  edition  is  called  for,  resulting,  as  we  are  informed, 
from  the  exhausrion  of  the  previous  large  edition.  We 
deem  it  scarcely  necessery  to  recommend  this  work 
to  physicians  as  it  is  now  widely  known,  and  most 
of  them  already  possess  it,  or 'will  certainly  do  so. 
To  students  we  unhesitatingly  recommend  it  as  the 
best  text-book  on  diseases  of  females  extant.— St. Louis 
Med.  Reporter,  June,  1S69. 

Of  all  the  army  of  books  that  have  appeared  of  late 
years,  on  tbe  diseases  of  the  uterus  and  its  appendages, 
we  knov-  u'nnae  that  is  so  clear,  comprehensive,  and 
practical  as  this  of  Dr.  Thomas',  or  one  that  we  should 
more  emphatically  recommend  to  the  young  practi- 
tioner, as  his  guide. — California  Med.  Gazette,  June, 
1869. 

If  not  the  best  work  extant  on  the  subject  of  which 
it  treats,  it  is  certainly  second  to  none  other.  So 
short  a  time  has  elapsed  since  the  medical  press 
teemed  with  commendatory  notices  of  the  first  edition, 
that  it  would  be  superfluous  to  give  an  extended  re- 
view of  what  is  now  firmly  established  as  the  American 
textbook  of  Gynecology.—  Ar.  Y.  Med.  Gazette,  July 
17,  1S69. 

This  is  a  new  and  revised  edition  of  a  work  which 
we  I'ecently  noticed  at  some  length,  and  earnestly 
commended  to  the  favorable  attention  of  our  readers. 
The  fact  that,  in  the  short  space  of  one  year,  this 
second  edition  makes  its  appearance,  shows  that  the 
general  judgment  of  the  profession  has  largely  con- 
firmed the  opinion  we  gave  at  that  time.— Cincinnati 
Lancet,  Aug.  1S69. 

It  is  so  shorfca  time  since  we  gave  a  full  review  of 
the  first  edition  of  this  book,  that  we  deem  it  only 
necessary  now  to  call  attention  to  the  second  appear- 
ance of  the  work.  Its  success  has  been  remarkable, 
and  we  can  only  congratulate  the  author  on  the 
brilliant  reception  his  book  has  received.—  X.  Y.  Med. 
Journal,  April,  1S69.     ^ 


We  regard  this  treatise  as  the  one  best  adapted  to 
serve  as  a  text-book  on  gynaecology. — St.  Louis  Med, 
and  Surg.  Journal,  May  10,  1S69. 

The  whole  work  as  it  now  stands  is  an  absolute 
indispensable  to  any  physician  aspiring  to  treat  the 
diseases  of  females  with  success,  and  according  to  the 
most  fully  accepted  views  of  their  aetiology  and  pa- 
thology.— Leavenworth  Medical  Herald,  May,  1S69. 

We  have  seldom  read  a  medical  book  in  which  we 
found  so  much  to  praise,  and  so  little — we  can  hardly 
say  to  object  to — to  mention  with  qualified  commen- 
dation. We  had  proposed  a  somewhat  extended 
review  with  copious  extracts,  but  we  hardly  know 
where  we  should  have  space  for  it.  We  therefore 
content  ourselves  with  expressing  the  belief  that 
every  practitioner  of  medicine  would  do  well  to  pos- 
sess himself  of  the  work. — Boston  Med.  and  Surg. 
Journal,  April  2ft,  1S69. 

The  number  of  works  published  on  diseases  of 
women  is  large,  not  a  few  of  which  are  very  valuable. 
But  of  those  which  are  the  most  valuable  we  do  not 
regard  tbe  work  of  Dr.  Thomas  as  second  to  any. 
Without  being  prolix,  it  treats  of  the  disorders  to 
which  it  is  devoted  fully,  perspicuously,  and  satisfac- 
torily. It  will  be  found  a  treasury  of  knowledge  to 
every  physician  who  turns  to  its  pages.  We  would 
like  to  make  a  number  of  quotations  from  the  work 
of  a  practical  bearing,  but  our  space  will  not  permit. 
The  work  should  find  a  place  in  the  libraries  of  all 
physicians. — Cincinnati  Med.  Repertory,  May,  1S69. 

No  one  will  be  surprised  to  learn  that  the  valuable, 
readable,  and  thoroughly  practical  book  of  Professor 
Thomas  has  so  soon  advanced  to  a  second  edition. 
Although  very  little  time  has  necessarily  been  allowed 
our  author  for  revision  and  improvement  of  the  work, 
he  has  performed  it  exceedingly  well.  Aside  from 
the  numerous  corrections  which  he  has  found  neces- 
sary to  make,  he  has  added  an  admirable  chapter  on 
chlorosis,  which  of  itself  is  worth  the  cost  of  the 
volume.— A*.   1'.  Med.  Record,  May  15,  1S69. 


O 


RURCHILL  {FLEETWOOD),  M.  D.,  31.  R.  I.  A. 

ESSAYS  ON  THE  PUERPERAL  FEVER.  AND  OTHER  DIS- 
EASES 'PECULIAR  TO  WOMEN.  Selected  from  the  writings  of  British  Authors  previ- 
ous to  the  close  of  the  Eighteenth  Century.  In  one  neat  octavo  volume  of  about  450 
pages,  extra  cloth.     $2  50. 


A  SHWELL  [SAMUEL),  M.  D., 

-^-L  Late  Obstetric  Physician  and  Lecturer  at  Guy's  Hospital. 

A  PRACTICAL  TREATISE  ON  THE  DISEASES  PECULIAR  TO 

"WOMEN.  Illustrated  by  Cases  derived  from  Hospital  and  Private  Practice.  Third  Ame- 
rican, from  the  Third  and  revised  London  edition.  In  one  octavo  volume,  extra  cloth,  of 
528  pages.     $3  50. 


EIGBY  ON  THE  CONSTITUTIONAL  TREATMENT 
OF  FEMALE  DISEASES.  In  one  neat  royal  12mo 
volume,  extra  cloth;  of  about  250  pages.    $1  00. 

DEWEES'S  TREATISE  ON  THE  DISEASES   OF  FE- 


MALES. With  illustrations.  Eleventh  Edition, 
with  the  Author's  last  improvements  and  correc- 
tions. In  one  octavo  volume  of  536  pages,  with 
plates,  extra  cloth,  $3  00. 


J>ARXES  (ROBERT),  M.  D.,  F.R.C.P., 

•*-*  Obstetric  Physician  to  St.  Thomas''  Hospital,  Ac. 

A  PRACTICAL   TREATISE   OX    THE  DISEASES   OF  WOMEN. 

In  one  handsome  octavo  volume  with  illustrations.     (Preparing.) 


Henry  C.  Lea's  Publications — (Diseases  of  Women). 


23 


TTODGE  (HUGH  L.),  M.D., 

■*■-*-  Emeritus  Professor  of  Obstetrics,  &c,  in  the  University  of  Pennsylr.au  in. 

ON  DISEASES  PECULIAR  TO  WOMEN;  including  Displacements 

of  the  Uterus.  With  original  illustrations.  Second  edition,  revised  and  enlarged.  In 
one  beautifully  printed  octavo  volume  of  531  pages,  extra  cloth.  $4  50.  (Lately  Issued.) 
In  the  preparation  of  this  edition  the  author  has  spared  no  pains  to  improve  it  with  the  results 
of  his  observation  and  study  during  the  interval  which  has  elapsed  since  the  first  appearance  of 
the  work.  Considerable  additions  have  thus  been  made  to  it,  which  have  been  partially  accom- 
modated by  an  enlargement  in  the  size  of  the  page,  to  avoid  increasing  unduly  the  bulk  of  the 
volume. 


From  Prof.  W.  H.  Btford,  of  the  Rush  Medical 
College,  Chicago. 

The  book  bears  the  impress  of  a  master  hand,  and 
must,  as  its  predecessor,  prove  acceptable  to  the  pro- 
fession.  In  diseases  of  women  Dr.  Hodge  has  estab- 
lished a  school  of  treatment  that  has  become  world- 
wide in  fame. 

Professor  Hodge's  work  is  truly  an  original  one 
from  beginning  to  end,  consequently  no  one  can  pe- 
ruse its  pages  without  learning  something  new.  The 
book,  which  is  by  no  means  a  large  one,  is  divided  into 
two  grand  sections,  so  to  speak  :  first,  that  treating  of 
the  nervous  sympathies  of  the  uterus,  and,  secondly, 
that  which  speaks  of  the  mechanical  treatment  of  dis- 
placements of  that  organ.  He  is  disposed,  as  a  non- 
believer  in   the  frequency  of  inflammations  of  the 

WEST  [CHARLES),  31. D. 

LECTURES  ON  THE  DISEASES  OF  WOMEN. 


uterus,  to  take  strong  ground  against  many  of  the 
highest  authorities  in  this  branch  of  medicine,  and 
the  arguments  which  he  offers  in  support  of  his  posi- 
tion are,  to  say  the  least,  well  put.  Numerous  wood- 
cuts adorn  this  portion  of  the  work,  and  add  incalcu- 
lably to  the  proper  appreciation  of  the  variously 
shaped  instruments  referred  to  by  our  author.  As  a 
contribution  to  the  study  of  women's  diseases,  it  is  of 
great  value,  and  is  abundantly  able  to  stand  on  its 
own  merits. — N.  Y.  Medical  Record,  Sept.  IS,  1868. 

In  this  point  of  view,  the  treatise  of  Professor 
Hodge  will  be  indispensable  to  every  student  in  its 
department.  The  large,  fair  type  and  general  perfec- 
tion of  workmanship  will  render  it  doubly  welcome. 
— Pacific  Med.  and  Surg.  Journal,  Oct.  1S68. 


from  the  Third  London  edition, 
cloth.     $3  75  ;  leather,  $4  75. 


Third  American, 

In  one  neat  octavo  volume  of  about  550  pages,  extra 


The  reputation  which  this  volume  has  acquired  as  a  standard  book  of  reference  in  its  depart- 
ment, renders  it  only  necessary  to  say  that  the  present  edition  has  received  a  careful  revision  at 
the  hands  of  the  author,  resulting  in  a  considerable  increase  of  size.  A  few  notices  of  previous 
editions  are  subjoined. 


The  manner  of  the  author  is  excellent,  his  descrip- 
tions graphic  and  perspicuous,  and  his  treatment  up 
to  the  level  of  the  time— clear,  precise,  definite,  and 
marked  by  strong  common  sense.  —  Chicago  Med. 
Journal,  Dec.  1861. 

We  cannot  too  highly  recommend  this,  the  second 
edition  of  Dr.  West's  excellent  lectures  on  the  dis- 
eases of  females.  We  know  of  no  other  book  on  this 
subject  from  which  we  have  derived  as  much  pleasure 
and  instruction.  Every  page  gives  evidence  of  the 
honest,  earnest,  and  diligent  searcher  after  truth.  He 
is  dot  the  mere  compiler  of  other  men's  ideas,  but  his 
lectures  are  the  result  often  years'  patient  investiga- 
tion in  one  of  the  widest  fields  for  women's  diseases — 
St.  Bartholomew's  Hospital.  As  a  teacher,  Dr.  West 
is  simple  and  earnest  in  his  language,  clear  and  com- 
prehensive in  his  perceptions,  aud  logical  in  his  de- 
ductions.— Cincinnati  Lancet,  Jan.  1S62. 

We  return  the  author  our  grateful  thanks  for  the 
vast  amount  of  instruction  he  has  afforded  us.  His 
valuable  treatise  needs  no  eulogy  on  our  part.  His 
graphic  diction  and  truthful  pictures  of  disease  all 
speak  for  themselves. — Medico-Chirurg.  Review. 

Most  justly  esteemed  a  standard  work It 

bears  evidence  of  Having  been  carefully  revised,  and 
is  well  worthy  of  the  fame  it  has  already  obtained. 
— Dub.  Med.  Quar.  Jour. 


As  a  writer,  Dr.  West  stands,  in  our  opinion,  se- 
cond only  to  Watson,  the  "Macaulay  of  Medicine;" 
he  possesses  that  happy  faculty  of  clothing  instruc- 
tion in  easy  garments;  combining  pleasure  with 
profit,  he  leads  his  pupils,  in  spite  of  the  ancient  pro- 
verb, along  a  royal  road  to  learning.  His  work  is  one 
which  will  not  satisfy  the  extreme  on  either  side,  but 
it  is  one  that  will  please  the  great  majority  who  are 
seeking  truth,  and  one  that  will  convince  the  student 
that  he  has  committed  himself  to  a  candid,  safe,  and 
valuable  guide. — N.  A.  Med. -Chirurg  Review. 

We  must  now  conclude  this  hastily  written  sketch 
with  the  confident  assurance  to  our  readers  that  the 
work  will  well  repay  perusal.  The  conscientious, 
painstaking,  practical  physician  is  apparent  on  every 
page. — N.  Y.  Journal  of  Medicine. 

We  have  to  say  of  it,  briefly  and  decidedly,  that  it 
is  the  best  work  on  the  subject  in  any  language,  and 
that  it  stamps  Dr.  West  as  the  facile  princeps  of 
British  obstetric  authors. — Edinburgh  Med.  Journal. 

We  gladly  recommend  his  lectures  as  in  the  highest 
degree  instructive  to  all  who  are  interested  in  ob- 
stetric practise.  —  London.  Lancet. 

We  know  of  no  treatise  of  the  kind  so  complete, 
and  yet  so  compact. — Chicago  Med.  Journal. 


Df   THE  SAME  AUTHOR.  

AN  ENQUIRY  INTO  THE  PATHOLOGICAL  IMPORTANCE  OF 

ULCERATION  OF  THE  OS  UTERI.     In  one  neat  octavo  volume,  extra  cloth.     $1  25. 


JlfEIGS  {CHARLES  D.),  31.  D., 

•*■•-*-  Late  Professor  of  Obstetrics,  &c.  in  Jefferson  Medical  College,  Philadelphia. 

WOMAN:    HER  DISEASES  AND  THEIR  REMEDIES.     A  Series 

of  Lectures  to  his  Class.     Fourth  and  Improved  edition.     In  one  large  and  beautifully 
printed  octavo  volume  of  over  700  pages,  extra  cloth,  $5  00  j  leather,  $6  00. 
J>Y  THE  SAME  AUTHOR.  

ON  THE  NATURE,  SIGNS,  AND  TREATMENT  OF  CHILDBED 

FEVER.     In  a  Series  of  Letters  addressed  to  the  Students  of  his  Class.     In  one  handsome 
octavo  volume  of  365  pages,  extra  cloth.     $2"00. 

&1MPSON  [SIR  JAMES  Y.),  M.  I). 
CLINICAL  LECTURES  ON  THE  DISEASES  OF  WOMEN.    With 

numerous  illustrations.  In  one  ootavo  volume  of  over  500  pages.  Second  edition,  preparing. 


24 


Henry  C.  Lea's  Publications — {Midwifery). 


JJODGE  {HUGH  L.),  31.  D., 

Emeritus  Professor  of  Midwifery,  &c.  in  the  University  of  Pennsylvania,  &c. 

THE  PRINCIPLES  AND  PRACTICE  OF  OBSTETRICS.  Illus- 
trated with  large  lithographic  plates  containing  one  hundred  and  fifty-nine  figures  from 
original  photographs,  and  with  numerous  wood-cuts.  In  one  large  and  beautifully  printed 
quarto  volume  of  550  double-columned  pages,  strongly  bound  in  extra  cloth,  $14. 

The  work  of  Dr.  Hodge  is  something  more  than  i 
simple  presentation  of  his  particular  views  in  the  de 
partraent  of  Obstetrics;  it  is  something  more  than  an 


ordinary  treatise  on  midwifery  ;  it  is,  in  fact,  a  cyclo- 
paedia of  midwifery.  He  has  aimed  to  embody  in  a 
single  volume  the  whole  science  and, art  of  Obstetrics. 
An  elaborate  text  is  combined  with  accurate  and  va- 
ried pictorial  illustrations,  so  that  no  fact  or  principle 
is  left  unstated  or  unexplained. — Am.  Med.  Times, 
Sept.  3,  1864. 

We  should  like  to  analyze  the  remainder  of  this 
excellent  work,  but  already  has  this  review  extended 
beyond  our  limited  space.  We  cannot  conclude  this 
notice  without  referring  to  the  excellent  finish  of  the 
work.  In  typography  it  is  not  to  be  excelled;  the 
paper  is  superior  to  what  is  usually  afforded  by  our 
American  cousins,  quite  equal  to  the  best  of  English 
books.  The  engravings  and  lithographs  are  most 
beautifully  executed.  The  work  recommends  itself 
for  its  originality,  and  is  in  every  way  a  most  valu- 
able addition  to  those  on  the  subject  of  obstetrics. — 
Canada  Med.  Journal,  Oct.  1S64. 

It  is  very  large,  profusely  and  elegantly  illustrated, 
and  is'fitted  to  take  its  place  near  the  works  of  great 
obstetricians.  Of  the  American  works  on  the  subject 
it  is  decidedly  the  best. — Edinb.  Med.  Jour.,  Dec.  '64. 

#**  Specimens  of  the  plates  and  letter-press  will  be  forwarded  to  any  address,  free  by  mail, 
on  receipt  of  six  cents  in  postage  stamps. 


We  have  examined  Professor  Hodge's  work  with 
great  satisfaction;  every  tonic  is  elaborated  most 
fully.  The  views  of  the  author  are  comprehensive, 
and  concisely  stated.  The  rules  of  practice  are  judi- 
cious, and  will  enable  the  practitioner  to  meet  every 
emergency  of  obstetric  complication  with  confidence. 
— Chicago  Med.  Journal,  Aug.  1864. 


More  time  than  we  have  had  at  our  disposal  since 
we  received  the  great  work  of  Dr.  Hodge  is  necessary 
to  do  it  justice.  It  is  undoubtedly  by  far  the  most 
original,  complete,  and  carefully  composed  treatise 
on  the  principles  and  practice  of  Obstetrics  which  has 
ever  been  issued  from  the  American  press. — Pacific 
Med.  and  Surg.  Journal,  July,  1864. 

We  have  read  Dr.  Hodge's  book  with  great  plea- 
sure, and  have  much  satisfaction  in  expressing  our 
commendation  of  it  as  a  whole.  It  is  certainly  highly 
instructive,  and  in  the  main,  we  believe,  correct.  The 
great  attention  which  the  author  has  devoted  to  the 
mechanism  of  parturition,  taken  along  with  the  con- 
clusions at  which  he  has  arrived,  point,  we  think, 
conclusively  to  the  fact  that,  in  Britain  at  least,  the 
doctrines  of  Naegele  have  been  too  blindly  received. 
— Glasgow  Med.  Journal,  Oct.  1S64. 


T 


UNNER  [THOMAS  H),  M.  D. 

ON  THE  SIGNS  AND  DISEASES  OF  PREGNANCY.     First  American 

from  the  Second  and  Enlarged  English  Edition.     With  four  colored  plates  and  illustrations 
on  wood.     In  one  handsome  octavo  volume  of  about  500  pages,  extra  cloth,  $4  25. 


The  very  thorough  revision  the  work  has  undergone 
has  added  greatly  to  its  practical  value,  and  increased 
materially  its  efficiency  as  a  guide  to  the  student  and 
to  the  voung  practitioner. — Am.  Joum.  Med.  Sci., 
April,  1S6S. 

With  the  immense  variety  of  subjects  treated  of 
and  the  ground  which  they  are  made  to  cover,  the  im- 
possibility of  giving  an  extended  review  of  this  truly 
remarkable  work  must  be  apparent.  We  have  not  a 
single  fault  to  find  with  it,  and  most  heartily  com- 
mend it  to  the  careful  study  of  every  physician  who 
would  not  only  always  be  sure  of  his  diagnosis  of 
pregnancy,  but  always  ready  to  treat  all  the  nume- 
rous ailments  that  are,  unfortunately  for  the  civilized 
women  of  to-day,  so  commonly  associated  with  the 
function.—  N.  Y.  Med.  Record,  March  16,  1S68. 

We  have  much  pleasure  in  calling  the  attention  of 
our  readers  to  the  volume  produced  by  Dr.  Tanner, 
the  second  edition  of  a  work  that  was,  in  its  original 


state  even,  acceptable  to  the  profession.  We  recom- 
mend obstetrical  students,  young  and  old,  to  have 
this  volume  in  their  collections.  It  contains  not  only 
a  fair  statement  of  the  signs,  symptoms,  and  diseases 
of  pregnancy,  but  comprises  in  addition  much  inter- 
esting relative  matter  that  is  not  to  be  found  in  any 
other  work  that  we  can  name. — Edinburgh  Med. 
Journal,  Jan.  1S68. 

In  its  treatment  of  the  signs  and  diseases  of  preg- 
nancy it  is  the  most  complete  book  we  know  of, 
abounding  on  every  page  with  matter  valuable  to  the 
general  practitioner. — Cincinnati  Med.  Repertory, 
March,  1S68. 

This  is  a  most  excellent  work,  and  should  be  on  the 
table  or  in  the  library  of  every  practitioner. — Hum- 
boldt Med.  Archives,  Feb.  1SHS. 

A  valuable  compendium,  enriched  by  his  own  la- 
bors, of  all  that  is  known  on  the  signs  and  diseases  of 
pregnancy. — St.  Louis  Med.  Reporter,  Feb.  15,  1868. 


s 


WAYNE  {JOSEPH  GRIFFITHS),  31.  D., 

Physician- Accoucheur  to  the  British  General  Hospital,  <$.•<?. 

OBSTETRIC  APHORISMS  FOR  THE  USE  OF  STUDENTS  COM- 
MENCING MIDWIFERY  PRACTICE.  From  the  Fourth  and  Revised  London  Edition, 
with  Additions  by  E.  R.  Hutchins,  M.  D.  With  Illustrations.  In  one  neat  12mo.  vol- 
ume.    Extra  cloth,  $1  25.     (Lately  Published.) 


It  is  really  a  capital  little  compendium  of  the  sub- 
ject, and  we  recommend  young  practitioners  to  buy  it 
and  carry  it  with  them  when  called  to  attend  cases  of 
labor.  They  can  while  away  the  otherwise  tedious 
hours  of  waiting,  and  thoroughly  fix  in  their  memo- 
ries the  most  important  practical  suggestions  it  con- 
tains. The  American  editor  has  materially  added  by 
his  notes  and  the  concluding  chapters  to  the  com- 
pleteness and  general  value  of  the  book. — Chicago 
Med.  Journal,  Feb.  1S70. 

The  manual  before  ns  contains  in  exceedingly  small 
compass — small  enough  to  carry  in  the  pockei — about 
all  there  is  of  obstetrics,  condensed  into  a  nutshell  of 
Aphorisms.  The  illustrations  are  well  selected,  aud 
serve  as  excellent  reminders  of  the  conduct  of  labor — 
regular  and  difficult. — Cincinnati  Lancet,  April,  '70. 

This  is  a  most  admirable  little  work,  aud  completely 


answers  the  purpose.  It  is  not  only  valuable  for 
young  beginners,  but  no  one  who  is  not  a  proficient 
in  the  art  of  obstetrics  should  be  without  it,  because 
it  condenses  all  that  is  necessary  to  know  for  ordi- 
nary midwifery  practice.  We  commend  the  book 
most  favorably. — St.  Louis  Med.  and  Surg.  Journal, 
Sept.  10,  1S70. 

A  studied  perusal  of  this  little  book  has  satisfied 
us  of  its  eminently  practical  value.  The  object  of  the 
work,  the  author  says,  in  his  preface,  is  to  give  the 
student  a  few  brief  and  practical  directions  respect- 
ing the  management  of  ordinary  cases  of  labor  :  aud 
also  to  point  out  to  him  in  extraordinary  cases  when 
and  how  he  may  act  upon  his  owu  responsibility,  and 
when  he  ought  to  send  for  assistance. — A".  1".  Medical 
Journal,  May,  1870. 


Henry  C.  Lea's  Publications — {Midwifery). 


25 


TLfEIQS  {CHARLES  D.),  M.D., 

•*•'-*-  Lately  Professor  of  Obstetrics,  &c,  in  the  Jefferson  Medical  College,  Philadelphia. 

OBSTETRICS:   THE    SCIENCE   AND   THE   ART.     Fifth   edition, 

revised.     With  one  hundred  and  thirty  illustrations.     In  one  beautifully  printed  octavo 
volume  of  760  large  pages.     Extra  cloth,  $5  50  ;  leather,  $6  50. 

It  is  to  the  student  that  our  author  has  more  par- 
ticularly addressed  himself;  hut  to  the  practitioner 
we  believe  it  would  he  equally  serviceable  as  a  book 
of  reference  No  work  that  we  have  met  with  so 
thoroughly  details  everything  that  falls  to  the  lot  of 


the  accoucheur  to  perform.     Every  detail,  no  matter 
how  minute   or   how  trivial,  has   found    a   place. — 
Canada  Medical  Journal,  July,  1S67. 
The  original  edition  is  already  so  extensively  and 


favorably  known  to  the  profession  that  no  recom- 
mendation is  necessary;  it  is  sufficient  to  say,  the 
present  edition  is  very  much  extended,  improved, 
and  perfected  Whilst  the  great  practical  talents  and 
unlimited  experience  of  the  author  render  it  a  most 
valuable  acquisition  to  the  practitioner,  it  is  so  con- 
densed as  to  constitute  a  most  eligible  and  excellent 
text-book  for  the  student. — Southern  Med.  and  Surg, 
journal,  July,  1S67. 


T>AMSBOTHAM  [FRANCIS  H.),  M.D. 


THE  PRINCIPLES  AND  PRACTICE  OF  OBSTETRIC  MEDI- 
CINE AND  SURGERY,  in  reference  to  the  Process  of  Parturition.  A  new  and  enlarged 
edition,  thoroughly  revised  by  the  author.  With  additions  by  W.  V.  Keating,  M.  D., 
Professor  of  Obstetrics,  &c,  in  the  Jefferson  Medical  College,  Philadelphia.  In  one  large 
and  handsome  imperial  octavo  volume  of  650  pages,  strongly  bound  in  leather,  with  raised 
bands;  with  sixty-four  beautiful  plates,  and  numerous  wood-cuts  in  the  text,  containing  in 
all  nearly  200  large  and  beautiful  figures.     $7  00. 

To  the  physician's  library  it  is  indispensable,  while 
to  the  student,  as  a  text-book,  from  which  to  extract 
the  material  for  laying  the  foundation  of  an  education 
on  obstetrical  science,  it  has  no  superior. — Ohio  Med. 
and  Surg.  Journal. 

When  we  call  to  mind  the  toil  we  underwent  in 
acquiring  a  knowledge  of  this  subject,  we  cannot  but 
envy  the  student  of  the  present  day  the  aid  which 
this  work  will  afford  him. — Am.  Jour,  of  the  Med. 
Sciences. 


We  will  only  add  that  the  student  will  learn  from 
It  all  he  need  to  know,  and  the  practitioner  will  find 
it,  as  a  book  of  reference,  surpassed  by  none  other. — 
Stethoscope. 

The  character  and  merits  of  Dr.  Ramsbotham's 
work  are  so  well  known  and  thoroughly  established, 
that  comment  is  unnecessary  and  praise  superfluous. 
The  illustrations,  which  are  numerous  and  accurate, 
are  executed  in  the  highest  style  of  art.  We  cannot 
too  highly  recommend  the  work  to  our  readers. — .Si. 
Louis  Med.  and  Surg.  Journal. 


QHURCHILL  [FLEETWOOD),  31.  D.,  M.R.I.  A. 

ON  THE  THEORY  AND  PRACTICE  OF  MIDWIFERY.    A  new 

American  from  the  fourth  revised  and  enlarged  London  edition.     With  notes  and  addition? 
by  D.  Francis  Condie,  M.  D.,  author  of  a  "Practical  Treatise  on  the  Diseases  of  Chil- 
dren," &c.     With  one  hundred  and  ninety-four  illustrations.     In  one  very  handsome  octavo 
volume  of  nearly  700  large  pages.     Extra  cloth,  $4  00;  leather,  $5  00. 
In  adapting  this  standard  favorite  to  the  wants  of  the  profession  in  the  United  States,  the  editor 
has  endeavored  to  insert  everything  that  his  experience  has  shown  him  would  be  desirable  for  the 
American  student,  including  a  large  number  of  illustrations.     With  the  sanction  of  the  author, 
he  has  added,  in  the  form  of  an  appendix,  some  chapters  from  a  little  "Manual  for  Mid  wives  and 
Nurses,"  recently  issued  by  Dr.  Churchill,  believing  that  the  details  there  presented  can  hardly 
fail  to  prove  of  advantage  to  the  junior  practitioner.     The  result  of  all  these  additions  is  that  the 
work  now  contains  fully  one-half  more  matter  than  the  last  American  edition,  with  nearly  one- 
half  more  illustrations ;  so  that,  notwithstanding  the  use  of  a  smaller  type,  the  volume  contains 
almost  two  hundred  pages  more  than  before. 


These  additions  render  the  work  still  more  com- 
plete and  acceptable  than  ever;  and  with  the  excel- 
lent style  in  which  the  publishers  have  presented 
this  edition  of  Churchill,  we  can  commend  it  to  the 
profession  with  great  cordiality  and  pleasure. — Cin- 
cinnati Lancet. 

Few  works  on  this  branch  of  medical  science  are 
equal  to  it,  certainly  none  excel  it,  whether  in  regard 
to  theory  or  practice,  and  in  one  respect  it  is  superior 
to  all  others,  viz.,  in  its  statistical  information,  and 
therefore,  on  these  grounds  a  most  valuable  work  for 
the  physician,  student,  or  lecturer,  all  of  whom  will 
find  in  it  the  information  which  they  are  seeking. — 
Brit.  Am.  Journal. 

The  present  treatise  is  very  mnch  enlarged  and 
amplified  beyond  the  previous  editions  but  nothing 


has  been  added  which  could  be  well  dispensed  with. 
An  examination  of  the  table  of  contents  shows  how 
thoroughly  the  author  has  gone  over  tl.|i  ground,  and 
the  care  he  has  taken  in  the  text  to  present  the  sub- 
jects in  all  their  bearings,  will  render  this  new  edition 
even  more  necessary  to  the  obstetric  student  than 
were  either  of  the  former  editions  at  the  date  of  their 
appearance.  No  treatise  on  obstetrics  with  which  we 
are  acquainted  can  compare  favorably  with  this,  in 
respect  to  the  amount  of  material  which  has  been 
gathered  from  every  source. — Boston  Med.  and  Surg. 
Journal. 

There  is  no  better  text-book  for  students,  or  work 
of  reference  and  study  for  the  practising  physician 
than  this.  It  should  adorn  and  enrich  every  medical 
library. — Chicago  Med.  Journal. 


M 


ONTGOMERY  [W.  F.),  M.D., 

Professor  of  Midwifery  in  the  King's  and  Queen's  College  of  Physicians  in  Ireland. 


AN  EXPOSITION  OF  THE  SIGNS  AND  SYMPTOMS  OF  PREG- 

NANCY.  With  some  other  Papers  on  Subjects  connected  with  Midwifery.  From  the  second 
and  enlarged  English  edition.  With  two  exquisite  colored  plates,  and  numerous  wood-cuts. 
In  one  very  handsome  octavo  volume  of  nearly  600  pages,  extra  cloth.     $3  75. 


RIGBY'S  SYSTEM  OF  MIDWIFERY.  With  Notes 
«,nd  Additional  Illustrations.  Second  American 
edition.  One  volume  octavo,  extra  cloth,  422  pages. 
$2  50. 


DEWEES'S  COMPREHENSIVE  SYSTEM  OF  MID- 
WIFERY. Twelfth  edition,  with  the  author's  last 
improvements  and  corrections.  In  one  octavo  vol- 
ume, extra  cloth,  of  600  pages.    $3  60. 


26 


Henry  C.  Lea's  Publications — (Surgery). 


SIR  OSS  (SAMUEL  D.),  M.D., 

'■^  Professor  of  Surgery  in  tlie  Jefferson  Medical  College  of  Philadelphia. 

A  SYSTEM  OF  SURGERY:   Pathological,  Diagnostic,  Therapeutic, 

and  Operative.    Illustrated  by  upwards  of  Thirteen  Hundred  Engravings.    Fourth  edition, 
carefully  revised,  and  improved.    In  two  large  and  beautifully  printed  royal  octavo  volumes 
of  2200  pages,  strongly  bound  in  leather,  with  raised  bands.     $15  00. 
The  continued  favor,  shown  by  the  exhaustion  of  successive  large  editions  of  this  great  work, 
proves  that  it  has  successfully  supplied  a  want  felt  by  American  practitioners  and  students.    Though 
but  little  over  six  years  have  elapsed  since  its  first  publication,  it  has  already  reached  its  fourth 
edition,  while  the  care  of  the  author  in  its  revision  and  correction  has  kept  it  in  a  constantly  im- 
proved shape.     By  the  use  of  a  close,  though  very  legible  type,  an  unusually  large  amount  of 
matter  is  condensed  in  its  pages,  the  two  volumes  containing  as  much  as  four  or  five  ordinary 
octavos.     This,  combined  with  the  most  careful  mechanical  execution,  and  its  very  durable  binding, 
renders  it  one  of  the  cheapest  works  accessible  to  the  profession .     Every  subject  properly  belonging 
to  the  domain  of  surgery  is  treated  in  detail,  so  that  the  student  who  possesses  this  work  may  be 
eaid  to  have  in  it  a  surgical  library. 

It  must  long  remain  the  most  comprehensive  wort  i  hesitation  in  pronouncing  it  without  a  rival  in  oni- 
on this  important  part  of  medicine. — Boston  Medical  |  language,  and  eqnaljo  the  best  systems  of  surgery  in 


and  Surgical  Journal,  March  23,  1865 

We  have  compared  it  with  most  of  our  standard 
works,  such  as  those  of  Erichsen,  Miller,  Fergusson, 
Syme,  and  others,  and  we  must,  in  justice  to  our 
author,  award  it  the  pre-eminence.  As  a  work,  com- 
plete in  almost  every  detail,  no  matter  how  minute 
or  trifling,  aud  embracing  every  subject  known  in 
the  principles  and  practice  of  surgery,  we  believe  it 
stands  vrithout  a  rival.  Dr.  Gross,  in  his  preface,  re- 
marks "my  aim  has  been  to  embrace  the  whole  do- 
main of  surgery,  and  to  allot  to  every  subject  its 
legitimate  claim  to  notice;"  and,  we  assure  our 
readers,  he  has  kept  his  word.  It  is  a  work  which 
we  can  most  confidently  recommend  to  our  brethren, 
for  its  utility  is  becoming  the  more  evident  the  longer 
it  is  upon  the  shelves  of  our  library. — Canada  Med. 
Journal,  September,  1865. 

The  first  two  editions  of  Professor  Gross'  System  of 
Surgery  are  so  well  known  to  the  profession,  and  so 
highly  prized,  that  it  would  be  idle  for  us  to  speak  in 
praise  of  this  work.—  Chicago  Medical  Journal, 
September,  1S65. 

We  gladly  indorse  the  favorable  recommendation 
of  the  work,  both  as  regards  matter  and  style,  which 
we  made  when  noticing  its  first  appearance.— British 
and  Foreign  Medico-Chirurgical  Review,  Oct.  1S65. 

The  most  complete  work  that  has  yet  issued  from 
the  press  on  the  science  and  practice  of  surgery. — 
London  Lancet. 

This  system  of  surgery  is,  we  predict,  destined  to 
take  a  commanding  position  in  our  surgical  litera- 
ture, and  be  the  crowning  glory  of  the  author's  well 
earned  fame.  As  an  authority  on  general  surgical 
subjects,  this  work  is  long  to  occupy  a  pre-eminent 
place,  not  only  at  home,  but  abroad.     We  have  no 


any  language. — N.  1".  Med.  Journal. 

Not  only  by  far  the  best  text-book  on  the  subject, 
as  a  whole,  within  the  reach  of  American  students, 
but  one  which  will  be  much  more  than  ever  likely 
to  be  resorted  to  and  regarded  as  a  high  authority 
abroad. — Am.  Journal  Mtd.  Sciences,  Jan.  1S65. 

The  work  contains  everything,  minor  and  major, 
operative  and  diagnostic,  inclnding  mensuration  and 
examination,  venereal  diseases,  and  uterine  manipu- 
lations and  operations.  It  is  a  complete  Thesaurus 
of  modern  eurgery,  where  the  student  aud  practi- 
tioner shall  nut  seek  in  vain  for  what  they  desire. — 
San  Francisco  Med.  Press,  Jan.  1S65. 

Open  it  where  we  may,  we  find  sound  practical  in- 
formation conveyed  in  plain  language.  This  book  is 
no  mere  provincial  or  even  national  system  of  sur- 
gery, but  a  work  which,  while  very  largely  indebted 
to  the  past,  has  a  strong  claim  on  the  gratitude  of  the 
future  of  surgical  science. — Edinburgh  Med.  Journal, 
Jan.  1S65. 

A  glance  at  the  work  is  sufficient  to  show  that  the 
author  and  publisher  have  spared  nohaborin  making 
it  the  most  complete  "System  of  Surgery"  ever  pub- 
lished in  any  country. — St.  Louis  Med.  and  Surg 
Journal,  April,  1S65. 

A  system  of  surgery  which  we  think  unrivalled  in 
our  language,  and  which  will  indelibly  associate  his 
name  with  surgical  science.  And  what,  in  our  opin- 
ion, enhances  the  value  of  the  work  is  that,  while  the 
practising  surgeon  will  find  all  that  he  requires  in  it, 
it  is  at  the  same  time  one  of  the  most  valuable  trea- 
tises which  can  be  put  into  the  hands  of  the  student 
seeking  to  know  the  principles  and  practice  of  this 
branch  of  the  profession  which  he  designs  subse- 
quently to  follow. — The  Brit.  Am.Journ.,  Montreal. 


DY  THE  SAME  AUTHOR. 

A   PRACTICAL    TREATISE    ON    FOREIGN    BODIES   IN  THE 

AIR-PASSAGES.     In  1  vol.  Svo.  cloth,  with  illustration?,     pp.  468.     $2  75. 


6KET'S  OPERATIVE  SURGERY.     In  1   vol.   Svo. 

cloth,  of  over  650  pages  ;  with  about  100  wood-cats. 

$3  25 
COOPER'S  LECTURES  ON  THE  PRINCIPLES  AND 

PRACTICE  OF  Sr/RGERY.  In  1  vol.  Svo.  cloth,  7.30  p.  $2. 


GIBSON'S  INSTITUTES  AND  PRACTICE  OF  SUR- 
GERY. Eighth  edition,  improved  and  altered.  With 
thirty-four  plates.  In  two  handsome  octavo  vol- 
umes, about  1000  pp. , leather,  raised  bands.  $6  50. 


MILLER  (JAMES), 

-*•"  Late  Professor  of  Surgery  inthe  University  of  Edinburgh,  &c. 

PRINCIPLES  OF  SURGERY.     Fourth  American,  from  the  third  and 

revised  Edinburgh  edition.     In  one  large  and  very  beautiful  volume  of  700  pages,  with 
two  hundred  and  forty  illustrations  on  wood,  extra  cloth.     $3  75. 
T>Y  THE  SAME  AUTHOR.  

THE   PRACTICE   OF   SURGERY.     Fourth  American,  from  the  last 

Edinburgh  edition.  Revised  by  the  American  editor.  Illustrated  by  three  hundred  ar.d 
sixty-four  engravings  on  wood.  In  one  large  octavo  volume  of  nearly  700  pages,  extra 
cloth.     $3  75. 


OARGENT  (F.  IT.),  M.D. 


ON  BANDAGING  AND  OTHER  OPERATIONS  OF  MINOR  SUR- 
GERY. New  edition,  with  an  additional  chapter  on  Military  Surgery.  One  handsome  royal 
!2mo.  volume,  of  nearly  400  pages,  with  184  wood-cuts      Extra  sloth. 


!1  75. 


Henry  C.  Lea's  Publications — (Surgery). 


27 


ASHHURST  {JOHN,  Jr.),  M.D., 

Surgeon  to  the  Episcopal  Hsopital,  Philadelphia . 

THE    PRINCIPLES    AND    PRACTICE   OF    SURGERY.     In   one 

very  large  and  handsome  octavo  volume  of  about  1000  page?,  with  nearly  550  illustrations, 
extra  cloth,  $fi  50;   leather,  raised  bands,  $7  50       (Just  Ready.) 

The  object  of  the  author  fans  been  to  present,  within  as  condensed  a  compass  as  possible,  a. 
complete  treatise  on  Surgery  in  all  its  branches,  suitable  both  as  a  text-book  for  the  student  and 
a  work  of  reference  for  the  practitioner.  So  much  has  of  late  years  been  done  for  the  advance- 
ment of  Surgical  Art  and  Science,  that  there  seemed  to  be  a  want  of  a  work  which  should  present 
the  latest  aspects  of  every  subject,  and  which,  by  its  American  character,  should  render  accessible 
to  the  profession  at  large  the  experience  of  the  practitioners  of  both  hemispheres.  This  has  been 
the  aim  of  the  author,  and  it  is  hoped  that  the  volume  will  be  found  to  fulfil  its  purpose  satisfac- 
torily. The  plan  and  general  outline  of  the  work  will  be  seen  by  the  annexed 
CONDENSED  SUMMARY  OF  CONTENTS. 

Chapter  I.  Inflammation.  II.  Treatment  of  Inflammation.  III.  Operations  in  general: 
Anesthetics.  IV.  Minor  Surgery.  V.  Amputations.  VI.  Special  Amputations.  VII.  Effects 
of  Injuries  in  General  :  Wounds.  VIII.  Gunshot  Wounds.  IX.  Injuries  of  Bloodvessels.  X. 
Injuries  of  Nerves,  Muscles  and  Tendons,  Lymphatics,  Bursae,  Bones,  and  Joints.  XI.  Fractures. 
XII.  Special  Fractures.  XIII.  Dislocations.  XIV.  Effects  of  Heat  and  Cold.  XV.  Injuries 
of  the  Head.  XVI.  Injuries  of  the  Back.  XVII.  Injuries  of  the  Face  and  Neck.  XVIII. 
Injuries  of  the  Chest.  XIX.  Injuries  of  the  Abdomen  and  Pelvis.  XX.  Diseases  resulting  from 
Inflammation.  XXI.  Erysipelas.  XXII.  Pypemia  XXIII.  Diathetic  Diseases:  Struma  (in- 
cluding Tubercle  and  Scrofula);  Rickets.  XXIV.  Venere:il  Diseases;  Gonorrhoea  and  Chancroid. 
XXV.  Venereal  Diseases  continued  :  Syphilis.  XXVI.  Tumors.  XXVII.  Surgical  Diseases  of 
Skin,  Areolar  Tissue,  Lymphatics,  Muscles,  Tendons,  and  Bursas.  XXVIII.  Surgical  Disease 
of  Nervous  System  (including  Tetanus).  XXIX.  Surgical  Diseases  of  Vascular  System  (includ- 
ing Aneurism).  XXX.  Diseases  of  Bone.  XXXI.  Diseases  of  Joints.  XXXII.  Excisions. 
XXXIII.  Orthopedic  Surgery.  XXXIV.  Diseases  of  Head  and  Spine.  XXXV.  Disenses  of  the 
Eye.  XXXVI.  Diseases  of  the  Ear.  XXXVII.  Disenses  of  the  Face  and  Neck.  XXXVIII. 
Diseases  of  the  Mouth,  Jaws,  and  Throat.  XXXIX.  Diseases  of  the  Breast.  XL.  Hernia. 
XLI.  Special  Hernise.  XLII.  Diseases  of  Intestinal  Canal.  XLIII.  Diseases  of  Abdominal 
Organs,  and  various  operations  on  the  Abdomen.  XLIV.  Urinary  Calculus.  LXV.  Diseases  of 
Bladder  and  Prostate.  XLVI.  Diseases  of  Urethra.  XLVII.  Diseases  of  Generative  Organs. 
Index. 


fiiRICHSEN  {JOHN), 

-*-*  Senior  Surgeon  to  University  College  Hospital. 

THE  SCIENCE  AND  ART  OF  SURGERY;  being  a  Treatise  on  Sur- 

gical  Injuries,  Diseases,  and  Operations.  From  the  Fifth  enlarged  and  carefully  revised 
London  Edition.  With  Additions  by  John  Ashhurst,  Jr.,  M.  D.,  Surgeon  to  the  Episcopal 
Hospital,  <fec.  Illustrated  by  over  six  hundred  Engravings  on  wood.  In  one  very  large 
and  beautifully  printed  imperial  octavo  volume,  containing  over  twelve  hundred  closely 
printed  pages:  cloth,  $7  50;  leather,  raised  bands,  $8  50.      {Lately  Published.) 

A  noble  volume,  to  review  which  would  require  an 
analysis  of  the  whole  domain  of  modern  surgery. 
Within  its  compreheusive  compass  will  be  found 
every  detail  of  information  which  is  needed  by  the 
practical  surgeon.— .V.  r.  Med.  Gazette,  Oct.  23,  1S69. 

If  there  are  two  books  which  are  more  familiar  and 
more  generally  known  to  the  medical  student,  they 
are  those  of  Watson's  Practice  and  Erichsen's  Sur- 
gery. And  few  will  deny  that  their  distinguished 
authors  are  deserving  of  this  and  all  honor  which 
has  been  paid  them.  Watson's  Practice  but  a  few 
years  since  might  have  been  called  the  Bible  of  Phy- 
sicians, and  Erichsen's  volume  now  before  us  is  not 
undeserviug  of  a  similar  compliment  from  the  sur- 
geon. The  original  English  edition  is  too  well  known 
lo  need  any  recommendation  on  our  part,  but  this 
American  edition  has  so  much  in  it  that  has  been 
added  by  the  American  editor,  Dr.  Ashhurst,  as  to 
call  forth  the  highest  praise  and  most  sincere  admi- 
ration of  the  completeness  with  which  he  has  done 
his  part  in  rendering  the  book  the  best  on  general 
surgery  which  is  offered  lo  the  surgeon  in  this  coun- 
try —  The  Am.  Joarn.  of  Obstetrics,  JXov.  ]S(39. 


Erichsen's  Surgery  needs  no  review  at  the  present 
day.  Long  ago  it  took  and  has  since  maintained  a 
leading  position  in  surgical  literature,  and  this  posi- 
tion is  so  firmly  held,  that  no  efforts  on  the  part  ofva 
reviewer  would  serve  to  weaken  the  estimate  which 
has  been  placed  upon  the  book — nor,  indeed,  could 
they  materially  strengthen  it.  The  duty,  then,  de- 
volving upon  us  is  simply  to  note  the  appearance  of 
this  new  edition,  and  to  point  out  the  improvements 
therein  made.  —  N.  Y.  Med.  Journal,  Jan.  1S70. 

In  the  recent  republication  in  this  country  of  the 
last  London  edition  of  'Erichsen's  Surgery"  the 
practitioner  and  student  are  supplied  with  a  guide 
and  text-book  which  apparently  leaves  nothing  to  be 
desired.  Full  and  complete  in  every  essential  par- 
ticular, and  inculcating  the  most  advanced  and  cor- 
rect modes  of  practice,  it  is  certain  to  come  into  very 
general  use.  The  additions  of  Dr.  Ashhurst,  though 
not  extensive,  are  to  the  point;  they  relate  chielly 
to  itema  of  American  practice. -tThe  Journal  of  Psy- 
chological Medicine,  Jan.  1S70. 

Whether  we  regard  it  as  a  text-book  for  the  medical 
student,  or  as  a  guide  for  the  practitioner,  it  deserves 
our  highest  praise. — Am.  Journ.  Med.  Sei.,  Jan.  ltVO. 


DY    THE   SAME   AUTHOR.     [Just  Issued.) 

ON  RAILWAY,  AND  OTHER  INJURIES  OF  THE  NERVOUS 

SYSTEM.     In  small  octavo  volume.     Extra  cloth,  $1  00. 


piRRIE  (  WILLIAM),  F.  R.  S.  E., 

-*■  Professor  of  Surgery  in  the  University  of  Aberdeen. 

THE  PRINCIPLES  AND  PRACTICE  OF  SURGERY.     Edited  by 

John  Neill,  M.  D.,  Professor  of  Surgery  in  the  Penna.  Medical  College,  Surgeon  to  the 
Pennsylvania  Hospital,  &c.  In  one  very  handsome  octavo  volume  of  780  pages,  with  316 
illustrations,  extra  cloth.     $'-i  75. 


28 


Henry  C.  Lea's  Publications — (Surgery). 


ThRUITT  (ROBERT),  M.R.C.S.,  frc. 

THE  PRINCIPLES  AND  PRACTICE  OF  MODERN  SURGERY. 

A  new  and  revised  American,  from  the  eighth  enlarged  and  improved  London  edition.  Illus- 
trated with  four  hundred  and  thirty-two  wood-engravings.  In  one  very  handsome  octavo 
volume,  of  nearly  700  large  and  closely  printed  pages.    Extra  cloth,  $4  00  ;  leather,  $5  00. 

All  that  the  surgical  student  or  practitioner  could  t  theoretical  surgical  opinions,  no  work  that  we  are  fit 
desire. — Dublin  Quarterly  Journal.  present  acquainted  with  can  at  all  compare  with  it. 

It  is  a  most  admirable  book.  We  do  not  know  It  is  a  compendium  of  surgical  theory  (if  we  may  use 
when  we  have  examined  one  with  more  pleasure.-  !  th«  word>  ^  practice  in  itself,  and  well  deserves 
Boston  Med.  and  Surg.  Journal.       "  the  estimate  placed  upon  it.— Brit.  Am.  Journal. 

In  Mr.  Druitt's  book,  though  containing  only  some  i  Thus  enlarged  and  improved,  it  will  continue  to 
seven  hundred  pages,  both  the  principles  and  the  rank  a™l)n«  °ur  best  text-books  on  elementary  sur- 
practice  of  surgery  are  treated,  and  so  clearly  and  \  ger  j.— Columbus  Rev.  of  Med.  and  Surg. 
perspicuously,  as  to  elucidate  every  important  topic.  We  must  close  this  brief  notice  of  an  admirable 
The  fact  that  "twelve  editions  have  already  been  called  '  work  by  recommending  it  to  the  earnest  attention  of 
for,  in  these  days  of  active  competition,  would  of  every  medical  student. — Charleston  Medical  Journal 
itself  show  it   to  possess  marked   snperiority.     We    and  Review. 


have  examined  the  book  most  thoroughly,  and  can 
say  that  this  success  is  well   merited.     His  book, 


A  text-book  which  the  general  voice  of  the  profes- 
sion in  both  England  and  America  has  commended  as 


moreover,  possesses  the  inestimable  advantages  of  one  of  the  most  admirable  "manuals,"  or,  "wide 
having  the  subjects  perfectly  well  arranged  and  clas-  '■  TOecMOT  »  as  its  English  title  runs,  which  can  be 
sified,  and  of  being  written  in  a  style  at  once  clear  placed  in  the  hands  of  the  stndent.  The  merits  of 
and  succinct.—  Am.  Journal  of  Med.  Sciences.  Druitt's  Surgery  are  too  well  known  to  every  one  to 

Whether  we  view  Druitt's  Surgery  as  a  guide  to    need  any  further  eulogium  from  us. — Nashville  Med. 
operative  procedures,  or  as  representing  the  latest    Journal. 

TJAMILTON  [FRANK  H.),  M.D., 

Professor  of  Fractures  and  Dislocations,  &c,  in  Bellevue  Bosp.  Med.  College,  Neio  York. 

A  PRACTICAL. TREATISE   ON  FRACTURES  AND   DISLOCA- 

TIONS.     Fourth  edition,  thoroughly  revised.     In  one  large  and  handsome  octavo  volume 
of  nearly  800  pages,  with  several  hundred  illustrations.    Extra  cloth,  §5  75  ;  leather,  $6  75. 
(Just  Ready.) 
In  revising  this  standard  work,  the  author  has  omitted  much  which  the  progress  of  science  has 
seemed  to  render  less  important,  and  has  thus  gained  room  for  a  large  amount  of  new  matter, 
so  that  with  but  little  increase  in  the  size  of  the  volume  he  has  yet  been  able  to  present  the  sub- 
ject in  its  most  recent  aspect.     The  series  of  illustrations  has  likewise   undergone  a  thorough 
revision  ;  nearly  one-fourth  of  the  wood-cuts  in  the  last  edition  have  been  rejected,  and  their  places 
supplied,  for  the  most  part,  with  original  drawings,  representing  the  most  approved  forms  of  ap- 
parel, and  the  latest  views  with  regard  to  the  pathology  of  fractures  and  dislocations.     In  its 
present  improved  form,  therefore,  it  is  hoped  that  the  volume  may  maintain  the  character  which 
it  has  acquired  of  a  standard  authority  on  every  detail  of  its  important  subject. 


It  is  not,  of  course,  our  intention  to  review  in  ex- 
tenso,  Hamilton  on  "Fractures  and  Dislocations." 
Eleven  years  ago  such  review  might  not  have  been 
out  of  place;  to-day  the  work  is  an  authority,  so  well, 
so  generally,  and  so  favorably  known,  that  it  only 
remains  for  the  reviewer  to  say  that  a  new  edition  is 
just  out.  and  it  is  better  than  either  of  its  predeces- 
sors.— Cincinnati  Clinic,  Oct.  11,  1S71. 

Undoubtedly  the  best  work  on  Fractures  and  Dis- 
locations in  the  English  language. — Cincinnati  Med. 
Repertory,  Oct.  1871. 

We  have  ouce  more  before  us  Dr.  Hamilton's  admi- 


rable treatise,  which  we  have  always  considered  the 
most  complete  and  reliable  work  on  the  subject.  As 
a  whole,  the  work  is  without  an  equal  in  the  litera- 
ture of  the  profession. — Boston  Med.  and  Surg. 
Journ.,  Oct.  12,  1871. 

It  is  unnecessary  at  this  time  to  commend  the  book, 
except  to  such  as  are  beginners  in  the  study  of  this 
particular  branch  of  surgery.  Every  practical  sur- 
geon in  this  country  and  abroad  knows  of  it  as  a  most 
trustworthy  guide,  and  one  which  they,  in  common 
wiih  us,  would  unqualifiedly  recommend  as  the  high- 
est authority  in  any  language. — N.  T.  Med.  Record, 
Oct.  16,  1S71. 


ASHTON  [T.  J.). 
ON  THE   DISEASES,  INJURIES,  AND  MALFORMATIONS   OF 

THE  RECTUM  AND  ANUS;  with  remarks  on  Habitual  Constipation.    Second  American, 
from  the  fourth  and  enlarged  London  edition.     With  handsome  illustrations.     In  one  very 
beautifully  printed  octavo  volume  of  about  300  pages.     $3  25. 
We  can  recommend  this  volume  of  Mr   Ashton's  in 

the  strongest  terms,  as  containing  all  the  latest  details 

of  the  pathology  and  treatment  of  diseases  connected 


with  the  rectum. — Canada  Med.  Journ.,  March,  1S66. 
One  of  the  most  valuable  special  treatises  that  the 
physician  and  surgeon  can   have  in  his  library. — 
Chicago  Medical  Examiner,  Jan.  1S66. 


The  short  period  which  has  elapsed  since  the  ap- 
pearance of  the  former  American  reprint,  and  the 
numerous  editions  published  in  England,  are  the  best 
arguments  we  can  offer  of  the  merits,  and  of  the  nse- 
lessness  of  any  commendation  on  our  part  of  a  book 
already  so  favorably  known  to  our  readers. — Boston 
Med.  and  Surg.  Journal,  Jan.  25,  1866. 


B 


1GELO  W  [HENRY  J.),  M.  D., 

Professor  of  Surgery  in  the  3fassachusetts  Med.  College. 

ON   THE   MECHANISM   OF    DISLOCATION  AND  FRACTURE 

OF  THE  niP.     With  the  Reduction  of  the  Dislocation  by  the  Flexion  Method.     With 
numerous  original  illustrations.      In  one  very  handsome  octavo  volume.     Cloth.     $2  50. 
(Lately  Issued.) 
We  cannot  too  highly  praise  this  book  as  the  work    graph  islargely  illustrated  with  exquisitely  executed 
of  an  accomplished  and  scientific  surgeon.     We  do     woodcuts,  after  photographs,  which  help  to  elucidate 
not  hesitate  to  say  that  he  has  done  much  to  clear  up     the  admirable  subject-matter  of  the  text.     We  cor- 
the  obscurities  connected  with  the  mechanism  of  dis-     dially  commend  the  "  Hip,"  by  Dr.   Bigelow,  to  the 
location  of  the  hip-joint,  and  he  has  laid  down  most     attention  of  surgeons.—  Dublin  Quarterly  Journal  of 
valuable  practical  rules  for  the  easy  and  most  sue-     Medical  Science,  Feb.  1870. 
ceesful  management  of  these  injuries     The  mono- 


Henry  C.  Lea's  Publications — (Surgery).  29 

WELLS  (J.  SOELBERG), 

'  '  Professor  of  Ophthalmology  in  King's  College  Hospital,  &c. 

A    TREATISE    ON    DISEASES    OF    THE    EYE.     First  American 

Edition,  with  additions;  illustrated  with  216  engravings  on  wood,  and  six  colored  plates. 

Together  with  selections  from  the  Test-types  of  Jaeger  and  Snellen.     In  one  large  and 

very  handsome  octavo  volume  of  about  750  pages  :    extra  cioth,   $5  00  ;    leather,  $8  00. 

(Lately  Issued.) 
A  work  has  long  been  wanting  which  should  represent  adequately  and  completely  the  present 
aspect  of  British  Ophthalmology,  and  this  want  it  has  been  the  aim ¥of  Mr.  Wells  to  supply.  The 
favorable  reception  of  his  volume  by  the  medical  press  is  a  guarantee  that  he  has  succeeded  in 
his  undertaking,  and  in  reproducing  the  work  in  this  country  every  effort  has  been  made  to 
render  it  in  every  way  suited  to  the  wants  of  the  American  praetitioner.  Such  additions  as 
seemed  desirable  have  been  introduced  by  the  editor,  Dr.  I.  Minis  Hays,  and  the  number  of 
illustrations  has  been  more  than  doubled.  The  importance  of  test-types  as  an  aid  to  diagnosis 
is  so  universally  acknowledged  at  the  present  day  that  it  Seemed  essential  to  the  completeness  of 
the  work  that  they  should  be  added,  and  as  the  author  recommends  the  use  of  those  both  of  Jaeger 
and  of  Snellen  for  different  purposes,  selections  have  been  made  from  each,  so  that  the  practitioner 
may  have  at  command  all  the  assistance  necessary.  The  work  is  thus  presented  as  in  every  way 
fitted  to  merit  the  confidence  of  the  American  profession. 

In  this  respect  the  work  before  us  is  of  much  more  !  mend  it  to  all  who  desire  to  consult  a  really  good 
service  to  the  general  practitioner  than  those  heavy  ;  work  on  ophthalmic  science.  The  American  edition 
compilations  which,  in  giving  every  person's  views,  '  of  Mr. Wells'  treatise  was  superintended  in  its  passage 
too  often  neglect  to  specify  those  which  are  most  in  ;  through  the  press  by  Dr.  I.  Minis  Hays,  who  has 
accordance  with  the  author's  opinions,  or  in  geueral  I  added  some  notes  of  his  own  where  it  seemed  desira- 
acceptance.  We  have  no  hesitation  in  recommending  ble.  He  has  also  introduced  more  than  one  hundred 
this  treatise,  as,  on  the  whole,  of  all  English  works  [  new  additional  wood-cuts,  and  added  selections  from 

the  test-types  of  Jaeger  and  of  Snellen. — Leavenworth 
Med.  Herald,  Jan.  1870. 

Without  doubt,  one  of  the  best  works  upon  the  sub- 
ject which  has  ever  been  published  ;  it  is  complete  on 
the  subject  of  which  it  treats,  and  is  a  necessary  work 
for  every  physician  who  attempts  to  treat  diseases  of 
the  eye. — Dominion  Med.  Journal,  Sept.  1S69. 


on  the  subject,  the  one  best  adapted  to  the  wants  of 
the  general  practitioner.  —  Edinburgh  Med.  Journal, 
March,  1870. 

A  treatise  of  rare  merit.  It  is  practical,  compre- 
hensive, and  yet  concise.  Upon  those  subjects  usually 
found  difficult  to  the  student,  he  has  dwelt  at  lengtli 
and  entered  into  full  explanation.  After  a  careful 
perusal  of  its  contents,  we  can  unhesitatingly  com- 


T 


OYNBEE  [JOSEPH),  F.R.S., 

Aural  Surgeon  to  and  Lecturer  on  Surgery  at  St.  Mary's  Hospital. 

THE  DISEASES  OF  THE  EAR:  their  Nature,  Diagnosis,  and  Treat- 

ment.     With  one  hundred  engravings  on  wood.     Second  American  edition.     In  one  very 
handsomely  printed  octavo  volume  of  440  pages;  extra  cloth,  $4. 


T  A  URENCE  {JOHN  Z.),  F.  R.  C.  S., 

Editor  of  the  Ophthalmic  Review,  &c. 

A  HANDY-BOOK  OF   OPHTHALMIC    SURGERY,  for  the  use  of 

Practitioners.  Second  Edition,  revised  and  enlarged.  With  numerous  illustrations.  In 
one  very  handsome  octavo  volume,  extra  cloth,  $3  00.  (Lately  Issued.) 
This  is,  as  its  name  suggests,  a  book  for  convenient  I  the  subject,  or  those  recently  published  by  Stellwag, 
reference  rather  than  an  exhaustive  treatise,  and  as  Wells,  Bader,  and  others,  Mr.  Laurence  will  prove  a 
such  it  will  be  found  very  valuable  to  the  general  I  safe  and  trustworthy  guide.  He  has  described  in  this 
physician.  It  gives  in  very  brief  terms  the  symp-  1  edition  those  novelties  which  have  secured  the  confi- 
toms  and  history  of  the  various  diseases  of  the  eye,  dence  of  the  profession  since  the  appearance  of  his 
with  just  enough  cases  detailed  to  elucidate  the  text  j  last.  To  the  portion  of  the  book  devoted  to  a  descrip- 
without  confusing  the  reader.    His  chapter  on  exami-  j  tion  of  the  optical  defects  of  the  eye,  the  publisher 


nation  of  the  eye  is  particularly  good,  and,  it  seems 
to  us,  better  calculated  to  enlighten  a  novice  than 
any  similar  instructions  we  have  read. — California 
Med.  Gazette,  Jan.  1870. 

For  those,  however,  who  must  assume  the  care  of 
diseases  and  injuries  of  the  eye,  and  who  are  too 
much  pressed  for  time  to  study  the  classic  works  on 


has  given  increased  value  by  the  addition  of  several 
pages  of  Snellen's  test-types,  so  generally  nsedtotest 
the  acuteness  of  vision,  and  which  are  difficult  to  ob- 
tain in  this  country.  The  volume  has  been  conside- 
rably enlarged  and  improved  by  the  revision  and  ad- 
ditions of  its  author,  expressly  for  the  American 
edition. — Am.  Journ.  Med.  Sciences,  Jan.  1S70. 


J  A  WSON  (GEORGE),  F.  R.  C.  &,  Engl, 

-*-*  Assistant  Surgeon  to  the  Royal  London  Ophthalmic  Hospital,  Moorflelds,  &c. 

INJURIES  OF  THE  EYE,  ORBIT,  AND  EYELIDS:  their  Imme- 

diate   and  Remote  Effects       With  about  one  hundred  illustrations.      In  one  very  hand- 
some octavo  volume,  extra  cloth,  $3  50 

It  is  an  admirable  practical  book  in  the  highest  and  best  sense  of  the  phrase. — London  Medical  Times 
and  Gazette,  May  18,  1867. 


MORLAND  (W.  W.),  M.D. 

DISEASES  OF  THE  URINARY  ORGANS;  a  Compendium  of  their 

Diagnosis,  Pathology,  and  Treatment.     With  illustrations      In  one  large  and  handsome 
octavo  volume  of  tibout  600  pages,  extra  oloth.     $3  50. 


B 


R  YA  NT  ( THO  MA  S) ,  F.  R.  C.S. 
THE    PRACTICE    OF   SURGERY.      A    Manual,   with   numerous 

engravings  on  wood.     In  one  very  handsome  volume.      (Preparing.) 


30 


Henry  C.  Lea's  Publications— (Surgery,  &c). 


WALES  {PHILIP  S.),  M.  D.,  Surgeon  D.  S.  N. 


MECHANICAL  THERAPEUTICS:  a  Practical  Treatise  on  Surgical 

Apparatus,   Appliances,  and  Elementary  Operations  :    embracing  Minor  Surgery,   Band- 
aging, Orthopraxy,  and  the  Treatment  of  Fractures  and  Dislocations.     With  six  hundred 
and  forty-ttwb  illustrations  on  wood.     In  one  large  and  handsome  octavo  volume  of  about 
70(1  page's:  extra  cloth,  $5  75;  leather,  $6  75. 
A  Naval  Medical  Board  directed  to  examine  and  report  upon  the  merits  of  this  volume,  officially 
states  that  "  it  should  in  our  opinion  become  a  standard  work  in  the  hands  of  every  naval  sur- 
geon ;"  and  its  adoption  for  use  in  both  the  Army  and  Navy  of  the  United  States  is  sufficient 
guarantee  of  its  adaptation  to  the  needs  of  e  very-day  practice. 

It  is  a  unique  specimen  of  literature  in  its  way,  in  It  will  prove  especially  useful  to  inexperience..!  conn- 
that  treating  upon  such  a  variety  of  subjects,  it  is  as  a  try  practitioners,  who  are  continually  required  to 
who'le  «o  completely  up  to  the  wants  of  the  student  ,  take  charge  of  surgical  cases,  under  circumstances 
and  the  general  practitioner.     We  have  never  seen    precluding  them  from  the  aid  of  experienced  surgeons. 


any  work  of  its  kind  that  can  compete  with  it  in  real 
utility  and  exteusive  adaptability.  In  conclusion, 
we  would  state,  at  the  risk  of  reiteration,  that  this 
is  the  most  comprehensive  book  on  the  subject  that  we 
have  seen  :  is  the  best  that  can  be  placed  in  the  hands 
of  the  student  in  need  of  a  first  book  on  surgery,  and 
the  most  useful  that  can  be  named  for  such 
practitioners  who,  without  any  special  prct 
to  surgery,  are  occasionally  liable  to  treat  surgical 
cases.— if.  1".  Med.  Record,  March  2,  1868. 

It  iscertainly  the  most  corapleteand  thorough  work 
of  its  kind  in  the  English  language.  Students  and 
young  practitioners  of  surgery  will  find  it  invaluable. 


—Pacific  Med.  and  Surg.  Journal.  Feb.  1S68. 

The  title  of  the  above  work  is  sufficiently  indica- 
tive of  its  contents.     "We  have  not  seen  for  a  long 
time  (in  the  English  language)  a  treatise  equal  to  this 
in   extent,  nor   one  which  is    better  adapted  to  the 
,     wants  of  the  general  student  and  practitioner      It  i= 


not  to  the  surgeon  alone  that  this  book  belongs  ;  the 
physician  has  frequent  opportunities  to  fill  an  emer- 
gency by  such  knowledge  as  is  here  given.  Every 
practitioner  should  make  purchase  of  such  a  book — 
it  will  last  him  his  lifetime. St.  Louis  Mad.  Re- 
porter, Feb.  1S6S. 


T 


'HO  MP  SON  {SIR  HENRY), 

Surgeon  and  Professor  of  Clinical  Surgery  to  University  College  Hospital. 

LECTURES  OX  DISEASES  OF  THE  URINARY  ORGANS. 


With 


illustrations  on  wood 

These  lectures  stand  the  severe  test.  They  are  in- 
structive without  being  tedious,  and  simple  without 
being  diffuse;  and  they  include  many  of  those  prac- 
tical hints  so  useful  for  the  student,  and  even  more 
valuable  to  the  young  practitioner. — Edinburgh  Med. 
Journal,  April,  1§69. 

Very  few  words  of  ours  are  necessary  to  recommend 
these  lectures  to  the  profession.     There  is  no  subject 


In  one  neat  octavo  volume,  extra  cloth.     $2  25. 

on  which  Sir  Henry  Thompson  speaks  with  more  au- 
thority than  that  in  which  he  has  specially  gathered 
iii-  laurels;  in  addition  to  this,  the  conversational 
style  of  instruction,  which  is  retained  in  these  printed 
lectures,  gives  them  an  attractiveness  which 
tematic  treatise  can  never  possess. — London  Medical 
Times-  and  Gazette,  April  21,  1669. 


B 


Y  THE  SAME  AUTHOR. 


ON  THE  PATHOLOGY  AND  TREATMENT  OF  STRICTURE  OF 

THE  URETHliA  AND  URINARY  FISTULA.     With  plates  and  wood-cuts.     From  the 
third  and  revised  English  edition.    In  one  very  handsome  octavo  volume,  extra  cloth,  $3  50. 
( Just  Issued.) 
This  classical  work  has  so  long  been  recognized  as  a  standard  authority  on  its  perplexing  sub- 
jects that  it  should  be  rendered  accessible  to  the  American  profession.      Having  enjoyed  the 
advantage  of  a  revision  at  the  hands  of  the  author  within  a  few  months,  it  will  be  found  to  present 
his  latest  views  and  to  be  on  a  level. with  the  most  recent  advances  of  surgical  science. 

With  a  work  accepted  as  the  authority  upon  the  I  ably  known  by  the  profession  as  this  before  us,  must 
mbjects  of  which  it  treats,  an  extended  notice  would  |  create  a  deiuaud  for  it  from  those  who  would  keep 
be  a  work  of  supererogation.  The  simple  announce-  I  themselves  well  up  in  this  department  of  surgery.— 
meat  of  another  edition  of  a  work  so  well  and  favor-  |  St.  Louis  Med.  Archives,  Feb.  1870. 


1AYLOR  {ALFRED  S.),  M.D., 

Lecturer  on  Med.  Jurisp.  and.  Chemistry  in  Guy's  Hospital. 

MEDICAL   JURISPRUDENCE.     Sixth   American,  from   the   eighth 

and  revised  London  edition.  With  Notes  and  References  to  American  Decisions,  by  Cle- 
ment B.  Penrose,  of  the  Philadelphia  Bar.  In  one  large  octavo  volume  of  776  pages, 
extra  cloth,  $4  50  ;  leather,  $5  oO. 

know  but  that  his  next  ease  may  create  for  him  an 
emergency  for  its  use.  To  those  who  are  not  the  for- 
tunate possessors  of  a  reliable,  readable,  interesting, 
and  thoroughly  practical  work  upon  the  subject,  we 
would  earnestly  recommend  this,  as  forming  the  best 
groundwork  for  all  their  future  studies  of  the  more 
elaborate  treatises. — New  York  Medical  Record,  Feb. 
15,  1S67. 


The  sixth  edition  of  this  popular  work  cotnea  to  us 
in  charge  of  a  new  editor,  Mr.  Penrose,  of  the  Phila- 
delphia bar,  who  has  done  much  to  render  it  useful, 
not  only  to  the  medical  practitioners  of  this  country, 
but  to  those  of  his  own  profession.  Wisely  retaining 
the  references  of  the  former  American  editor,  Dr. 
Hartshorue,  he  has  added  many  valuable  notes  of  his 
own.  The  reputation  of  Or.  Taylor's  work  is  so  well 
established,  that  it  needs  no  recommendation.  He  is 
now  the  highest  living  authority  o'n  all  matters  con- 
nected with  forensic  medicine,  and  every  successive 


The  present  edition  of  this  valuable  manual  is  a 
great  improvement  on  those  which  have  preceded  it. 
It  makes  thus  by  far  the  be^t  guide-book  in  this  de- 


edition  of  his  valuable  work  gives  fresh  assurauce  to  I  ,,artment  of  medicine  for  students  and  the  general 
his  many  admirers  that  he  will  continue  to  maintain  '  ,)1;tcti,iouer  in  our  language. —Boston  Mt.d.  and  Sura 
his  well-earned  position.     No  one  should,  in  fact,  be    Journal   Dec  27   18t>tt. 
without  a  text-book  on  the  subject,  as  he  does  not  ! 


Henry  C.  Lea's  Publications — (Medical  Jurisprudence,  &c).     31 


-DLANDFORD  [G.  FIELDING),  M.  D.,  F.  R.  C  P., 

J-*  Lecturer  on  Psychological  Medicine  at  the  School  of  St.  George's  Hospital,  &c. 

INSANITY  AND  ITS  TREATMENT:   Lectures  on  the  Treatment, 

Medical  and   Legal,  of  Insane  Patients.     With  a  Summary  of  the  Laws  in  force  in  the 
United  States  on   the  Confinement  of  the  Insane.     By  Isaac  Ray,  M.  D.     In  one  very 
handsome  octavo  volume  of  471  pages:  extra  cloth,  $3  25.     {Just  Issued.) 
This  volume  is  presented  to  meet  the  want,  so  frequently  expressed,  of  a  comprehensive  trea- 
tise, in  moderate  compass,  on  the  pathology,  diagnosis,  and  treatment  of  insanity.    To  render  it  of 
more  value  to  the  practitioner  in  this  country,  Dr.  Raj7  has  added  an  appendix  which  affords  in- 
formation, not  elsewhere  to  be  found  in  so  accessible  a  form,  to  physicians  who  may  at  any  moment 
be  called  upon  to  take  action  in  relation  to  patients. 

It  satisfies  a  want  which  must  have  been  sorely  i  as  our  own  reading  extends)  in  any  other. — London 


felt  by  the  busy  general  practitioners  of  this  country 
It  takes  the  form  of  a  manual  of  clinical  description 
of  the  various  forms  of  insanity,  with  a  description 
of  the  mode  of  examining  persons  suspected  of  in- 
sanity. We  call  particular  attention  to  this  feature 
of  the  book,  as  giving  it  a  unique  value  to  the  gene- 
ral practitioner.  If  we  pass  from  theoretical  conside- 
rations to  descriptions  of  the  varieties  of  insanity  as 
actually  seen  in  practice  and  the  appropriate  treat- 
ment for  them,  we  find  in  Dr.  Blandford's  work  a 
considerable  advance  over  previous  writings  on  the 
subject.  His  pictures  of  the  various  forms  of  mental 
disease  are  so  clear  and  good  that  no  reader  can  fail 
to  be  struck  with  their  superiority  to  those  given  in 
ordinary  manuals  in  the  English  language  or  (so  far 


Practitioner,  Feb.  1S71. 

Dr.  Blandford's  book  well  meets  the  prevailing  de- 
ficiency, and  is  one  of  that  class,  unhappily  too  small, 
which  prove  a  real  blessing  to  the  busy  practitioner 
who  has  no  other  time  for  reading  but  those  odd  mo- 
ments which  he  can  catch  in  his  brief  intervals  of 
leisure.  It  is  so  free  from  defects  and  is  so  fair  a  re- 
presentation of  the  most  approved  views  respecting 
insanity,  that  we  find  in  it  small  occasion  fur  criti- 
cism, and  can  do  little  more  than  commend  it  as  an 
admirable  manual  for  practical  use.  "We  end  as  we 
began,  in  heartily  recommending  it  as  a  most  useful 
and  reliable  guide  to  the  general  practitioner. — Am. 
Journal  Med.  Sciences,  April,  1871. 


TW~INSLOW  [FORBES),  31. D.,  D.C.L.,  §c 

ON  OBSCURE  DISEASES  OF  THE  BRAIN  AND  DISORDERS 

OF  THE  MIND;  their  incipient  Symptoms,  Pathology,  Diagnosis,  Treatment,  and  Pro- 
phylaxis. Second  American,  from  the  third  and  revised  English  edition.  In  one  handsome 
octavo  volume  of  nearly  600  pages,  extra  cloth.     $4  25.      {Lately  Issued.) 

A  work  which,  like  the  present,  will  largely  aid 
the  practitioner  in  recognizing  and  arresting  the  first 
insidious  advances  of  cerebral  and  mental  disease,  is 
one  of  immense  practical  value,  and  demands  earnest 
attention  and  diligent  study  on  the  part  of  all  who 
have  embraced   the  medical   profession,  and   have 


thereby  undertaken  responsibilities  in  which  the 
welfare  and  happiness  of  individuals  and  families 
are  largely  involved.    We  shall  therefore  close  this 


brief  and  necessarily  very  imperfect  notice  of  Dr. 
Winslow's  great  and  classical  work  by  expressing 
our  conviction  that  it  is  long  since  so  important  and 
beautifully  written  a  volume  has  issued  from  the 
British  medical  press. — Lublin  Medical  Press. 


It  is  the  most  interesting  as  well  as  valuable  book 
that  we  have  seen  for  a  long  time.  It  is  truly  fasci- 
nating.— Am.  Jour.  Med.  Sciences. 


T  EA  [HENRY  C). 

SUPERSTITION    AND    FORCE:    ESSAYS    ON    THE   WAGER   OF 

LAW,  THE  WAGER  OF  BATTLE,  THE  ORDEAL,  AND  TORTURE.  Second  Edition, 
Enlarged.  In  one  handsome  volume  royal  12mo.  of  nearly  500  pages;  extra  cloth,  $2  75. 
(Just  Issued.)  , 

We  know  of  no  single  work  which  contains,  in  so  i  interesting  phases  of  human  society  and  progress 


small  a  compass,  so  much  illustrative  of  the  strangest 
operations  of  the  human  mind.  Foot-notes  give  the 
authority  for  each  statement,  showing  vast  research 
and  wonderful  industry.  We  advise  our  confreres 
to  read  this  book  and  ponder  its  teachings. — Chicago 
Med.  Journal,  Aug.  1870. 

As  a  work  of  curious  inquiry  on  certain  outlying 
points  of  obsolete  law,  "Superstition  and  Force"  is 
one  of  the  most  remarkable  books  we  have  met  with. 
— London  Athenaum,  Nov.  '3,  1S66. 

He  has  thrown  a  great  deal  of  light  upon  what  must 
he  regarded  as  one  of  the  most  instructive  as  well  as 


The  fulness  and  breadth  with  which  lie  has  carried 
out  his  comparative  survey  of  this  repulsive  field  of 
history  [Torture],  are  such  as  to  preclude  our  doing 
justice  to  the  work  within  our  present  limits.  But 
here,  as  throughout  the  volume,  there  will  be  found 
a  wealth  of  illustration  and  a  critical  grasp  of  the 
philosophical  import  of  facts  which  wilt  render  Mr. 
Lea's  labors  of  sterling  value  to  the  historical  stu- 
dent.— London  Saturday  Review,  Oct.  8,  1870. 

As  a  book  of  ready  reference  on  the  subject,  it  is  oi 
the  highest  value.  —  Westminster  Review,  Oct.  1S67. 


/; 


Y  THE  SAME  AUTHOR.     (Just  Issued.) 

STUDIES  IN  CHURCH  HISTORY— THE  RISE  OF  THE  TEM- 
PORAL POWER— BENEFIT  OF  CLERGY— EXCOMMUNICATION.  In  one  large  royal 
12mo.  volume  of  516  pp.  extra  cloth.     $2  75. 


The  story  was  never  told  more  calmly  or  with 
greater  learning  or  wiser  thought.  We  doubt,  indeed, 
if  any  other  study  of  this  field  can  be  compared  with 
this  for  clearness,  accuracy,  and  power.  —  Chicago 
Examiner,  Dec.  1870. 

Mr.  Lea's  latest  work,  "Studies  in  Church  History," 
fully  sustains  tin'  promise  of  the  liisi.  it  deals  with 
three  subjects — the  Temporal  Power,  Benofit  of 
Clergy,  and  Excommunication,  the  record  of  which 
has  a  peculiar  importance  for  the  English  student,  aud 
is  a  chapter  on  Ancient  Law  likely  to  be  regarded  as 
final.  We  cau  hardly  pass  from  our  mention  of  such 
works  as  those — with  which  that  on  "Sacerdotal 
Celibacy"  should  be  iucluded — without   noting  the 


literary  phenomenon  that  the  head  of  one  of  the  first 
American  houses  is  also  the  writer  of  some  of  its  most 
origin;!  1  books. — London  Athenaum,  Jan.  7,  1871. 

Mr.  Lea  lias  done  great  honor  to  him  elf  and  this 
country  by  the  admirable  works  he  lias  written  on 
-logical  aud  cognate  subjects.  We  have  already 
had  occasion  to  commend  his  "Superstition  and 
Force"  aud  his  "History  of  Sacerdotal  Celibacy." 
The  present  volume  is  fully  as  admirable  in  its  me- 
thod of  dealing  witli  topics  and  in  the  thoroughness — 
a  quality  so  frequently  lacking  in  American  authors — 
with  which  they  are  investigated. — A'.  1'.  Journal  of 
Psychol.  Medicine,  July,  isru. 


32 


Henry  C.  Lea's  Publications. 


INDEX    TO    CATALOGUE. 


American  Journal  of  the  Medical  Sciences 
Abstract,  Half-Yearly,  of  the  Med   Sciences 
Anatomical  Atlas,  by  Smith  and  Horner 
Ashton  on  the  Rectum  and  Anus  . 
Attfield's  Chemistry       .... 
Ashwell  on  Diseases  of  Females  . 
Ashhurst's  Surgery  .... 

Barnes  on  Diseases  of  Women 
Bryant's  Practical  Surgery     . 
Blandford  on  Insanily     .... 
Basbam  on  Renal  Diseases 
Brinton  on  the  Stomach 
Bigelow  on  the  Hip  .... 

Barclay  s  Medical  Diagnosis  . 
Barlow's  Practice  of  Medicine 
Bowman's  (John  E. )  Practical  Chemistry 
Bowman's  (John  E.)  Medical  Chemistry 
Brande  &  Taylor's  Chemistry 
Buckler  on  Bronchitis     .... 
Bucknill  and  Tuke  on  Insanity 
Bnmstead  on  Venereal    .... 
Bumstead  and  Cullerier's  Atlas  of  Venereal 
Carpenter's  Human  Physiology     . 
Carpenter's  Comparative  Physiology  . 
Carpenter  on  the  Use  and  Abuse  of  Alcohol 
Carson's  Synopsis  of  Materia  Medica    . 
Chambers  "on  the  Indigestions 
Chambers's  Restorative  Medicine 
Christison  and  Griffith's  Dispensatory 
Churchill's  System  of  Midwifery  . 
Churchill  on  Puerperal  Fever 
Condie  on  Diseases  of  Children     . 
Cooper's  (B.  B  )  Lectures  on  Surgery    . 
Cullerier's  Atlas  of  Venereal  Diseases 
Cyclopedia  of  Practical  Medicine  . 
Dalton's  Human  Physiology  . 
De  Jongh  on  Cod-Liver  Oil      . 
Dewees's  System  of  Midwifery 
Dewees  on  Diseases  of  Females     . 
Dewees  on  Diseases  of  Children     . 
Druitt's  Modern  Surgery 
Dunglison's  Medical  Dictionary    . 
Dunglison's  Human  Physiology    . 
Dnnglison  on  New  Remedies 
Ellis's  Medical  Formulary,  by  Smith   . 
Erichsen's  System  of  Surgery 
Erichsen  on  Nervous  Injuries 
Flint  on  Respiratory  Organs  . 

Flint  on  the  Heart 

Flint's  Practice  of  Medicine   . 
Fownes's  Elementary  Chemistry  . 
Fulleron   the  Lungs,  &c. 
Green's  Pathology  and  Morbid  Anatomy 

Gibson's  Surgery 

Gluge's  Pathological  Histology,  by  Leidy 
Graham's  Elements  of  Chemistry  . 

Gray's  Anatomy 

Griffith's  (R.  E.)  Universal  Formulary 
Gross  on  Foreign  Bodies  in  Air-Passages 
Gross's  Principles  and  Practice  of  Surgery 
Gross's  Pathological  Anatomy 
Guersant  on  Surgical  Diseases  of  Children 
Bartshorne's  Essentials  of  Medicine     . 
Hartshorne's  Conspectus  of  the  Medical  Sciences 
Hamilton  on  Dislocations  and  Fractures 
Heath's  Practical  Anatomy    . 
Hoblyn's  Medical  Dictionary 

Hodge  on  Women 

Hodge's  Obstetrics 

Hodges'  Practical  Dissections 
Holland's  Medical  Notes  and  Reflections 
Horner's  Anatomy  and  Histology 
Hudson  on  Fevers,  .... 

Hill  on  Venereal  Diseases 
Hillier's  Handbook  of  Skin  Diseases 
Jones  and  Sieveking's  Pathological  Anatomy 
Jones  (C.  Handfield)  on  Nervous  Disorders 

Kirkes'  Physiology 

Knapp's  Chemical  Technology 
Lea's  Superstition  and  Force 


PAGE 
1 

3 
6 

2S 
10 

22 


I  Lea's  Studies  in  Church  History 

Lallemand  and  Wilson  on  Spermatorrhoea 

La  Roche  on  Yellow  Fever    . 

La  Roche  on  Pneumonia,  &c. 

Laurence  and  Moon's  Ophthalmic  Surgery 

Lawson  on  the  Eye  

■  Laycock  on  Medical  Observation  . 

Lehmann's  Physiological  Chemistry,  2  vols 

Lehmaun's  Chemical  Physiology  . 

Ludlow's  Manual  of  Examinations 
;  Lyons  on  Fever        .         .'        . 

Maclise's  Surgical  Anatomy  . 
'  Marshall's  Physiology    .... 

Medical  News  and  Library     . 

Meigs's  Obstetrics,  the  Science  and  the  Art 
!  Meigs's  Lectures  on  Diseases  of  Women 

Meigs  on  Puerperal  Fever 

Miller's  Practice  of  Surgery  . 
j  Miller's  Principles  of  Surgery 

Montgomery  on  Pregnancy     . 

Morland  on  Urinary  Organs   . 

Morland  on  Uisemia 

Neill  and  Smith's  Compendium  of  Med.  Scien< 
;  Neligan's  Alias  of  Diseases  of  the  Skin 

Neligan  on  Diseases  of  the  Skin 
:  Odling's  Practical  Chemistry 
j  Pavy  on  Digestion 

Prize  Essays  on  Consumption 

Parrish's  Practical  Pharmacy 

Pirrie's  System  of  Surgery 

Pereira'a  Mat.  Medica  and  Therapeutics,  abrids 

Quain  and  Sharpey's  Anatomy,  by  Leidy 

Ranking's  Abstract  .... 

Radclitf  and  others  on  the  Nerves,  &c. 
:  Roberts  on  Urinary  Diseases  . 

Ranfsbotham  on  Parturition  . 

Rigby  on  Female  Diseases      ... 

Rigby's  Midwifery 

Rokitansky's  Pathological  Anatomy     . 
I  Royle's  Materia  Medica  and  Therapeutics 
|  Salter  on  Asthma     .         .  • 

Swayne's  Obstetric  Aphorisms 

Sargent's  Minor  Surgery 

Sharpey  and  Quain's  Anatomy,  by  Leidy 

Simon's  General  Pathology    . 

Simpson  on  Females        .... 

Skey's  Operative  Surgery 

Slade  on  Diphtheria        .... 

Smith  (J.  L.)  on  Children 

Smith  (H.  H.)  and  Horner's  Anatomical  Atlas 

Smith  (Edward)  on  Consumption  . 

Smith  on  Wasting  Diseases  of  Children 

Solly  on  Anatomy  and  Diseases  of  the  Brain 

StilKi's  Therapeutics 

Tanner's  Mauual  of  Clinical  Medicine 

Tanner  on  Pregnancy 

Taylor's  Medical  Jurisprudence 

Thomas  on  Diseases  of  Females 

Thompson  on  Urinary  Organs 

Thorap-on  on  Stricture    . 

Todd  and  Bowman's  Physiological  Ans 

Todd  on  Acute  Diseases  . 

Toynbee  on  the  Ear 

Wales  on  Surgical  Operations 

Walshe  on  the  Heart 

Watson's  Practice  of  Physic  . 

Wells  on  the  Eye     . 

West  on  Diseases  of  Females 

West  on  Diseases  of  Children 

West  on  Nervous  Disorders  of  Childrer 

West  on  Ulceration  of  Os  Uteri 

What  to  Observe  in  Medical  Cases 

Williams's  Principles  of  Medicine 

Williams  on  Consumption 

Wilson's  Human  Anatomy     . 

Wilson  on  Diseases  of  the  Skin     . 

Wilson's  Plates  on  Diseases  of  the  Skir 

Wilson's  Handbook  of  Cutaneous  Medicine 

Wilson  on  Spermatorrhoea 

Winslow  on  Brain  and  Mind 


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